Preoperative Diagnosis and Early Complications in Thoracolumbar Spine Surgery A Single Center Prospective Study

Study Design: Prospective observational cohort study. Objective: To determine the incidence of early complications with thoracolumbar spine surgery and its correlation with preoperative diagnosis. Summary of Background Data: The reported incidence of early complications associated with thoracolumbar surgery is highly variable. Varying definitions of what constitutes a "complication" and varying study methodologies make evaluation and comparison of the literature difficult. No large study has investigated the effect of preoperative diagnosis and patient comorbidities on early postoperative complications in thoracolumbar surgery. Methods: One-hundred twenty-eight consecutive patients who underwent thoracolumbar surgery by the neurosurgical service at the Thomas Jefferson University Hospital were prospectively entered into a central database from May to December 2008. An earlier-described, binary definition of major and minor complication was used. Data on preoperative diagnosis, comorbidities, body mass index, surgical procedure, length of stay (LOS), and early complication was examined using chi(2) and time-to-discharge survival analysis. Results: The overall complication incidence was 59.4%, with a minor complication incidence of 52.3% and a major complication incidence of 24.2%. The highest incidences of complications occurred in patients with the diagnosis of infection and tumor, where incidence exceeded 70%; this difference did not achieve statistical significance. The overall median LOS was 7 days; LOS was longer in patients with traumatic pathology (17 d) and patients with neoplastic pathology (14 d) (P < 0.05). Conclusions: A higher incidence of complications than earlier studies was noted. A trend toward higher complication incidence in patients with infectious or neoplastic disease was observed. The severity of patient pathology, the broader definitions of complication used, and the elimination of recall bias by the use of a prospective study design accounts for the higher incidence of complications reported in this series. However, a large, prospective study using clear definitions is needed to elucidate the true incidence of early complications in thoracolumbar surgery.