Di Capua et al reported risk factors associated with major complications after posterior lumbar fusion surgery. These can help to identify a patient who may benefit from more aggressive management. The authors are from Mount Sinai Hospital in New York City, University of New South Wales and Prince of Wales Private Hospital in Sydney, Australia.
Patient selection: elective posterior lumbar fusion (PLF)
Major complications: deep or organ space surgical site infection (not superficial), wound dehiscence, pulmonary complication, renal complication, peripheral nerve injury, cardiac complication, perioperative blood transfusion, sepsis, CNS complication, reoperation or unplanned readmission
Risk factors for >= 2 major complications:
(1) ASA class >= 3
(2) osteotomy
(3) pelvic fixation
(4) operative duration >= 4 hours
(5) bleeding disorder
(6) partial or totally dependent functional status prior to surgery
Steroid use for a chronic condition within the past 30 days is an additional risk factor when the analysis is done for >= 3 major complications.
Recent weight loss >= 10% within the past 6 months was an additional risk factor when the analysis was done for >=1 major complications.
Performance:
• The definition of major complications seem rather nonspecific. Blood transfusion may or may not necessarily be major. Renal or pulmonary complications are not defined by severity.
