Liver disease is an independent predictor of poor 30-day outcomes following surgery for degenerative disease of the cervical spine

Publication date: Available online 24 July 2018

Source: The Spine Journal

Author(s): Nicholas J Goel, Prateek Agarwal, Arka N Mallela, Kalil G Abdullah, Zarina S Ali, Ali K Ozturk, Neil R Malhotra, James M Schuster, H Isaac Chen

Abstract

Background and Context

The impact of underlying liver disease on surgical outcomes has been recognized in a wide variety of surgical disciplines. However, less empiric data is available about the importance of liver disease in spinal surgery.

Purpose

To measure the independent impact of underlying liver disease on 30-day outcomes following surgery for the degenerative cervical spine.

Study Design

Retrospective comparative study

Patient Sample

A cohort of 21,207 patients undergoing elective surgery for degenerative disease of the cervical spine from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP).

Outcome Measures

Outcome measures included mortality, hospital length of stay, and postoperative complications within 30 days of surgery.

Methods

The NSQIP dataset was queried for patients undergoing surgery for degenerative disease of the cervical spine from 2006 to 2015. Assessment of underlying liver disease was based on aspartate aminotransferase-to-platelet ratio index (APRI) and Model of End Stage Liver Disease-Sodium (MELD-Na) scores, computed from preoperative laboratory data. The effect of liver disease on outcomes was assessed by bivariate and multivariate analysis, in comparison with 16 other preoperative and operative factors. This study had no sources of funding, and the authors have no conflicts of interest to disclose.

Results

Liver disease could be assessed in 21,207 patients based on preoperative laboratory values. Mild liver disease was identified in 2.2% of patients and advanced disease was identified in 1.6% of patients. The 30-day mortality rates were 1.7% and 5.1% in mild and advanced liver disease respectively, as compared with 0.6% in patients with healthy livers. The 30-day complication rates were 11.8% and 31.5% in these patients respectively, compared with 8.8% in patients with healthy livers. In multivariate analysis, the presence of any liver disease (mild or advanced) was independently associated with increased risk of mortality (OR = 2.00, 95% CI = 1.12-3.55, P = 0.019), morbidity (OR = 1.35, 95% CI = 1.07-1.70, P = 0.012), and length of hospital stay longer than 7 days (OR = 1.73, 95% CI = 1.40-2.13, P < 0.001), when compared with 18 other preoperative and operative factors. Liver disease was also independently associated with perioperative respiratory failure (OR = 1.80, 95% CI = 1.21-2.68, P = 0.004), bleeding requiring transfusion (OR = 1.43, 95% CI = 1.01-2.02, P = 0.044), wound disruption (OR = 2.82, 95% CI = 1.04-7.66, P = 0.042), and unplanned reoperation (OR = 1.49, 95% CI = 1.05-2.11, P = 0.025).

Conclusions

Liver disease independently predicts poor perioperative outcome following surgery for degenerative disease of the cervical spine. Based on these findings, careful consideration of a patient's underlying liver function before surgery may prove valuable in surgical decision-making, preoperative patient counseling, and postoperative patient care.

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