Risk factors for cardiac complications after spine surgery

Study design: Registry study using prospectively collected data Objective: To determine risk factors for cardiac complications in spine surgery. Methods: The Spine End Results Registry 2003–2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, surgical invasiveness and adverse outcomes were prospectively recorded. The primary outcome of measure was the occurrence of a cardiac complication in the perioperative period. Relative risk (RR) and 95 % confidence intervals were calculated for each of the categorical variables. Multiple log-binomial regression analysis was performed to investigate the independent factors associated with cardiac complication. Results: The incidence of cardiac complication after spine surgery was 6.7 %. There were 136 cardiac complications in 107 patients after spine surgery. Age, diabetes, previous cardiac history, elevated adjusted Charlson comorbidity score, revision surgery, combined anterior-posterior approaches, and surgical invasiveness were statistically significant risk factors for cardiac complication after spine surgery. Conclusions: The results of the present study suggest numerous statistically significant risk factors for cardiac complications after spine surgery. These results may aid the clinician with preoperative risk stratification and patient counseling. STUDY RATIONALE Numerous studies have examined the morbidity and mortality of spine surgery 1 2 3 4 5 6 7 8 9, however, there is a paucity of literature examining the occurrence of cardiac complications after spine surgery. Cardiac complications are a leading cause of death after non-cardiac surgery 4 5 10. Lee et al reported a 0.8 % incidence of cardiac complications after lumbar fusion in retrospective review of 901 patients 11, but identification of statistically significant risk factors was limited by the study methodology. OBJECTIVE The objective of this study is to identify risk factors for cardiac complications after spine surgery.