Medical optimization of modifiable risk factors before thoracolumbar three-column osteotomies: an analysis of 195 patients.
PURPOSE
To determine the rate of preoperative modifiable laboratory abnormalities (both major and minor) and the association with early postoperative medical and surgical complications.


METHODS
All patients undergoing thoracolumbar three-column osteotomy between 2013 and 2016 with preoperative laboratory data were identified. Potential preoperative modifiable laboratory abnormalities (major and minor) were assessed including hyponatremia (sodium < 130 and < 135 mEq/L), anemia (hematocrit < 25% and < 30%), renal insufficiency (creatinine ≥ 1.8 and ≥ 1.2 mg/dL), coagulopathy (INR ≥ 1.8 and ≥ 1.2), and hypoalbuminemia (albumin < 2.5 and < 3.5 g/dL). Multivariate logistic regression was used to determine associations with 30-day complications after controlling for possible confounding factors.


RESULTS
A total of 195 patients were identified. The rates of major and minor preoperative laboratory abnormalities were 7.7% and 31.3%, respectively. The rates of serious medical, minor medical, and surgical complications over 30-days were 6.7%, 21.5%, and 10.3%, respectively. In multivariate analysis the presence of major preoperative laboratory abnormalities had a significant association with serious medical complications (odds ratio [OR] 77.8, P < 0.001), and minor medical complications (OR 13.3, P < 0.001), but not surgical complications (P = 0.243). The presence of minor preoperative laboratory abnormalities had a significant association with serious medical complications (OR 10.4, P = 0.041) and minor medical complications (OR 2.4, P = 0.045), but not surgical complications (P = 0.490).


CONCLUSIONS
While major laboratory abnormalities had a strong association with complications, even minor modifiable laboratory abnormalities had a significant association with both serious and minor medical complications.
['Samuel|Andre M|AM|', 'Maza|Noor|N|', 'Vaishnav|Avani S|AS|', 'Lovecchio|Francis C|FC|', 'Othman|Yahya A|YA|', 'McAnany|Steven J|SJ|', 'Iyer|Sravisht|S|', 'Albert|Todd J|TJ|', 'Gang|Catherine Himo|CH|', 'Qureshi|Sheeraz A|SA|']
D000293:Adolescent D000328:Adult D000740:Anemia D001778:Blood Coagulation Disorders D019411:Clinical Laboratory Techniques D005260:Female D006801:Humans D034141:Hypoalbuminemia D007010:Hyponatremia D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D010027:Osteotomy D011183:Postoperative Complications D057234:Preoperative Period D051437:Renal Insufficiency D012307:Risk Factors D013904:Thoracic Vertebrae D055815:Young Adult
Three-column osteotomy Complications Adult spinal deformity Preoperative medical optimization Readmission Thoracolumbar spine