Age and comorbidities increase the risk of postoperative complications

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A study published in the Journal of Bone and Joint Surgery has found that increasing age and comorbidities increase the risk of death or postoperative complications after spine surgery.

Investigators Schoenfeld et al reviewed 3475 patients, registered to the database of the National Surgical Quality Improvement Program, who underwent spinal surgery between 2005 and 2008.


Overall, after spinal surgery, 10 patients died and 407 complications were recorded (in 263 patients). Of these complications, 265 were major and 142 were minor. 

 

As might be expected, increasing age was found to significantly increase the risk of death and significantly increase the risk of major complications.

 

In a univariate analysis, the presence of certain comorbidities (such as diabetes) was found to significantly increase the risk of a patient sustaining at least one minor complication Although some of these comorbidities ceased to be significant risk factors when a multivariate analysis was performed, an American Society of Anesthesiologists’ classification of two or more (which is associated with the presence of comorbidities) was still found to be a significant risk factor for complications.


Additionally, female sex, prolonged operating times, and a history of sepsis were found to significantly affect the risk of one or more minor complications.

 

Authors Schoenfeld et al reported: “It is in the best interests of patients and surgeons contemplating spine surgery to understand the types of complications that may present in the early postoperative period, as well as potential risk factors for their development…the results of this study can potentially enhance patient care and safety by informing preoperative discussions, patient selection, and medical optimisation in the preoperative and perioperative period.”

 

Raj Rao, professor of orthopaedic surgery, Department of Orthopaedic Surgery, Medical School of Wisconsin, Milwaukee, USA, reviewed the study in an editorial in the Journal of Bone and Joint Surgery. He wrote that a better understanding of anticipated outcomes and their association with pre-existing comorbidities will help patients to develop a more realistic expectation of the operation that is being considered. “Monitoring of anaesthetic techniques and perioperative care processes will provide further clarification in ascertaining the causes of immediate perioperative morbidity and mortality, and eventually allow the development of better care pathways.” He added that the surgeon had the “ultimate responsibility” for deciding whether the benefits of the surgery outweighed the risks, but said that surgery “does not occur in a vacuum.”


“Surgeons and hospital administrators should combine their efforts to ensure that effective multidisciplinary care, involving the anaesthesiologist, internist, surgeon, nurses, and therapist, is provided throughout the perioperative period for the patient undergoing spinal surgery.”


Speaking to Spinal News International, Rao explained that such a multidisciplinary team was necessary because: “Good anaesthesia care during and immediately postoperatively is important. Internists are often involved in the preoperative clearance of patients and many times help in the medical care of patients postoperatively. Good nursing and therapy care provided in the hospital is essential to the recovery of patients. Therefore, all of these factors help in the overall recovery of patients and in minimising perioperative complications.”

 

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