1488. Assessing Risk Factors for Postoperative Complication Following Posterior Cervical Fusion Surgery

Authors: Ryan K Badiee; Andrew Chan, MD; Joshua Rivera; Lee Tan, MD; Dean Chou, MD; Praveen Mummaneni, MD (SAN FRANCISCO, CA)

Introduction:

Few studies have identified predictors of complications following posterior cervical laminectomy and fusion (PCF) for cervical spondylotic myelopathy. This study seeks to identify risk factors associated with medical, surgical, and overall complication following PCF surgery.

Methods:

Adults undergoing PCF from May 2012 through July 2018 were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Preoperative medication use were defined as the presence of any active prescription at the time of surgery. Medical complications included urinary tract infection, anemia, thrombotic events, arrhythmia, cardiac arrest, pneumonia, sepsis, and death. Surgical complications included dysphagia, durotomy, surgical site infection, seroma, new neurologic deficit, hardware malposition, and surgical revision within 30 days. Univariate analysis of potential risk factors was performed using Student’s t test for continuous variables and Chi-Squared tests for dichotomous variables. Multivariate logistic regression models, incorporating variables significant at P=0.20 on univariate analysis, were then developed to examine their relative contributions.

Results:

A total of 210 patients were included, of which 99 (47.1%) were female. The average number of vertebrae fused was 5.39 (SD=1.04) with an average surgery duration of 235 minutes (SD=58.6). The medical, surgical, and overall complication rates were 11.4%, 22.9%, and 31.0% respectively. Risk factors associated with medical complication in multivariate analysis included the length of fusion (OR=2.94, p=0.03) and preoperative antidepressant use (OR=3.12, p=0.03). Multivariate analysis revealed no significant predictors of surgical complication, however the incidence of any complication was associated with surgery duration (OR=1.005, p<0.001) and preoperative narcotic use (OR=2.01, p=0.03). 

Conclusion:

After adjusting for demographic, clinical, and surgical characteristics, the length of vertebral fusion, and preoperative antidepressant and narcotic use emerged as significant risk factors for postoperative complication. This interaction between preoperative narcotic use and postoperative complication following PCF should be explored further in prospective study.