PMID- 23289509
OWN - NLM
STAT- MEDLINE
DCOM- 20130516
LR  - 20130304
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 18
IP  - 3
DP  - 2013 Mar
TI  - Impact of perioperative complications on clinical outcome scores in lumbar fusion 
      surgery.
PG  - 265-8
LID - 10.3171/2012.12.SPINE12805 [doi]
AB  - OBJECT: Although lumbar fusion is effective in well-selected patients, it is not 
      without complications associated with short-term morbidity. There is a paucity of 
      literature on the effect of these complications on long-term clinical outcomes. 
      The purpose of this study was to determine whether perioperative 
      complications-that is, those occurring within 30 days after surgery-alter the 
      long-term clinical outcomes after lumbar fusion. METHODS: The authors 
      retrospectively reviewed surgical and clinical databases for the period from 2001 
      to 2008 to identify patients who had undergone instrumented lumbar spinal fusion 
      and had complete preoperative and 2-year postoperative outcome measures data. 
      Outcome measures included the 36-Item Short-Form Health Survey (SF-36) Physical 
      Component Summary, SF-36 Mental Component Summary, Oswestry Disability Index 
      (ODI), and Numeric Rating Scales (0-10) for back and leg pain. Three patient 
      groups were created for comparison-one with major complications, one with only 
      minor complications, and another with no complications-using propensity matching 
      techniques based on demographics, baseline clinical outcome scores, and surgical 
      characteristics. Preoperative and 2-year postoperative outcome scores in the 
      groups were compared. One-way ANOVA was used to compare continuous variables, and 
      the Fisher exact test was used to compare categorical variables between the 
      groups. Significance was set at p < 0.001. RESULTS: In the database with 1144 
      patients, 81 had a major complication. Of these 81 patients, 78 were propensity 
      matched to a similar group of patients with minor complications and another group 
      with no complications. Comparison of the 3 groups revealed that 2-year 
      postoperative outcomes were not statistically different for any of the measures. 
      Overall ODI at 2 years was better in patients having no complications (39.6) or 
      only minor complications (37.0) than in those having major complications (44.5), 
      but this difference was not statistically significant (p = 0.074). The proportion 
      of patients reaching a minimum clinically important difference (MCID) for ODI was 
      statistically significantly smaller in the major complication group (31%) than in 
      the minor complication (51%) and no complication groups (65%; p < 0.001). 
      CONCLUSIONS: A smaller proportion of patients achieved MCID for ODI 2 years after 
      a major perioperative complication following lumbar fusion than after a minor 
      complication or no complications.
FAU - Lambat, Manish P
AU  - Lambat MP
AD  - Norton Leatherman Spine Center, Louisville, KY 40202, USA.
FAU - Glassman, Steven D
AU  - Glassman SD
FAU - Carreon, Leah Y
AU  - Carreon LY
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130104
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Analysis of Variance
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Lumbar Vertebrae/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement
MH  - Postoperative Complications/*epidemiology
MH  - Quality of Life
MH  - Spinal Fusion/*methods
MH  - Treatment Outcome
EDAT- 2013/01/08 06:00
MHDA- 2013/05/17 06:00
CRDT- 2013/01/08 06:00
PHST- 2013/01/08 06:00 [entrez]
PHST- 2013/01/08 06:00 [pubmed]
PHST- 2013/05/17 06:00 [medline]
AID - 10.3171/2012.12.SPINE12805 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2013 Mar;18(3):265-8. doi: 10.3171/2012.12.SPINE12805. Epub 
      2013 Jan 4.