Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Anmol Gupta; Thomas Cha; Joseph Schwab; Harold Fogel; Daniel Tobert; Afshin E. Razi; Carl Paulino; Christopher M. Bono; Stuart Hershman

doi:10.1055/s-0041-1729466

Journal of Clinical Interventional Radiology ISVIR, Table of Contents

CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 6(01): 3-9
DOI: 10.1055/s-0041-1729466

Original Article

Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Anmol Gupta

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Thomas Cha

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Joseph Schwab

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Harold Fogel

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Daniel Tobert

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Afshin E. Razi

²Department of Orthopaedics, Maimonides Bone and Joint Center, Maimonides Medical Center, Brooklyn, New York, United States

,

Carl Paulino

³Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, NYP Brooklyn Methodist Hospital, Brooklyn, New York, United States

,

Christopher M. Bono

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Stuart Hershman

¹Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States

› Author Affiliations

Abstract

Introduction Studies have shown that osteoporotic patients are more likely to have medical or surgical complications postoperatively. In this study, we determine the predictive value of various comorbidities on the likelihood of postoperative complications, mortality, and 30-day readmission following cement augmentation for osteoporotic vertebral compression fractures (OVCFs).

Materials and Methods A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database from 2007 to 2014 identified 1979 patients who met inclusion criteria. A multivariate logistic regression analysis was utilized to determine the relationship between various comorbidities and perioperative mortality, postoperative complications, and 30-day readmission rates.

Results A history of cerebrovascular accident (CVA), coagulopathy, diminished preoperative functional status, and/or an American Society of Anesthesiologists (ASA) class > 2 were statistical predictors of postoperative complications. CVA generated the highest odds ratio among these comorbidities (OR = 5.36, p = 0.02 for minor complications; OR = 4.60 p = 0.05 for major complications). Among the 15 comorbidities considered, steroid use (OR =1.81; p = 0.03) and an ASA class > 2 (OR = 14.65; p = 0.01) were the only ones that were correlated with mortality; an ASA class > 2 had a particularly strong effect on the likelihood of mortality (OR = 14.65). Chronic obstructive pulmonary disorder (COPD), obesity, significant weight loss, and an ASA class > 2 were correlated with 30-day readmissions. Congestive heart failure (CHF), diabetes, dialysis, hypertension, or smoking was not correlated with adverse postoperative outcomes.

Conclusion Of the 15 comorbidities considered in this study, four were statistically associated with increased rates of postoperative complications, two were associated with increased mortality, and four were associated with increased rates of readmission at 30 days. The presence of CHF, diabetes mellitus (DM), hypertension, ascites, renal failure, or smoking were not associated with the adverse outcomes studied.

Level of Evidence III.

Keywords

mortality - vertebral compression fracture - osteoporosis - cement augmentation

Full Text

References

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