The Effects of Peri-Operative Adverse Events on Clinical and Patient-Reported Outcomes After Surgery for Degenerative Cervical Myelopathy: An Observational Cohort Study from the Canadian Spine Outcomes and Research Network-Reference-Cited by-同舟云学术

The Effects of Peri-Operative Adverse Events on Clinical and Patient-Reported Outcomes After Surgery for Degenerative Cervical Myelopathy: An Observational Cohort Study from the Canadian Spine Outcomes and Research Network

Published:2024-03-11 Issue: Volume: Page:
ISSN:0148-396X
Container-title:Neurosurgery
language:en
Short-container-title:

Author:

Malhotra Armaan K.¹²³^ORCID,Evaniew Nathan⁴,Dea Nicolas⁵,Fisher Charles G.⁵,Street John T.⁵,Cadotte David W.⁴,Jacobs W. Bradley⁴,Thomas Kenneth C.⁴,Attabib Najmedden⁶,Manson Neil⁷,Hall Hamilton⁸,Bailey Christopher S.⁹,Nataraj Andrew¹⁰,Phan Philippe¹¹,Rampersaud Y Raja¹²,Paquet Jerome¹³,Weber Michael H.¹⁴,Christie Sean D.¹⁵,McIntosh Greg¹⁶,Wilson Jefferson R.¹²³

Affiliation:

1. Division of Neurosurgery, Unity Health, University of Toronto, Toronto, Ontario, Canada;

2. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;

3. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada;

4. University of Calgary Spine Program, University of Calgary, Alberta, Canada;

5. Department of Orthopaedic Surgery, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada;

6. Division of Neurosurgery, Zone 2, Horizon Health Network, Canada East Spine Centre, Saint John, New Brunswick, Canada;

7. Division of Orthopaedics, Canada East Spine Centre and Horizon Health Network, Saint John, New Brunswick, Canada;

8. Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

9. Department of Surgery, London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, Ontario, Canada;

10. Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada;

11. Division of Orthopaedic Surgery, The Ottawa Hospital, Civic Campus, University of Ottawa, Ottawa, Ontario, Canada;

12. Department of Surgery, Schroeder Arthritis Institute, Krembil Research Institute, Orthopaedics, University of Toronto, Toronto, Ontario, Canada;

13. Centre de Recherche CHU de Quebec, CHU de Quebec-Université Laval, Quebec City, Quebec, Canada;

14. Division of Orthopaedics, Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada;

15. Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada;

16. Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada

Abstract

BACKGROUND AND OBJECTIVES: There is a lack of data examining the effects of perioperative adverse events (AEs) on long-term outcomes for patients undergoing surgery for degenerative cervical myelopathy. We aimed to investigate associations between the occurrence of perioperative AEs and coprimary outcomes: (1) modified Japanese Orthopaedic Association (mJOA) score and (2) Neck Disability Index (NDI) score. METHODS: We analyzed data from 800 patients prospectively enrolled in the Canadian Spine Outcomes and Research Network multicenter observational study. The Spine AEs Severity system was used to collect intraoperative and postoperative AEs. Patients were assessed at up to 2 years after surgery using the NDI and the mJOA scale. We used a linear mixed-effect regression to assess the influence of AEs on longitudinal outcome measures as well as multivariable logistic regression to assess factors associated with meeting minimal clinically important difference (MCID) thresholds at 1 year. RESULTS: There were 167 (20.9%) patients with minor AEs and 36 (4.5%) patients with major AEs. The occurrence of major AEs was associated with an average increase in NDI of 6.8 points (95% CI: 1.1-12.4, P = .019) and reduction of 1.5 points for mJOA scores (95% CI: −2.3 to −0.8, P < .001) up to 2 years after surgery. Occurrence of major AEs reduced the odds of patients achieving MCID targets at 1 year after surgery for mJOA (odds ratio 0.23, 95% CI: 0.086-0.53, P = .001) and for NDI (odds ratio 0.34, 95% CI: 0.11-0.84, P = .032). CONCLUSION: Major AEs were associated with reduced functional gains and worse recovery trajectories for patients undergoing surgery for degenerative cervical myelopathy. Occurrence of major AEs reduced the probability of achieving mJOA and NDI MCID thresholds at 1 year. Both minor and major AEs significantly increased health resource utilization by reducing the proportion of discharges home and increasing length of stay.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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