Comparative analysis of peri-operative complications between a multicenter prospective cervical deformity database and the nationwide inpatient sample database

Publication date: Available online 17 May 2017
Source:The Spine Journal
Author(s): Peter G. Passias, Samantha R. Horn, Cyrus M. Jalai, Gregory Poorman, Olivia J. Bono, Subaraman Ramchandran, Justin S. Smith, Justin K. Scheer, Daniel M. Sciubba, D. Kojo Hamilton, Gregory Mundis, Cheongeun Oh, Eric O. Klineberg, Virginie Lafage, Christopher I. Shaffrey, Christopher P. Ames
Background ContextComplication rates for adult cervical deformity are poorly characterized given the complexity and heterogeneity of cases.PurposeTo compare peri-operative complication rates following adult cervical deformity corrective surgery between a prospective multi-center database for cervical deformity patients (PCD) and Nationwide Inpatient Sample (NIS).Study Design/SettingRetrospective review of prospective databases.Patient Sample11,501 adult cervical deformity patients (11,379 patients from NIS and 122 patients from PCD database).Outcome MeasuresPeri-operative medical and surgical complications.MethodsThe NIS was queried (2001-2013) for cervical deformity discharges for patients ≥18yrs undergoing cervical fusions using ICD-9 coding. Patients ≥18 years from the PCD database (2013-2015) were selected. Equivalent complications were identified and rates were compared. Bonferroni correction (p<0.004) was used for Pearson χ². Binary logistic regression was used to evaluate differences in complication rates between databases.Results11,379 NIS patients and 122 PCD patients were identified. PCD patients were older (62.49 vs. 55.15,p<0.001) but displayed similar gender distribution. Intra-operative complication rate was higher in PCD (39.3%) compared to NIS (9.2%,p<0.001). PCD had an increased risk of reporting overall complications than NIS (OR:2.81, CI:1.81-4.38). Only device-related complications were greater in NIS (7.1% vs. 1.1%,p=0.007). PCD patients displayed higher rates of the following complications: peripheral vascular (0.8% vs. 0.1%,p=0.001), GI (2.5% vs. 0.2%,p<0.001), infection (8.2% vs. 0.5%,p<0.001), dural tear (4.1% vs. 0.6%, p<0.001), and dysphagia (9.8% vs. 1.9%,p<0.001). GU, wound, and DVT complications were similar between databases (p>0.004). Based on surgical approach, PCD reported higher GI and neurologic complication rates for combined anterior/posterior procedures (p<0.001). For posterior-only procedures, NIS had more device-related complications (12.4% vs. 0.1%,p=0.003), while PCD had more infections (9.3% vs. 0.7%,p<0.001).ConclusionsAnalysis of the surgeon-maintained cervical database revealed higher overall and individual complication rates and higher data granularity. The nationwide database may underestimate ACD patient complications particularly in regards to peri-operative surgical details due to coding and deformity generalizations. The surgeon-maintained database captures the surgical details, but may underestimate some medical complications.



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