Risk of spinal surgery among individuals who have been re-vascularized for coronary artery disease.

Abstract

Hypothesis

Revascularization is a more effective intervention to reduce future postop complications.

Methods

Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having previous history of vascular stenting (Stent), coronary artery bypass graft (CABG), and no previous heart procedure (No-HP). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, and comorbidities. Binary logistic regression assessed the odds of 30-day and 90-day postoperative (postop) complications associated with each heart procedure (Odds Ratio [95 % confidence interval]). Statistical significance was set p < 0.05.

Results

731,173 elective spine fusion patients included. Overall, 8,401 pts underwent a CABG, 24,037 pts Stent, and 698,735 had No-HP prior to spine fusion surgery. Compared to Stent and No-HP patients, CABG patients had higher rates of morbid obesity, chronic kidney disease, and diabetes (p < 0.001 for all). Meanwhile, stent patients had higher rates of PVD, hypertension, and hyperlipidemia (all p < 0.001). 30-days post-op, CABG patients had significantly higher complication rates including pneumonia, CVA, MI, sepsis, and death compared to No-HP (all p < 0.001). Stent patients vs. No-HF had higher 30-day post-op complication rates including pneumonia, CVA, MI, sepsis, and death. Furthermore, adjusting for age, comorbidities, and sex Stent was significantly predictive of a MI 30-days post-op (OR: 1.90 [1.53-2.34], P < 0.001). Additionally, controlling for levels fused, stent patients compared to CABG patients had 1.99x greater odds of a MI within 30-days (OR: 1.99 [1.26-3.31], p = 0.005) and 2.02x odds within 90-days postop (OR: 2.2 [1.53-2.71, p < 0.001).

Conclusion

With regards to spine surgery, coronary artery bypass graft remains the gold standard for risk reduction. Stenting does not appear to minimize risk of experiencing a post-procedure cardiac event as dramatically as CABG.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.jocn.2023.11.029

Publication Info

Passias, Peter G, Waleed Ahmad, Bhaveen H Kapadia, Oscar Krol, Joshua Bell, Pramod Kamalapathy, Bailey Imbo, Peter Tretiakov, et al. (2024). Risk of spinal surgery among individuals who have been re-vascularized for coronary artery disease. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 119. pp. 164–169. 10.1016/j.jocn.2023.11.029 Retrieved from https://hdl.handle.net/10161/31757.

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Scholars@Duke

Passias

Peter Passias

Instructor in the Department of Orthopaedic Surgery

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