Pre- and postoperative factors and laboratory values predicting outcome in patients undergoing lumbar fusion surgery

• Published in: World neurosurgery
• Main Authors: Leu, S, Kamenova, M, Mehrkens, A, Mariani, L, Schären, S, Soleman, J
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Neurosurgery; CRP; C-reactive protein; thrombocytes; difference between pre- and postoperative CK-levels; European System for Cardiac Operative Risk Evaluation; difference between pre- and postoperative Hb-levels; EuroScore; Crea; CRP-diff; hemoglobin; ASA; Tc; creatinine; Lc; difference between pre- and postoperative CRP-levels; creatine kinase; Hb; BMI; complications; lumbar fusion surgery; body mass index; leucocytes; Tc-diff; CK; difference between pre- and postoperative Tc-levels; American Society of Anesthesiologists; CK-diff; LOS; length of stay; Hb-diff
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.05.011

Abstract Aim. To determine whether complications in lumbar fusion surgery could be estimated from patient factors and perioperative laboratory values. Additionally, risk scores for detection of patients prone to complications were defined. Methods We retrospectively collected data of patients undergoing lumbar fusion surgery between 2013 and 2015. The patients were divided into group A (no complications), and B (systemic and infectious complications within 30 days postoperatively). Patient related factors and levels of perioperative laboratory values were compared between the groups and analyzed for possible impact on complications and length of stay (LOS) in the hospital. Results Data of 132 consecutive patients (74 women (56.1%), median age 68.5 years) were analyzed. Postoperative complications occurred in 29.5%. Higher postoperative creatine kinase (CK-) and c-reactive protein- (CRP) and lower postoperative hemoglobin- and thrombocytes-values as well as higher differences between pre- and postoperative CK-, CRP-, and hemoglobin-values were associated with postoperative complications. Among others, the combinations of advanced age and elevated BMI (p=0.0062, OR: 3.018), or advanced age, elevated BMI, and postoperative CK > 166 U/l (p=0.0016, OR: 3.637) revealed patients with a threefold risk for complications. The combination of advanced age, ASA-score > 2 and preoperative hemoglobin < 12.9 g/dl was associated with a LOS of 20.3 versus 11 days (p= 0.01). Conclusions Patients with postoperative complications and extended LOS seem to show significant differences in various perioperative laboratory values and patient factors. Perioperative risk assessments using cutoff values and risk scores may help identify patients prone to complications and extended resource use.