1498. Benefits of Medical Optimization before Thoracolumbar Three-Column Osteotomies: An Analysis of 618 Patients

Authors: Andre Samuel; Avani Vaishnav, MBBS; Steven McAnany, MD; Todd Albert, MD; Sravisht Iyer, MD; Catherine Himo Gang, MPH; Sheeraz Qureshi, MD, MBA (New York, NY)

Introduction:

Thoracolumbar three-column osteotomies are associated with high postoperative morbidity. Preoperative modifiable risk factors have not been explored, presumably secondary to limited cohort sizes.

Methods:

A retrospective review was conducted of a national cohort of patients undergoing thoracolumbar three-column osteotomy between 2013 and 2016. Post-operative complications, readmissions, and reoperations were observed for 30 days postoperatively. Potential patient-sided, risk factors including preoperative laboratory values were assessed and correlated with postoperative outcomes. This includes hyponatremia (serum sodium < 135 mEq/L), anemia (hematocrit < 30%), renal insufficiency (creatinine ≥ 1.2 mg/dL), coagulopathy (INR ≥ 1.2), or hypoalbuminemia (albumin < 3.5 g/dL). Patients were classified as medically optimized if their aforementioned laboratory values were within normal limits.

Results:

A total of 618 patients who underwent thoracolumbar three-column osteotomies between 2013 and 2016 were identified (Table 1). Complications, readmissions, and reoperations occurred at relatively high rates (Table 2). 27.7% of patients were not medically optimized (Table 3). Among patients with adequate preoperative optimization, 6.2% had major complications (P < 0.01), 16.3% had minor complications (P < 0.01), and 8.6% had reoperation or readmission related to surgical complication (P = 0.67).  Preoperative renal insufficiency (odds ratio[OR]: 32.6, P = 0.003), preoperative anemia (OR: 249.9, P = 0.02 [Hct < 25]; OR: 38.3, P < 0.01 [Hct 25-30]), and chronic obstructive pulmonary disorder (COPD; OR: 5.7, P = 0.01) were associated with major complications (Table 4).

Conclusion:

Despite the high risk for complications associated with the procedure, over 25% of patients who underwent thoracolumbar three-column osteotomies lacked preoperative optimization of correctible medical laboratory values.