Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine

• Published in: World neurosurgery Vol. 170; pp. e520 - e528
• Main Authors: Cabrera, Juan P., Carazzo, Charles A., Guiroy, Alfredo, White, Kevin P., Guasque, Joana, Sfreddo, Ericson, Joaquim, Andrei F., Yurac, Ratko, Zanardi, Carlos, Picard, Nelson, Donato, Maximiliano, Gorgas, Alberto, Peña, Efrén, González, Óscar, Mandiola, Sergio, Remondino, Rodrigo, Ortiz, Pablo Nicolas, Jiménez, José, Jesus Gonzalez, Jose de, Martinez, Oscar, Reyes, Pedro, Jara, Juan, Burgos, Julio, Gagliardi, Martin, Ciancio, Alejandro Morales, Uruchi, Daniel, Martínez, Ricardo, Mireles, Nicolás, Meira, Paulo Henrique, Astur, Nelson, Meves, Robert, Vieira, Rian, Borges, Renan, Chaves, Jennyfer, Guimaraes, Ricardo, Balen, Matheus, Zamorano, Juan J., Zanini, Guilherme Rocha, Senna, Germano, Cabrera, Paulo Roberto, Ordoñez, Fausto, Vásquez, FranlyArismendy, Daniel, Jefferson, Veiga, Jose Carlos, Santoro, Pedro Del, Sebben, Andre Luis, Orso, Vinicius, Penteado, Ricardo, Pino, Christian, Velarde, Esther, Jacob, Charbel, Dias, Wanderson, Ujhelly, Jose Ignacio, Estay, Ayelen, Noleto, Gustavo, Sousa, Icaro de, Amorim, Robson, Carneiro, Marlon, Montoya, Fabián, Flórez, David, Corrêa, Raphael Augusto, Santiago, Bastianon, Gonzalez, Alvaro Silva
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2023
• Subjects: Fracture fixation; Humans; Lumbar Vertebrae - injuries; Lumbar Vertebrae - surgery; Morbidity; Postoperative complications; Postoperative Complications - epidemiology; Retrospective Studies; Risk Factors; Spinal fractures; Spinal Fractures - complications; Spinal Fractures - epidemiology; Spinal Fractures - surgery; Spinal Injuries - complications; Spinal Injuries - surgery; Thoracic Vertebrae - injuries; Thoracic Vertebrae - surgery; Treatment Outcome; OR; ASIA; CI; Fracture fixation; Spinal fractures; AIS; Morbidity; Postoperative complications; Risk factors
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2022.11.059

Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures.
We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed.
Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73–6.60), having ≥1 comorbid illness (2.44, 1.61–3.70), surgery delayed due to health instability (2.56, 1.50–4.37), and ASIA Impairment Scalelevel A (3.36, 1.78–6.35), while absence of impairment (0.39, 0.22–0.71), ASIAlevel E (0.39, 0.22–0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36–0.99) were protective.
Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.