Coagulation Profile as a Risk Factor for 30-day Morbidity Following Cervical Laminectomy and Fusion

Study Design. Retrospective analysis of prospectively collected data. Objective. The aim of this study was to determine the ability of abnormal coagulation profile to predict adverse events following posterior cervical laminectomy and fusion (PCLF). Summary of Background Data. PCLF is an increasingly common procedure used to treat a variety of traumatic and degenerative spinal conditions. Abnormal coagulation profile is associated with postoperative adverse events, including blood transfusion. There is a paucity of literature that specifically addresses the relationship between coagulation profile and complications following PCLF. Methods. ACS-NSQIP was utilized to identify patients undergoing PCLF between 2006 and 2013. A total of 3546 patients met inclusion criteria. Multivariate analysis was utilized to identify associations between abnormal coagulation profile and postoperative complications. Results. Membership in the low-platelet cohort was an independent risk factor for myocardial infarction (Odds Ratio (OR)=5.4 [1.0, 29.1], P=0.049) and bleeding transfusion (OR=2.0 [1.2, 3.4], P=0.011). Membership in the high international normalized ratio group was an independent risk factor for pneumonia (OR=6.3 [2.5, 16.1], P<0.001), ventilation >48hours (OR=6.5 [2.3, 18.4], P<0.001), organ space surgical site infection (OR=11.1 [2.1, 57.3], P=0.004), urinary tract infection (OR=3.0 [1.2, 8.0], P=0.024), bleeding transfusion (OR=6.0 [3.4, 10.7], P<0.001), sepsis (OR=5.1 [1.6, 16.4], P=0.006), and septic shock (OR=6.8 [1.7, 27.4], P=0.007). Membership in the bleeding disorders cohort was an independent predictor of unplanned intubation (OR=3.2 [1.1, 9.5], P=0.041), pneumonia (OR=2.9 [1.2, 7.2], P=0.023), ventilation >48hours (OR=4.8 [1.9, 12.4], P=0.001), cerebrovascular accident/stroke with neurological deficit (OR=24.8 [2.9, 210.6], P=0.003), bleeding transfusion (OR=2.1 [1.1, 4.1], P=0.032), reoperation (OR=3.6 [1.4, 9.3], P=0.008), and sepsis (OR=3.4 [1.1, 10.4], P=0.031). Conclusion. This is the first large study to document abnormal coagulation profile as an independent predictor of outcomes following PCLF. Abnormal coagulation profile represents a predictor of complications that can be medically mitigated, and is therefore a valuable parameter to assess preoperatively. Coagulation profile should continue to play a role in targeting patients for risk stratification, preoperative optimization, and quality improvement initiatives.