Risk factors for adverse cardiac events after lumbar spine fusion

Background: To determine the incidence and risk factors for adverse cardiac events after lumbar spine fusion. Methods: A total of 50 495 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent lumbar spine fusion between 2005 and 2015. The 30-day postoperative data were analyzed to assess for the incidence of adverse cardiac events including cardiac arrest or myocardial infarction. Of those who experienced an event, patient- and surgery-specific parameters were evaluated to assess for risk factors. Results: A total of 240 cardiac events occurred in the studied cohort (4.76 events/1000 patients). Factors that were associated with an increased cardiac risk were age (odds ratio [OR] ¼ 1.039, 95% confidence interval [CI] ¼ 1.03, 1.05, P, .001), male sex (OR ¼ 1.51, 95% CI ¼ 1.17, 1.94, P ¼ .001), insulin-dependent diabetes (OR ¼ 1.83, 95% CI ¼ 1.29, 2.6, P ¼ .001), American Society of Anesthesiologists (ASA) score .3 (OR ¼ 1.92, 95% CI ¼ 1.00, 3.65, P ¼ .048), absolute hematocrit different from 45 (OR ¼ 1.07, 95% CI ¼ 1.04, 1.10, P, .001), and smoking (OR ¼ 1.39, 95% CI ¼ 1.02, 1.90, P ¼ .04). The impact of sustaining a cardiac event in the setting of single-level lumbar fusion is catastrophic as the 30-day postoperative mortality rate for those sustaining an event was 24.6% (59/240 patients), compared to 0.2% (87/50 255) for those not sustaining an event (P, .001). Conclusions: Cardiac events after lumbar fusion are a rare but devastating series of complications. Several risk factors were identified, including insulin-dependent diabetes mellitus, smoking, advanced age, male sex, ASA score of .3, and anemia/polycythemia. Considering the severity of these consequences, appropriate risk stratification is imperative, and optimization of modifiable risk factors may mitigate this risk.