Predictors of Nonneurologic Complications and Increased Length of Stay After Cervical Spine Osteotomy

BACKGROUND: Although previous studies have used National Surgical Quality Improvement Program (NSQIP) data to study complications of thoracolumbar spinal deformity surgery, investigation of cervical spine deformity surgery has been limited. We performed a retrospective analysis of the NSQIP database to identify predictors of complications after cervical spine osteotomy. METHODS: Patients undergoing cervical spine osteotomy were identified in the NSQIP dataset using Current Procedural Terminology codes from years 2007-2016. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. Patient and case clinical predictors of any of the reported complications and increased LOS were identified in multivariate logistic and Poisson regression analyses, respectively. RESULTS: There were 950 patients identified with mean age 56.1 +/- 12.4 years and mean body mass index 29.9 +/- 6.8. Mean LOS was 3.5 +/- 4.9 days. Overall medical complication rate was 15.8%. The most common complications were transfusion (78; 8.2%), readmission (45; 4.7%), reoperation (32; 3.4%), and reintubation (28; 3.0%). Risk factors for any complication included increased age (P = 0.0467), American Society of Anesthesiologists classification III (P = 0.0023) and IV (P = 0.0013), and increased operative duration (P < 0.0001). Risk factors for increased LOS were decreased functional status (P = 0.0037), disseminated cancer (P = 0.0061), American Society of Anesthesiologists classification III and IV (P < 0.0001), increased operative duration (P < 0.0001), and orthopaedic surgeon (vs. neurosurgeon) (P = 0.0156). CONCLUSIONS: This study is the largest to date of patients undergoing cervical osteotomy and provides useful clinical data for patient selection and counseling and 30-day reoperation and readmission rates.