Introduction: Laminectomy is commonly performed for excision of intraspinal neoplasms and non-neoplastic lesions. Studies have not evaluated postoperative complications between these two indications for laminectomy. Our objective was to compare the prevalence of and risk factors for complications following laminectomy for intraspinal neoplasms and non-neoplastic lesions using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
Methods: Patients who underwent laminectomy performed by neurosurgeons for intraspinal neoplasms (CPT: 63275-8, 63280-7, 63290) and non-neoplastic lesions (CPT: 63270-3, 63265-8) were extracted from the 2005-2015 ACS-NSQIP. Prevalence of 30-day postoperative complications was estimated. Multivariable logistic regression identified demographic, comorbid, and perioperative characteristics associated with presence of any complication.
Results: There were 5,239 cases of laminectomy (2,599 intraspinal neoplasms, 2,640 non-neoplastic intraspinal lesions) for intraspinal lesions. Non-neoplastic intraspinal lesions were more likely to be extradural (77.58% vs. 40.94%; p<.001) and within the lumbar region (68.37% vs. 27.97%; p<.001). Postoperative complications occurred more frequently following laminectomy for intraspinal neoplasms when compared to non-neoplastic lesions (24.89% vs. 17.92%; p<.001). Predictors for complications included: thoracic level, intradural location, non-white race, dyspnea, dependent functional status, ventilator dependence, disseminated cancer, wound infection, chronic steroid use, bleeding disorder, preoperative transfusion, preoperative sepsis, America Society of Anesthesiologists (ASA) class III-V, emergent surgery, inpatient status, transfer from a location other than home, wound class II-IV, and longer duration of surgery. After controlling for covariates, laminectomy for intraspinal neoplasms did not have higher odds of any complication when compared to non-neoplasic lesions (OR: 1.18; 95% CI: 0.96-1.44; p=0.12).
Conclusions: The prevalence of postoperative complications following laminectomy for intraspinal neoplasms and non-neoplastic lesions was 24.89% and 17.92%, respectively. The odds of complications did not differ between laminectomy for intraspinal neoplasms and non-neoplastic lesions in multivariable models. However, there were 18 other variables that significantly predicted postoperative complications and may assist neurosurgeons in stratifying risk for patients undergoing these procedures.
Patient Care: This study compares the prevalence of postoperative complications following laminectomy for intraspinal neoplasms and non-neoplastic lesions. Our findings highlight risk factors for any complication following these procedures. When applied to clinical settings, these results will help guide neurosurgeons in stratifying preoperative risk for complications among patients undergoing laminectomy for intraspinal neoplasms and non-neoplastic lesions.
Learning Objectives: At the conclusion of this session, participants should be able to: 1) describe demographic, comorbid, and perioperative characteristics of patients undergoing laminectomy for intraspinal neoplasms and non-neoplastic lesions; 2) estimate the prevalence of postoperative complications; and 3) identify risk factors for postoperative complications.