Impact of Chronic Obstructive Pulmonary Disease on Postoperative Complication Rates, Ambulation, and Length of Hospital Stay After Elective Spinal Fusion (≥3 Levels) in Elderly Spine Deformity Patients

Aladine A Elsamadicy; Amanda R Sergesketter; Hanna Kemeny; Owoicho Adogwa; Aaron Tarnasky; Lefko Charalambous; David E T Lubkin; Mark A Davison; Joseph Cheng; Carlos A Bagley; Isaac O Karikari

doi:10.1016/j.wneu.2018.05.185

Impact of Chronic Obstructive Pulmonary Disease on Postoperative Complication Rates, Ambulation, and Length of Hospital Stay After Elective Spinal Fusion (≥3 Levels) in Elderly Spine Deformity Patients

World Neurosurg. 2018 Aug:116:e1122-e1128. doi: 10.1016/j.wneu.2018.05.185. Epub 2018 Jun 2.

Affiliations

¹ Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Neurosurgery, Yale University Medical Center, New Haven, Connecticut, USA.
² Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
³ Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: owoicho.adogwa@gmail.com.
⁴ Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
⁵ Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
⁶ Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA.

PMID: 29870850
DOI: 10.1016/j.wneu.2018.05.185

Abstract

Objective: To investigate the impact that chronic obstructive pulmonary disease (COPD) has on postoperative complication rates, ambulation, and hospital length of stay for elderly spinal deformity patients after elective spinal fusion (≥3 levels).

Methods: The medical records of 559 elderly (≥60 years old) spine deformity patients undergoing elective spinal fusion (≥3 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 60 patients with COPD (10.7%) and 499 patients without COPD (89.3%). Patient demographics, comorbidities, postoperative complications, ambulatory status, and readmission rates were collected. The primary outcomes investigated in this study were complication rates and length of hospital stay.

Results: Demographics and comorbidities were similar between groups, with a difference in proportion of smokers (COPD group: 25.0% vs. no COPD group: 9.6%, P = 0.0004). The median number of fusion levels (P = 0.840), operative time (P = 0.842), estimated blood loss (P = 0.336), and incidences of durotomy (P = 0.258) was similar between both cohorts. The COPD cohort experienced a higher rate of postoperative fever (10.0% vs. 3.0%, P = 0.007) and pneumonia (5.0% vs. 0.4%, P = 0.0004), respectively. There was a significant difference in the number of feet walked on the first day of ambulation after surgery (COPD group: 58.6 ± 78.4 vs. no COPD group: 84.0 ± 102.8, P = 0.040). Length of hospital stay was significantly longer in the COPD cohort than the no COPD cohort (7.7 ± 6.4 vs. 6.0 ± 4.0 days, respectively; P = 0.0498).

Conclusions: Our study demonstrates that elderly patients with COPD have increased lengths of stay and higher rates of postoperative pneumonia after spinal fusion. This determination identifies a potentially modifiable risk factor for increased utilization of health care resources.

Keywords: Ambulation; Chronic obstructive pulmonary disease; Elderly; Length of stay; Postoperative complications; Spinal Deformity; Spinal Fusion.

MeSH terms

Aged
Aged, 80 and over
Elective Surgical Procedures / methods
Female
Humans
Length of Stay*
Male
Middle Aged
Patient Readmission / statistics & numerical data
Postoperative Complications / epidemiology*
Pulmonary Disease, Chronic Obstructive / complications
Retrospective Studies
Risk Factors
Spinal Diseases / surgery
Spinal Fusion* / adverse effects
Walking / physiology