Temporal Analysis of Postoperative Complications Following Traumatic Thoracolumbar Fracture Surgery

Introduction: Traumatic thoracolumbar spine surgery is associated with favorable outcomes but the procedure carries the risk of both minor and major postoperative complications. While many studies have previously delved into understanding and examining the complications of the procedure, data are scarce on the timing of these complications during the postoperative period.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify all patients undergoing spine fusion procedures for traumatic thoracolumbar spine fractures from 2011 to 2021. The investigation targeted ten distinct postoperative complications occurring within 30 days following the surgical intervention. The median day on which each of these complications was diagnosed was recorded and analyzed.

Results: A total of 66,876 patients met inclusion criteria with an overall complication rate of 20.1%. The median day of diagnosis (IQR) for each complication was as follows: myocardial infarction (3, 1–6.75), pulmonary embolism (7, 3–14), reintubation (4, 1–11), pneumonia (5, 2–10.25), urinary tract infection (UTI; 10, 5–17), sepsis (12, 4.25–18.75), deep vein thrombosis (10, 5–17), deep surgical site infection (SSI; 17, 13–23), superficial SSI (17, 12–22), and organ space SSI (16, 9–22). The three complications that were most commonly diagnosed before hospital discharge included UTI (1.8%), superficial SSI (1.3%), and sepsis (1%). On univariate analysis, predictors of complication occurrence included ventilator dependence (OR 10.3, 95% CI 5.9 – 18.1, p< 0.001), renal failure (OR 6.1, 95% CI 3.3 – 11.5, p< 0.001), hemodialysis (OR 4.8 95% CI 3.7 – 6.2, p< 0.001), disseminated cancer (OR 3.9 95% CI 3.5– 4.5, p< 0.001), preoperative transfusion 48 hours preoperatively (OR 9.1 95% CI 6.9 – 12, p< 0.001) and preoperative sepsis 48 hours preoperatively (OR 4 95% CI 3.4 – 4.7, p< 0.001).

Conclusion : Understanding the exact timing of specific complications after traumatic thoracolumbar spine fusion surgery is important for patients and medical professionals. It emphasizes the need of ongoing efforts in preventing these consequences and the necessity of increased awareness during the times when the risk is greatest.