Presenting a review of surgeries for degenerative spine disorders at EuroSpine 2013 (2-4 October, Liverpool, UK), Jyrki Salmenkivi (Helsinki University Central Hospital, Espoo, Finland) said that surgery for degenerative conditions was safe and that deaths due to medical errors were rare. However, he added that age, male gender, and cardiovascular disease increase the risk of death after surgery.
Salmenkivi reported that the incidence of medical adverse effects is highest in patients undergoing surgery, particularly those undergoing general or orthopaedic surgery. He added: “In Finland, it has been estimated that medical adverse effects may cause 1,700 deaths per year.”
In their study, Salmenkivi and colleagues aimed to evaluate the number of deaths and reasons for death after surgery for degenerative spine disorders. They also sought to analyse risk factors for mortality and tried to identify ways of preventing death after surgery.
Using data from the Finnish PERFECT-back database (data collected from a hospital discharge register), the authors found 61,166 patients who had undergone surgery for a degenerative spine condition between 1997 and 2009. Patients either had a herniated lumbar disc, spinal stenosis, degenerative disc disease, or spondylolysis or spondylolisthesis.
A total of 408 (0.67%) patients died during the first year after surgery—mortality was 0.02% during the first week, 0.03% at 30 days, and 0.12% at nine months. Overall, there were 50 deaths related to spine surgery (including 16 myocardial infarctions, seven cases of cerebral infraction/bleeding, and seven cases of pneumonia). However, Salmenkivi commented: “Death because of medical error was utterly rare. Only one person died directly because of surgery.”
Also, Salmenkivi et al found that ischaemic heart disease, hypertension, diabetes, male gender, and age greater than 75 years all increased the risk of death after surgery. The presenter concluded: “Careful consideration of the expected gains and risks after surgery, prevention of unintended errors during surgery, and sharp recognition and treatment of complications once they occur are recommended to decrease the risk for serious adverse events after surgery.”