Perioperative Morbidity and Mortality in Patients Undergoing Spinal Surgery at Vachiraphuket Hospital: Retrospective Review in 300 Cases
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Abstract
Background: Spinal surgery is high risk of perioperative morbidity and mortality. Elderly, female, multiple levels of surgery and long operative time were high risk groups. Objectives: To identify incidence and risk factors predicting cardiovascular (CVS) and respiratory morbidity. Methods: Retrospectively reviewed anesthetic records of 300 spinal surgeries from July 2019- December 2020. Data collection included comorbid conditions, previous lumbar spine surgery, diagnosis, number of surgical levels, operative time, intraoperative blood loss, CVS morbidity, respiratory morbidity (desaturation, reintubation, remained intubation, transfer to ICU) and mortality rate in first 24 hours-post-operatively. Analysis with Chi-square, t-test, Odds ratio, 95%CI and multivariate logistic regression, P-value < 0.05 was considered significant. Results: Incidence of CVS and respiratory morbidity was 38% and 7.3%, respectively. The factors predicting CVS morbidity were age ≥ 65 years-old (adjusted OR = 4.13, 95%CI = 2.37-7.18), hypertension (adjusted OR = 6.65, 95%CI = 3.94-11.21) and blood loss ≥30% of blood volume (adjusted OR = 6.82, 95%CI = 2.83-16.43). Risk factors of respiratory morbidity were ASA class ≥III (adjusted OR = 17.66, 95%CI = 2.34-133.13), preoperative respiratory problem (adjusted OR = 7.16, 95%CI = 2.57-19.92), surgical level >3 (adjusted OR = 4.18, 95%CI = 1.73-10.13), cervical compare with thoracolumbar surgery (adjusted OR = 3.3, 95%CI 1.29-8.33) and diagnosis of tumor (adjusted OR = 10.07, 95%CI = 2.61-38.94). Conclusion: Hypertension, elderly and blood loss ≥30% of blood volume were the high risk groups of CVS morbidity. Surgical level >3, cervical surgery, tumor, ASA class ≥III and preoperative respiratory problem were risk factors of respiratory morbidity.
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