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• W4292375840 abstract "BACKGROUND CONTEXT Preoperative risk stratification is critical to determining which adult spinal deformity (ASD) patients may develop postop complications and to maximize surgical success. Currently it is unknown if a preoperative inflammatory state results in a higher risk for postop complications. This information can be used in risk stratification models to aid in complication avoidance. PURPOSE To determine if patients with preoperative elevated serum markers for inflammation have higher rates of postoperative complications STUDY DESIGN/SETTING Retrospective review of multicenter prospective ASD database. PATIENT SAMPLE ASD patients. OUTCOME MEASURES C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), complications by type and by severity of intervention: none, mild, moderate and severe. Demographic and surgical variables: age, estimated blood loss (EBL), operating room (OR) time, body mass index (BMI), America Society of Anesthesia physical classification scale (ASA), Charlson comorbidity index (CCI), Edmonton frailty scale (EF), 3-column osteotomy (3CO), number of post fusion levels. METHODS Preoperative labs were drawn on ASD patients and the inflammatory markers were CRP and ESR. CRP thresholds for cardiac risk: normal = 3. The CRP moderate and elevated values were combined into one group named elevated. Normal ESR thresholds: Male age 50, =20, Female >50, =30. Patients were stratified by having normal or elevated markers and rates of complications were compared between the groups. A multivariate model with CRP/ESR and demographic/surgical variables for postoperative complications. Health-related quality of life (HRQOL) metrics were compared RESULTS The total number of patients with preoperative CRP was 159 and ESR was 158. CRP: normal=114 patients (71.7%), moderate elevation=28 (17.6%), severe elevation=17 (10.7%). Combined elevated=45/159(28.3%). Elevated ESR=25(15.8%), normal=133(84.2%). The elevated CRP group had significantly higher rate of moderate complication 13/45(28.9%) vs 16/114(14.0%), p=0.03 and severe complication 15/45 (33.3%) vs 17/114(14.9%, p=0.009. Elevated ESR patients had significantly higher rate of moderate complication 9/25 (36.0%) vs 20/133 (15.0%), p=0.01. In multivariable logistic regression elevated CRP had odds ratio for moderate complication of 3.3 (95% CI 1.4-7.6, p=0.006), and for severe complication of 2.3 (95% CI 1.05-5.1, p=0.037). Multivariable logistic regression for elevated ESR and moderate complication had odds ratio of 2.9 (95%CI 1.04-7.8, p=0.041). Elevated CRP also had significantly higher rate of wound complications (15.6% vs 3.5%, p=0.007) and MSK complications (11.1% vs 1.8%, p=0.01). Elevated ESR had significantly higher rate of cardiac complications (32.0% vs 13.5%, p=0.02) and neurological complications (24.0% vs 9.0%, p=0.03). Elevated CRP had worse preoperative leg pain, SRS Activity and VR12 PCS(p<0.05). Elevated ESR had worse baseline ODI (p=0.03). CONCLUSIONS A preoperative inflammatory state as defined by elevated CRP and ESR is an independent risk factor for the development of moderate and severe postop complications. Having elevated preop CRP is 3.3 and 2.3 times more likely to have a moderate and severe complication, respectively. Elevated ESR is 2.9 times more likely to have a moderate complication. This data can be used in risk stratification models to aid in minimizing postoperative complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Preoperative risk stratification is critical to determining which adult spinal deformity (ASD) patients may develop postop complications and to maximize surgical success. Currently it is unknown if a preoperative inflammatory state results in a higher risk for postop complications. This information can be used in risk stratification models to aid in complication avoidance. To determine if patients with preoperative elevated serum markers for inflammation have higher rates of postoperative complications Retrospective review of multicenter prospective ASD database. ASD patients. C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), complications by type and by severity of intervention: none, mild, moderate and severe. Demographic and surgical variables: age, estimated blood loss (EBL), operating room (OR) time, body mass index (BMI), America Society of Anesthesia physical classification scale (ASA), Charlson comorbidity index (CCI), Edmonton frailty scale (EF), 3-column osteotomy (3CO), number of post fusion levels. Preoperative labs were drawn on ASD patients and the inflammatory markers were CRP and ESR. CRP thresholds for cardiac risk: normal = 3. The CRP moderate and elevated values were combined into one group named elevated. Normal ESR thresholds: Male age 50, =20, Female >50, =30. Patients were stratified by having normal or elevated markers and rates of complications were compared between the groups. A multivariate model with CRP/ESR and demographic/surgical variables for postoperative complications. Health-related quality of life (HRQOL) metrics were compared The total number of patients with preoperative CRP was 159 and ESR was 158. CRP: normal=114 patients (71.7%), moderate elevation=28 (17.6%), severe elevation=17 (10.7%). Combined elevated=45/159(28.3%). Elevated ESR=25(15.8%), normal=133(84.2%). The elevated CRP group had significantly higher rate of moderate complication 13/45(28.9%) vs 16/114(14.0%), p=0.03 and severe complication 15/45 (33.3%) vs 17/114(14.9%, p=0.009. Elevated ESR patients had significantly higher rate of moderate complication 9/25 (36.0%) vs 20/133 (15.0%), p=0.01. In multivariable logistic regression elevated CRP had odds ratio for moderate complication of 3.3 (95% CI 1.4-7.6, p=0.006), and for severe complication of 2.3 (95% CI 1.05-5.1, p=0.037). Multivariable logistic regression for elevated ESR and moderate complication had odds ratio of 2.9 (95%CI 1.04-7.8, p=0.041). Elevated CRP also had significantly higher rate of wound complications (15.6% vs 3.5%, p=0.007) and MSK complications (11.1% vs 1.8%, p=0.01). Elevated ESR had significantly higher rate of cardiac complications (32.0% vs 13.5%, p=0.02) and neurological complications (24.0% vs 9.0%, p=0.03). Elevated CRP had worse preoperative leg pain, SRS Activity and VR12 PCS(p<0.05). Elevated ESR had worse baseline ODI (p=0.03). A preoperative inflammatory state as defined by elevated CRP and ESR is an independent risk factor for the development of moderate and severe postop complications. Having elevated preop CRP is 3.3 and 2.3 times more likely to have a moderate and severe complication, respectively. Elevated ESR is 2.9 times more likely to have a moderate complication. This data can be used in risk stratification models to aid in minimizing postoperative complications." @default.
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• W4292375840 date "2022-09-01" @default.
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• W4292375840 title "230. The preoperative inflammatory state is an independent risk factor for short term postoperative complications in adult spinal deformity patients" @default.
• W4292375840 doi "https://doi.org/10.1016/j.spinee.2022.06.250" @default.
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