@article{805f12b0dec745a1903a39611fee9286,
title = "Incidence, impact, and risk factors of adverse events in thoracic and lumbar spine fractures: An ambispective cohort analysis of 390 patients",
abstract = "Background context Adverse events (AEs) in thoracic and lumbar spine fractures are common, but little is known about the type of AEs that are specific to this population. Furthermore, very little is known about the incidence and clinical impact of these AEs on patients in the presence of traumatic spinal cord injury and whether they are treated operatively or nonoperatively. Purpose The purpose of this study was to determine primarily the incidence of AEs in patients with thoracic or lumbar spine fractures treated both operatively and nonoperatively and their impact on length of stay (LOS) and secondarily the difference in the incidence of AEs in both neurologically intact and compromised patients. Study design/setting This is an ambispective cohort study at a quaternary referral center. Patient sample Patients admitted at our institution with thoracic or lumbar fractures from January 2009 to December 2013 were identified. Patients with full Spine Adverse Events Severity System (SAVES) data were included. Outcome measures Number and type of AEs collected from SAVES were assessed. Impact of AE on acute LOS was also determined. Methods Data on intraoperative, preoperative, and postoperative AEs were prospectively collected using the SAVES data collection. Logistic regression was used to model the likelihood of experiencing at least one AE based on the patient characteristics. The impact of the total number of AEs experienced by a patient and that of each of the most common AEs on LOS was determined using Poisson regression. Results Three hundred and ninety patients were included in the final analysis. Two hundred and seventy-six patients (70.8%) were treated operatively. One hundred and forty patients (36%) experienced neurologic deficit as a result of their initial injury. Adverse events occurred 56% of the time in the operatively treated patients and only 13% of the time in the nonoperative group. The presence of neurologic deficit increased the risk of AEs especially in high thoracic (T1-T6) trauma increasing the odds of having an AE by 12.1 (p<.0001). The most common AEs were urinary tract infections (19.7%), neuropathic pain (12.3%), pneumonias (11.8%), delirium (10.5%), and ileus (6.2%). Length of hospital stay increased significantly with pneumonia (p<.0001) and delirium (p=.0001). Conclusions The presence of neurologic injury and the need for operative fixation of thoracic or lumbar injuries lead to a greater risk of AEs. Only pneumonia and delirium consistently increase LOS.",
keywords = "Adverse event, Lumbar, Operative, Spine, Thoracic, Traumatic spinal cord injury",
author = "Glennie, {R. Andrew} and Tamir Ailon and Kyun Yang and Juliet Batke and Fisher, {Charles G.} and Dvorak, {Marcel F.} and Vaccaro, {Alexander R.} and Fehlings, {Michael G.} and Paul Arnold and Harrop, {James S.} and Street, {John T.}",
note = "Funding Information: Author disclosures: RAG: Nothing to disclose. TA: Nothing to disclose. KY: Nothing to disclose. JB: Research Support (Investigator Salary, Staff/Materials): Medtronic (F, Paid directly to institution); Fellowship Support: Medtronic (D, Paid directly to institution). CGF : Royalties: Medtronic (F); Consulting: Medtronic (F), Nuvasive (F); Grants: OREF (D); Fellowship Support: Medtronic (F, Paid directly to institution), AO Spine (F, Paid directly to institution). MFD : Royalties: Medtronic (F); Consulting: Medtronic (E); Speaking and/or Teaching Arrangements: Medtronic (F); Trips/Travel AO spine International (F), Medtronic (F); Endowments: Chair in Spinal Cord Injury Research (E, Paid directly to institution); Grants: Rick Hansen Institute (H, Paid directly to institution); Fellowship support: Medtronic (F, Paid directly to institution), Depuy Synthesis (F, Paid directly to institution), AO Spine (F, Paid directly to institution). ARV: Royalties: DePuy (C), Medtronics (H), Stryker Spine (G), Biomet Spine (C), Globus (F), Nuvasive (B), Aesculap (B); Stock Ownership: Replication Medica (15,000 shares, B), Globus (123,398 shares, L), K-2 Medical, Paradigm Spine (97,500 units, F), Stout Medical (1% company, E), Spine Medica (25,000 stock options, value unknown), Computational Biodynamics (50% ownership, value unknown), Progressive Spinal Technologies (30% ownership, value unknown), Spinology (8,125 shares, value unknown), Small Bone Innovations (15,000 shares, value unknown), Cross Current (62,500 shares, D), Syndicom (2,750 shares, B), In Vivo (123,935 shares, value unknown), Flagship Surgical (D), Advanced Spinal Intellectual Properties (30% ownership, value unknown), Cytonics (25,000 shares, value unknown), Bonovo Orthopedics (100,000 shares, paid F), Electrocore (50,000 shares, value unknown), Gamma Spine (15% ownership, value unknown), Location-Based Intelligence (20% ownership, value unknown), Flowpharma (nonqualified stock options 200,000, value unknown), R.S.I. (50% ownership, value unknown), Rothman Institute and Related Properties (practice, value unknown), Innovative Surgical Design (30% ownership, value unknown), Spinicity (53,000 shares, 3.4% ownership); Consulting: Gerson Lehrman Group (B), Guidepoint Global (B), Medacorp (B), Stout Medical (B), Innovative Surgical Design (B), Orthobullets (A); Board of Directors: AO Spine, Innovative Surgical Design, Association of Collaborative Spine Research, Spinicity; Grants: Stryker Spine, Cerapedics, Nuvasive (C). MGF: Nothing to disclose. PA: Stock Ownership: Z-plasty (A); Consulting: Medtronic, Lifespine (A), Integra life (B), Spinewave, Stryker Spine (C), Fziomed (B), MIEMS (B), AO Spine North America (B), Cerapedics-past relationship (B); Speaking and/or Teaching Arrangements: University of Missouri (A); Board of Directors: AO Spine North America-past relationship; Grants: AO Spine North America (E). JSH: Consulting: Depuy Spine (D, Paid directly to institution); Scientific Advisory Board/Other Office: Tejin (B); Scientific Advisory Board/Other Office: Bioventus (B). JTS: Speaking and/or Teaching Arrangements: Medtronic (B); Research Support (Investigator Salary, Staff/Materials): Medtronic (F, Paid directly to institution); Fellowship Support: Medtronic (D, Paid directly to institution). Publisher Copyright: {\textcopyright} 2015 Elsevier Inc. All rights reserved.",
year = "2015",
month = apr,
day = "1",
doi = "10.1016/j.spinee.2014.11.016",
language = "English (US)",
volume = "15",
pages = "629--637",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "4",
}