Patient comorbidity score predicting the incidence of perioperative complications: assessing the impact of comorbidities on complications in spine surgery

Clinical article

Peter G. CampbellDepartment of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;

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Sanjay YadlaDepartment of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;

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Rani NasserDepartment of Neurosurgery, Albert Einstein Medical Center, New York, New York; and

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Jennifer MaloneDepartment of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;

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Mitchell G. MaltenfortDepartment of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;

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John K. RatliffDepartment of Neurosurgery, Stanford University Medical Center, Stanford, California

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Object

Present attempts to control health care costs focus on reducing the incidence of complications and hospital-acquired conditions (HACs). One approach uses restriction or elimination of hospital payments for HACs. Present approaches assume that all HACs are created equal and that payment restrictions should be applied uniformly. Patient factors, and especially patient comorbidities, likely impact complication incidence. The relationship of patient comorbidities and complication incidence in spine surgery has not been prospectively reported.

Methods

The authors conducted a prospective assessment of complications in spine surgery during a 6-month period; an independent auditor and a validated definition of perioperative complications were used. Initial demographics captured relevant patient comorbidities. The authors constructed a model of relative risk assessment based on the presence of a variety of comorbidities. They examined the impact of specific comorbidities and the cumulative effect of multiple comorbidities on complication incidence.

Results

Two hundred forty-nine patients undergoing 259 procedures at a tertiary care facility were evaluated during the 6-month duration of the study. Eighty percent of the patients underwent fusion procedures. One hundred thirty patients (52.2%) experienced at least 1 complication, with major complications occurring in 21.4% and minor complications in 46.4% of the cohort. Major complications doubled the median duration of hospital stay, from 6 to 12 days in cervical spine patients and from 7 to 14 days in thoracolumbar spine patients. At least 1 comorbid condition was present in 86% of the patients. An increasing number of comorbidities strongly correlated with increased risk of major, minor, and any complications (p = 0.017, p < 0.0001, and p < 0.0001, respectively). Patient factors correlating with increased risk of specific complications included systemic malignancy and cardiac conditions other than hypertension.

Conclusions

Comorbidities significantly increase the risk of perioperative complications. An increasing number of comorbidities in an individual patient significantly increases the risk of a perioperative adverse event. Patient factors significantly impact the relative risk of HACs and perioperative complications.

Abbreviations used in this paper:

BMI = body mass index; HACs = hospital-acquired conditions; LOS = length of stay; NIS = Nationwide Inpatient Sample.
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