Mortality and morbidity after spinal surgery in patients with parkinson's disease: a retrospective matched-pair cohort study

Abstract BACKGROUND CONTEXT There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD). PURPOSE To investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes. STUDY DESIGN Retrospective matched-pair cohort study. PATIENT SAMPLE Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. OUTCOME MEASURES In-hospital mortality and occurrence of postoperative complications. METHODS For each patient with PD, we randomly selected up to 4 age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke and renal failure). Multiple imputation was used for missing data. This study was funded by grants from the Ministry of Health, Labour and Welfare, Japan (Research on Policy Planning and Evaluation, grant numbers: H27-Policy-Designated-009 and H27-Policy-Strategy-011; Research on Intractable Diseases grant number: H23-Nanchi-032). The authors have no conflicts of interest to declare. RESULTS Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than controls (0.8% versus 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% versus 5.1% in controls). Postoperative delirium was more common in PD patients (30.3%) than controls (4.3%). PD was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37–2.22; p