Incidence and Predictive Factors of Sepsis Following Adult Spinal Deformity Surgery.
Abstract
BACKGROUND:Surgery for adult spinal deformity (ASD) improves quality of life, yet
morbidity is high. Sepsis is a challenging postoperative complication that can result
in death and drive inpatient resources. OBJECTIVE:To identify the incidence and risk
factors for development of sepsis within 30 days following ASD surgery. METHODS:Adult
patients who underwent thoracolumbar spinal deformity correction between 2008 and
2014 were identified in the National Surgical Quality Improvement Program database.
Demographic and operative variables were extracted. The primary outcome was development
of postoperative sepsis. Multivariable logistic regression modeling was used to identify
independent risk factors for sepsis. RESULTS:A total of 6158 patients underwent ASD
surgery. Of these, 156 (2.5%) developed sepsis postoperatively. Independent risk factors
included operative time (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.003-1.005,
P < .001), male sex (OR: 1.47, 95% CI: 1.05-2.05, P = .023), diabetes (OR: 1.59, 95%
CI: 1.05-2.40, P = .027), functional dependency (OR: 1.82, 95% CI: 1.12-2.95, P =
.015), weight loss (OR: 2.45, 95% CI: 1.04-5.78, P = .040), bleeding disorder (OR:
2.58, 95% CI: 1.34-4.93, P = .004), and ascites (OR: 56.11, 95% CI: 5.01-628.50, P =
.001). This model demonstrated strong predictive capacity, with an area under the
curve of 0.80. Patients who developed sepsis were significantly more likely to have
a prolonged hospital stay (P < .001), be readmitted (P < .001), and die (P < .001).
The median (range) time to sepsis was 9 d (0-30). CONCLUSION:In patients undergoing
ASD surgery, male sex, diabetes, ascites, bleeding disorder, functional dependency,
excessive weight loss and increased operative time independently predicted sepsis.
This perioperative patient profile can be used for preoperative risk assessment, patient
counseling, and postoperative management for patients undergoing ASD surgery.
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https://hdl.handle.net/10161/17639Published Version (Please cite this version)
10.1093/neuros/nyx578Publication Info
Zuckerman, Scott L; Lakomkin, Nikita; Stannard, Blaine P; Hadjipanayis, Constantinos
G; Shaffrey, Christopher I; Smith, Justin S; & Cheng, Joseph S (2018). Incidence and Predictive Factors of Sepsis Following Adult Spinal Deformity Surgery.
Neurosurgery, 83(5). pp. 965-972. 10.1093/neuros/nyx578. Retrieved from https://hdl.handle.net/10161/17639.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Christopher Ignatius Shaffrey
Professor of Orthopaedic Surgery
I have more than 25 years of experience treating patients of all ages with spinal
disorders. I have had an interest in the management of spinal disorders since starting
my medical education. I performed residencies in both orthopaedic surgery and neurosurgery
to gain a comprehensive understanding of the entire range of spinal disorders. My
goal has been to find innovative ways to manage the range of spinal conditions, straightforward
to complex. I have a focus on managing patients with complex s

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