The utility of preoperative labs in predicting postoperative complications following posterolateral lumbar fusion

Publication date: Available online 18 October 2017
Source:The Spine Journal
Author(s): Nikita Lakomkin, Vadim Goz, Joseph S. Cheng, Darrel S. Brodke, William Ryan Spiker
Background ContextSeveral studies have suggested that lab results have minimal impact on clinical decision-making in surgery. Despite the widespread use of preoperative testing in spine surgery and the large volume of posterolateral lumbar fusions (PLFs) being performed each year, no study has assessed the ability of preoperative labs to predict adverse events following PLF.PurposeThe purpose of this study was to explore the relationship between commonly obtained preoperative lab results and postoperative complications following 1-2 level PLF.Study DesignThis is a retrospective study of prospectively collected data.Patient SampleThe 2006-2013 ACS-NSQIP database was employed to identify all patients who underwent 1-2 level PLF.Outcome MeasuresThe outcome variables of interest were 30-day postoperative complications, which were assessed as major complications, minor adverse events, and total complications.MethodsDemographics, comorbidities, and perioperative characteristics were collected for each patient. Preoperative labs included sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white blood cell count, hematocrit, platelet count, prothrombin time, INR, and partial thromboplastin time. Bivariate analysis and multivariate logistic regression modeling was used to explore the relationship between abnormal preoperative labs and the incidence of postoperative complications.ResultsAfter controlling for age, ASA score, length of surgery, and all significant comorbidities, abnormal sodium (OR=2.47, 95%CI: 1.45-4.19, p=0.001) and abnormal INR (OR=2.33, 95%CI: 1.09-4.98, p=0.029) were significantly associated with the development of any complication. Sodium (OR=1.61, 95%CI: 1.01-2.54, p=0.04) and platelets (OR=1.58, 95%CI: 1.02-2.44, p=0.04) were associated with minor complications. Meanwhile, creatinine (OR=1.74, 95%CI: 1.02-2.99, p=0.04) and platelets (OR=1.71, 95%CI: 1.02-2.89, p=0.04) were significant predictors of major adverse events.ConclusionsThis study represents the first attempt to assess the utility of preoperative labs in predicting postoperative complications in PLF. Although the majority of labs were not significantly associated with adverse events, abnormal sodium values, INR, creatinine, and platelets were shown to be predictive of various complications.



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