Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery.

Fu, Kai-Ming G; Smith, Justin S; Polly, David W; Ames, Christopher P; Berven, Sigurd H; Perra, Joseph H; McCarthy, Richard E; Knapp, D Raymond; Shaffrey, Christopher I; Scoliosis Research Society Morbidity and Mortality Committee

Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery.

dc.contributor.author	Fu, Kai-Ming G
dc.contributor.author	Smith, Justin S
dc.contributor.author	Polly, David W
dc.contributor.author	Ames, Christopher P
dc.contributor.author	Berven, Sigurd H
dc.contributor.author	Perra, Joseph H
dc.contributor.author	McCarthy, Richard E
dc.contributor.author	Knapp, D Raymond
dc.contributor.author	Shaffrey, Christopher I
dc.contributor.author	Scoliosis Research Society Morbidity and Mortality Committee
dc.date.accessioned	2023-10-11T18:35:41Z
dc.date.available	2023-10-11T18:35:41Z
dc.date.issued	2011-04
dc.date.updated	2023-10-11T18:35:40Z
dc.description.abstract	Object Patients with varied medical comorbidities often present with spinal pathology for which operative intervention is potentially indicated, but few studies have examined risk stratification in determining morbidity and mortality rates associated with the operative treatment of spinal disorders. This study provides an analysis of morbidity and mortality data associated with 22,857 cases reported in the multicenter, multisurgeon Scoliosis Research Society Morbidity and Mortality database stratified by American Society of Anesthesiologists (ASA) physical status classification, a commonly used system to describe preoperative physical status and to predict operative morbidity. Methods The Scoliosis Research Society Morbidity and Mortality database was queried for the year 2007, the year in which ASA data were collected. Inclusion criterion was a reported ASA grade. Cases were categorized by operation type and disease process. Details on the surgical approach and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Two large subgroups--patients with adult degenerative lumbar disease and patients with major deformity--were also analyzed separately. Statistical analyses were performed with the chi-square test. Results The population studied comprised 22,857 patients. Spinal disease included degenerative disease (9409 cases), scoliosis (6782 cases), spondylolisthesis (2144 cases), trauma (1314 cases), kyphosis (831 cases), and other (2377 cases). The overall complication rate was 8.4%. Complication rates for ASA Grades 1 through 5 were 5.4%, 9.0%, 14.4%, 20.3%, and 50.0%, respectively (p = 0.001). In patients undergoing surgery for degenerative lumbar diseases and major adult deformity, similarly increasing rates of morbidity were found in higher-grade patients. The mortality rate was also higher in higher-grade patients. The incidence of major complications, including wound infections, hematomas, respiratory problems, and thromboembolic events, was also greater in patients with higher ASA grades. Conclusions Patients with higher ASA grades undergoing spinal surgery had significantly higher rates of morbidity than those with lower ASA grades. Given the common application of the ASA system to surgical patients, this grade may prove helpful for surgical decision making and preoperative counseling with regard to risks of morbidity and mortality.
dc.identifier.issn	1547-5654
dc.identifier.issn	1547-5646
dc.identifier.uri	https://hdl.handle.net/10161/29246
dc.language	eng
dc.publisher	Journal of Neurosurgery Publishing Group (JNSPG)
dc.relation.ispartof	Journal of neurosurgery. Spine
dc.relation.isversionof	10.3171/2010.12.spine10486
dc.subject	Scoliosis Research Society Morbidity and Mortality Committee
dc.subject	Spine
dc.subject	Humans
dc.subject	Spinal Diseases
dc.subject	Postoperative Complications
dc.subject	Treatment Outcome
dc.subject	Orthopedic Procedures
dc.subject	Incidence
dc.subject	Anesthesiology
dc.subject	Databases, Factual
dc.subject	Adolescent
dc.subject	Adult
dc.subject	Aged
dc.subject	Middle Aged
dc.subject	Societies, Medical
dc.subject	Female
dc.subject	Male
dc.title	Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery.
dc.type	Journal article
duke.contributor.orcid	Shaffrey, Christopher I\|0000-0001-9760-8386
pubs.begin-page	470
pubs.end-page	474
pubs.issue	4
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Orthopaedic Surgery
pubs.organisational-group	Neurosurgery
pubs.publication-status	Published
pubs.volume	14