Risk factors analysis of early complications in long-level fusion and instrumentation for adult degenerative scoliosis

English Keywords:Adult degenerative scoliosis  Surgery  Complications  Risk factors

English Abstract:

  【Abstract】 Objectives: To investigate the risk factors of early complications in long-level fusion and instrumentation for adult degenerative scoliosis(ADS). Methods: This retrospective study included patients with ADS who underwent posterior long-level fusion and instrumentation from December 2011 to December 2018. Patients were divided into two groups according to the occurrence of intra- and post-operative complications in 6 weeks. Early complications included pneumonia, urinary tract infection, wound infection, gastrointestinal discomfort or incomplete ileus, dural tear, pleural effusion, arrhythmia and shock. Patients′ demographics characteristics included gender, age, bone mineral density(BMD) and comorbidities. Preoperative assessment data included American society of anesthesiologists(ASA) risk grade, nutritional risk screening, deep vein thrombosis(DVT) risk grade and operative risk assessment. Radiographic parameters included coronal Cobb angle, coronal balance distance(CBD) and sagittal vertebral axis(SVA). Intraoperative data included operation time, intraoperative blood loss and transfusion, level of decompression, number of instrumented and fusion vertebrae. Postoperative data included hospital stay, the times and amount of blood transfusion, the minimum value of postoperative hemoglobin and albumin. Potential risk factors were identified by univariate logistic regression analysis after comparing the difference of clinical data in two groups. Multivariate logistic regression analysis was performed to verify the independent risk factors of early complications. Results: 64 patients was enrolled, 23 males and 41 females, the mean age was 60.8±7.6(50-78) years. Early complications were developed in 21 of 64 patients until 6 weeks after operation, the incidence rate is 32.81%(21/64). There were significant difference in parameters including comorbidities(57.1% vs 25.6%), preoperative nutritional risk screening≥1 score(42.9% vs 16.3%, P=0.021), operative risk assessment≥2 score(52.4% vs 25.6%, P=0.034), operation time(279.3±97.8 min vs 238.8±59.3 min, P=0.034), and levels of instrumentation(8.1±1.6 vs 6.9±2.1, P=0.016). There were no significant difference in parameters including gender, age, bone mineral density(BMD), coronal Cobb angle, coronal balance distance(CBD), and sagittal vertebral axis(SVA), preoperative American society of anesthesiologists(ASA) risk grade, deep vein thrombosis(DVT) risk grade, intraoperative blood loss and transfusion, level of decompression, number of instrumented and fusion vertebrae, the minimum value of postoperative hemoglobin and albumin, hospital stay, the times and amount of blood transfusionbetween two groups. These parameters with significant difference between the two groups were analysised by using univariate logistic regression, it showed that preoperative nutritional risk screening score, operative risk assessment score, operation time and levels of instrumentation were the potential risk factors of early complications. Analysis of the multivariate logistic regression showed that for every 1 point(OR=3.114, P=0.032) increase in preoperation nutritional risk screening score and 1 minute(OR=1.010, P=0.033) increase in operative time, the risk of early complications increased 2.11 times and 0.01 times respectively. Preoperative nutritional risk screening score and operation time were two independent factors of early complications after long-level fusion and instrumentation in ADS. Conclusions: By improving preoperative nutritional status, lower nutritional risk score and shortening the operation time are benefit to reduce early complications in long-level fusion and instrumentation for ADS.