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Titel på arbejdetEpidemiology, morbidity and mortality in Adult Spinal Deformity surgery - a nationwide study
NavnFrederik Taylor Pitter
Afdeling / StedSpine Unit, Department of Orthopedic Surgery, University Hospital of Copenhagen Rigshospitalet
UniversitetUniversity of Copenhagen
  • Spine Surgery
Abstract / Summary

This thesis has focus on the postoperative safety in first time surgery for Adult Spinal Deformity (ASD). The ASD includes deformity of the spine in both the coronal and the sagittal plane. The corrective ASD procedure is an extensive surgical event for the patient and some postoperative morbidity is expected. Several studies have reported on postoperative complications, but no detailed nationwide data exists.
During the past decade utilization of ASD surgery has increased, both in Denmark and internationally. This is partially due to the population growing older; but also advances in surgical and anesthesiological techniques allowing more patients to undergo surgery.
This thesis is based on three studies, and the primary aim was to describe the postoperative morbidity and mortality after first time ASD surgery. The specific aims were to examine risk of extended length of stay, readmission, revision and mortality, to analyze reasons for extended length of stay, readmission, revision and mortality and assess analgesic use before and after surgery.
Study I and II investigated the postoperative safety, based on data from the Danish National Patient Registry. Study III investigated analgesic use one year before and one year after surgery based on data from the Danish National Health Service Prescription Database.
Major challenges in the early postoperative setting were medically related complications, with pain/mobilization difficulties as main reason. Only few severe complications were observed within 90 days. Mortality within 90 days was low. Within two years 20% of patients underwent revision, with implant failure as main reason.
Increased age and comorbidity burden were separately associated with extended length of stay, readmission and revision. The patients had similar analgesic use before and after ASD surgery. Also, number of chronic preoperative opioid users did not decrease postoperatively. Increased age and chronic preoperative opioid use were separately associated with postoperative chronic opioid use.
The three studies in this thesis provide valuable information on the morbidity after first time ASD surgery. Important areas for improvement have been identified to further enhance patient recovery. This has led to the planning of new studies and initial steps for a new pathway of care.