Clavien-Dindo classification and risk factors for early postoperative complications in thoracic-lumbar-sacral spinal tuberculosis patients

English Keywords:Thoracic-lumbar-sacral spinal tuberculosis  Postoperative complication  Risk factors  Clavien-Dindo classification

English Abstract:

  【Abstract】 Objectives: To assess the early postoperative complications of thoracic-lumbar-sacral spinal tuberculosis by using the Clavien-Dindo(C-D) classification system, and to identify the risk factors related with them. Methods: All 187 cases of thoracic-lumbar-sacral spinal tuberculosis who were treated by one-stage debridement, interbody fusion and instrumentation between January 2000 and December 2015 were retrospectively analyzed． There were 112 males and 75 females, with an average age of 45.7±16.0 years(range, 18-85 years). 74 cases were suffered from neurological dysfunction and 29 cases were complicated with comorbidities. There were 40 cases(21.4%) with thoracic tuberculosis, 51 cases(27.3%) with thoracolumbar tuberculosis, 74 cases(39.6%) with lumbar tuberculosis, and 22 cases(11.8%) with lumbosacral tuberculosis. 55 cases were treated by anterior approach, 98 cases were treated by posterior approach, and anterior approach combined posterior approach surgery was performed in 34 cases． Postoperative complications during hospitalization period(≤30d) were collected and evaluated by C-D classification. Univariate logistic regression analysis was used to evaluate possible relationships between early postoperative complications and the factors including: age, sex, history of smoking, preoperative ASIA grade, preoperative comorbidities, duration of preoperative anti-TB treatment, location of spinal lesion, extent of disease, preoperative hemoglobin, preoperative albumin, preoperative erythrocyte sedimentation rate, surgical approach, operation time, and intraoperative blood loss. Variables with P<0.2 in the univariate analysis were considered in a multivariate logistic analysis that identified significant independent risk factors. Results: The overall complication rate was 37.4%(70/187). According to the C-D classification, the incidence of complications of grade Ⅰ, grade Ⅱ, grade Ⅲ, grade Ⅳ and grade Ⅴ was 24.1%, 8.0%, 2.7%, 2.1% and 0.5%, respectively. Univariate logistic regression analysis showed that preoperative comorbidities, extent of disease, preoperative hemoglobin and preoperative albumin were associated with overall complications. Age, preoperative comorbidities, duration of preoperative anti-TB treatment, preoperative albumin and operation time were associated with grade Ⅱ or above complications. Multivariate logistic regression analysis identified low level of preoperative albumin(P=0.034) was an independent risk factor for overall complications. Preoperative comorbidities(P=0.024) and prolonged operation time(P=0.015) as the independent risk factors for grade Ⅱ or above complications. Conclusions: C-D system is simple and can suggest the severity of complications. It is an effective method for assessing postoperative complications. Low level of preoperative albumin is a risk factor for overall complications after surgery. Preoperative comorbidities and prolonged operation time are risk factors for grade Ⅱ or above of postoperative complications.