Spine Surgery Morbidity vs Other Major Surgery

How invasive or morbid is spine fusion surgery as compared to, for example, organ transplantation, cardiac diseases, or certain cancers?

A multicenter team of researchers decided to tackle that question and compared the invasiveness of adult spinal deformity surgery to other surgical procedures. Their work, “Comparison of Surgical Invasiveness and Morbidity of Adult Spinal Deformity Surgery to Other Major Operations,” appears in the July 20, 2021, edition of The Spine Journal.

Scott L. Zuckerman, M.D., M.P.H. assistant professor of neurological surgery at Vanderbilt University Medical Center in Nashville, Tennessee, and study co-author explained that, as a major surgery, both physicians and the general public need context with which to evaluate these procedures. Specifically, he explained to OTW, “Adult spinal deformity operations are major surgeries that can last upwards of 8-10 hours, often presenting with compromised respiratory and/or cardiac function.”

“Given that the general public, and even other physicians, may not fully appreciate the full breadth of different spine operations, ranging from a single-level decompression to a large deformity surgery, we thought it may be of benefit to all types of healthcare providers to better understand the nature and invasiveness of adult spinal deformity operations.”

A First in the Literature

“Along with colleague and Mayo Clinic neurosurgery resident, Dr. Nikita Lakomkin, and senior mentor Dr. Lawrence Lenke, we sought to compare adult spinal deformity operations to other common operations in medicine, such that healthcare providers can better contextualize the seriousness of adult spinal deformity surgery,” explained Dr. Zuckerman. “To our knowledge, no prior studies have compared the surgical invasiveness and morbidity of adult spinal deformity surgery to other commonly performed operations.”

With the use of a large, national database that includes many different surgeries, we first created a Surgical Invasiveness and Morbidity Score made up of several perioperative factors (operative time, transfusions, ventilation) and postoperative complications.”

“Among the 18 surgical procedures, adult spinal deformity surgery ranked third in operative duration (351 min), surpassed only by microsurgical free flap (486 min) and esophagectomy (354 min),” wrote the authors. “Adult spinal deformity ranked 4th in the proportion of patients requiring transfusion (50.9%), with only CABG (64.1%), open AAA repair (61.6%), and MVR (57.1%) with a greater incidence. By contrast, ASD ranked 6th in hospital LOS, 8th in BMI, and 12th in age.”

“While controlling for important perioperative factors, we found that adult spinal deformity surgery had the 4th highest Surgical Invasiveness and Morbidity Score, behind only coronary artery bypass grafting, abdominal aortic aneurysm repair, and cystectomy.”

“Adult spinal deformity surgery was associated with a significantly greater Surgical Invasiveness and Morbidity Score than 13 other major surgeries, including esophagectomy, free flap, pancreatectomy, hepatectomy, craniotomy for tumor, sacral chordoma resection, and pneumonectomy, all of which are procedures acknowledged to be rather invasive and morbid. These results reinforce that major adult spinal deformity reconstruction surgery is comparable to some of the most serious operations performed in medicine.”

Establishing a Baseline

“By comparing adult spinal deformity surgery to other major operations throughout medicine, it is our hope that healthcare providers of all settings can better appreciate the seriousness and invasiveness of major spinal reconstruction surgery. Moreover, this information can be disseminated to hospital administrators and policymakers, without formal medical training, to easily compare adult spinal deformity surgery to other commonly performed operations. Lastly, patients can also use this simple comparison to help decide if surgical treatment is most appropriate for them.”