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Acta Neurochirurgica

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Open Access 01-12-2024 | Spinal Stenosis | Original Article

Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources

Authors: Ole Kristian Alhaug, Filip C. Dolatowski, Simran Kaur, Greger Lønne

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Purpose

Lumbar spinal stenosis (LSS) is a prevalent disorder, and surgery for LSS is a common procedure. Postoperative complications occur after any surgery and impose costs for society and costs and additional morbidity for patients. Since complications are relatively rare, medical registries of large populations may provide valuable knowledge. However, recording of complications in registries can be incomplete.

To better estimate the true prevalence of complications after LSS surgery, we reviewed two different sources of data and recorded complications for a sample of Norwegian LSS patients.

Methods

474 patients treated surgically for LSS during 2015 and 2016 at four hospitals reported to a national spine registry (NORspine).

Postoperative complications were recorded by patients in NORspine, and we cross-referenced complications documented in NORspine with the patients´ electronic patient records (EPR) to re-test the complication rates. We performed descriptive statistics of complication rates using the two different data sources above, and analyzed the association between postoperative complications and clinical outcome with logistic regression.

Results

The mean (95%CI) patient age was 66.3 (65.3–67.2) years, and 254 (53.6%) were females. All patients were treated with decompression, and 51 (10.7%) received an additional fusion during the index surgery. Combining the two data sources, we found a total rate for postoperative complications of 22.4%, the NORspine registry reported a complication rate of 15.6%, and the EPR review resulted in a complication rate of 16.0%. However, the types of complications were inconsistent across the two data sources. According to NORspine, the frequency of reoperation within 90 days was 0.9% and according to EPR 3.4%. The rates of wound infection were for NORspine 3.1% and EPR review 2.1%.

There was no association between postoperative complication and patient reported outcome.

Conclusion

Postoperative complications occurred in 22% of LSS patients. The frequency of different postoperative complications differed between the two data sources.

Aalto T, Sinikallio S, Kröger H, Viinamäki H, Herno A, Leinonen V, Turunen V, Savolainen S, Airaksinen O (2012) Preoperative predictors for good postoperative satisfaction and functional outcome in lumbar spinal stenosis surgery–a prospective observational study with a two-year follow-up. Scand J Surg 101(4):255–260. https://doi.org/10.1177/145749691210100406CrossRefPubMed

Alhaug OK, Dolatowski FC, Solberg TK, Lønne G (2021) Criteria for failure and worsening after surgery for lumbar spinal stenosis: a prospective national spine registry observational study. Spine J 21(9):1489–1496. https://doi.org/10.1016/j.spinee.2021.04.008CrossRefPubMed

Alhaug OK, Kaur S, Dolatowski F, Småstuen MC, Solberg TK, Lønne G (2022) Accuracy and agreement of national spine register data for 474 patients compared to corresponding electronic patient records. Eur Spine J 31(3):801–811. https://doi.org/10.1007/s00586-021-07093-8CrossRefPubMed

Cairns A, Battleday FM, Velikova G et al (2020) General patient satisfaction after elective and acute thoracic surgery is associated with postoperative complications. J Thorac Dis 12(5):2088–2095 (ISSN 2072-1439)CrossRefPubMedPubMedCentral

Deyo RA, Hickam D, Duckart JP, Piedra M (2013) Complications after surgery for lumbar stenosis in a veteran population. Spine (Phila Pa 1976) 38(19):1695–702. https://doi.org/10.1097/BRS.0b013e31829f65c1CrossRefPubMed

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.aeCrossRefPubMedPubMedCentral

Endler P, Ekman P, Hellström F, Möller H, Gerdhem P (2020) Minor effect of loss to follow-up on outcome interpretation in the Swedish spine register. Eur Spine J 29(2):213–220. https://doi.org/10.1007/s00586-019-06181-0CrossRefPubMed

Golubovsky JL, Ilyas H, Chen J, Tanenbaum JE, Mroz TE, Steinmetz MP (2018) Risk factors and associated complications for postoperative urinary retention after lumbar surgery for lumbar spinal stenosis. Spine J 18(9):1533–1539. https://doi.org/10.1016/j.spinee.2018.01.022CrossRefPubMed

Hébert JJ, Abraham E, Wedderkopp N et al (2020) Preoperative Factors Predict Postoperative Trajectories of Pain and Disability Following Surgery for Degenerative Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 45:E1421–E1430CrossRefPubMed

10.

Hohenberger C, Albert R, Schmidt NO, Doenitz C, Werle H, Schebesch KM (2022) Incidence of medical and surgical complications after elective lumbar spine surgery. Clin Neurol Neurosurg 220:107348. https://doi.org/10.1016/j.clineuro.2022.107348. (ISSN 0303-8467)CrossRefPubMed

11.

Højmark K, Støttrup C, Carreon L, Andersen MO (2016) Patient-reported outcome measures unbiased by loss of follow-up. Single-center study based on DaneSpine, the Danish spine surgery registry. Eur Spine J 25(1):282–286. https://doi.org/10.1007/s00586-015-4127-3CrossRefPubMed

12.

Kamper SJ, Ostelo RW, Knol DL, Maher CG, de Vet HC, Hancock MJ (2010) Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status. J Clin Epidemiol 63(7):760-766.e1. https://doi.org/10.1016/j.jclinepi.2009.09.009CrossRefPubMed

13.

Kaur S, Alhaug OK, Dolatowski FC, Solberg TK, Lønne G (2023) Characteristics and outcomes of patients who did not respond to a national spine surgery registry. BMC Musculoskelet Disord 24(1):164. https://doi.org/10.1186/s12891-023-06267-3CrossRefPubMedPubMedCentral

14.

Lobo Prabhu K, Cleghorn MC, Elnahas A et al (2018) Is quality important to our patients? The relationship between surgical outcomes and patient satisfaction. BMJ Qual Saf 27:48–52CrossRefPubMed

15.

Lovi A, Gallazzi E, Galbusera F, Colombini A, Pregliasco F, Peretti G, Brayda-Bruno M (2021) Perioperative adverse events in adult and pediadric spine surgery: a prospective cohort analysis of 364 consecutive patients. Brain Spine 29(2):100858. https://doi.org/10.1016/j.bas.2021.100858CrossRef

16.

Meyer B, Shiban E, Albers LE, Krieg SM (2020) Completeness and accuracy of data in spine registries: an independent audit-based study. Eur Spine J 29(6):1453–1461. https://doi.org/10.1007/s00586-020-06342-6CrossRefPubMed

17.

Mikkelsen E, Ingebrigtsen T, Thyrhaug AM, Olsen LR, Nygaard ØP, Austevoll I, Brox JI, Hellum C, Kolstad F, Lønne G, Solberg TK (2023) The Norwegian registry for spine surgery (NORspine): cohort profile. Eur Spine J. https://doi.org/10.1007/s00586-023-07929-5CrossRefPubMed

18.

Pascucci S, Langella F, Franzò M, Tesse MG, Ciminello E, Biondi A, Carrani E, Sampaolo L, Zanoli G, Berjano P, Torre M (2023) National spine surgery registries’ characteristics and aims: globally accepted standards have yet to be met. Results of a scoping review and a complementary survey. J Orthop Traumatol. 24(1):49. https://doi.org/10.1186/s10195-023-00732-4CrossRefPubMedPubMedCentral

19.

Poon MTC, Demetriades AK (2023) Routine healthcare data for adverse events after spinal surgery. Acta Neurochir 165:3991–3992. https://doi.org/10.1007/s00701-023-05783-4CrossRefPubMed

20.

Rampersaud YR, Anderson PA, Dimar JR 2nd, Fisher CG, Spine Trauma Study Group and Degenerative Spine Study Group (2016) Fisher CG spinal adverse events severity system, version 2 (SAVES-V2): inter- and intraobserver reliability assessment. J Neurosurg Spine 25(2):256–63. https://doi.org/10.3171/2016.1.SPINE14808CrossRefPubMed

21.

Saarinen IH, Koivisto JM, Kaipia A, Haavisto E (2020) Perceived quality of surgical care in association with patient-related factors and correlation to reported postoperative complications in Finland: a cross-sectional study. BMJ Open 10(11):e037708. https://doi.org/10.1136/bmjopen-2020-037708CrossRefPubMedPubMedCentral

22.

Sarnthein J, Staartjes VE, Regli L et al (2022) Neurosurgery outcomes and complications in a monocentric 7-year patient registry. Brain Spine 2:100860. https://doi.org/10.1016/j.bas.2022.100860

23.

Sigmundsson FG, Kang XP, Jönsson B, Strömqvist B (2012) Prognostic factors in lumbar spinal stenosis surgery. Acta Orthop 83(5):536–542. https://doi.org/10.3109/17453674.2012.733915CrossRefPubMedPubMedCentral

24.

Solberg TK, Sørlie A, Sjaavik K, Nygaard ØP, Ingebrigtsen T (2011) Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine? Acta Orthop 82(1):56–63. https://doi.org/10.3109/17453674.2010.548024CrossRefPubMedPubMedCentral

25.

Strömqvist B, Fritzell P, Hägg O, Jönsson B, Swedish Society of Spinal Surgeons (2009) The Swedish spine register: development, design and utility. Eur Spine J 18(Suppl 3):294–304. https://doi.org/10.1007/s00586-009-1043-4CrossRefPubMedPubMedCentral

26.

Turcotte JJ, Patton CM (2018) Predictors of postoperative complications after surgery for lumbar spinal stenosis and degenerative lumbar spondylolisthesis. J Am Acad Orthop Surg Glob Res Rev 2(12):e085. https://doi.org/10.5435/JAAOSGlobal-D-18-00085CrossRefPubMedPubMedCentral

27.

van Hoof ML, Jacobs WC, Willems PC, Wouters MWJM, de Kleuver M, Peul WC, Ostelo RWJG, Fritzell P (2015) Evidence and practice in spine registries. A systematic review, and recommendations for future design of registries. Acta Orthopaedic 86(5):534–544. https://doi.org/10.3109/17453674.2015.1043174CrossRef

28.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147(8):573–577CrossRef

29.

Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES (2006) United States’ trends and regional variations in lumbar spine surgery: 1992–2003. Spine (Phila Pa 1976). 31(23):2707–14. https://doi.org/10.1097/01.brs.0000248132.15231.feCrossRefPubMedPubMedCentral

30.

Weiss H, Garcia RM, Hopkins B, Shlobin N, Dahdaleh NS (2019) A systematic review of complications following minimally invasive spine surgery including transforaminal lumbar interbody fusion. Curr Rev Musculoskelet Med 12(3):328–339. https://doi.org/10.1007/s12178-019-09574-2CrossRefPubMedPubMedCentral

31.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson ANA, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358(8):794–810. https://doi.org/10.1056/NEJMoa0707136CrossRefPubMedPubMedCentral

32.

Wong AP, Shih P, Smith TR, Slimack NP, Dahdaleh NS, Aoun SG, El Ahmadieh TY, Smith ZA, Scheer JK, Koski TR, Liu JC, Fessler RG (2014) Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foramintomy, discectomy, or laminectomy. World Neurosurg 81(3–4):634–40. https://doi.org/10.1016/j.wneu.2013.11.012CrossRefPubMed

Title: Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources
Authors: Ole Kristian Alhaug
Filip C. Dolatowski
Simran Kaur
Greger Lønne
Publication date: 01-12-2024
Publisher: Springer Vienna
Keyword: Spinal Stenosis
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-06086-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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