O-182 - VASCULAR SURGERY ASSISTANCE ALLOWS TO MAINTAIN A LOW RATE OF COMPLICATIONS IN ORTHOPEDIC SPINE PROCEDURES

TOPIC:
Other
AUTHORS:
Vacirca A. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Faggioli G. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Palermo S. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Sufali G. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Pipola V. (Spine Surgery, Istituto Ortopedico Rizzoli, IRCCS ~ Bologna ~ Italy) , Caputo S. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Pini R. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Gallitto E. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy) , Gasbarrini A. (Spine Surgery, Istituto Ortopedico Rizzoli, IRCCS ~ Bologna ~ Italy) , Gargiulo M. (Vascular Surgery, University of Bologna, DIMES ~ Bologna ~ Italy)
Introduction:
Spine surgery for both degenerative (DD) and oncological vertebral diseases (OD) carries a potential risk of vascular complications, particularly hemorrhage (1) and hematoma (2), due to the anatomical localization of the great thoracic and abdominal vessels. Aim of the study was to analyze the experience of a busy spine surgery unit assisted by a vascular team.
Methods:
All the spine surgery procedures performed under the assistance of a vascular team from January 2018 to December 2021 were retrospectively analyzed. The disease involved all different segments of the column, such as thoracic, thoraco-lumbar, lumbar and sacral. The vascular access was chosen depending on the segment involved and its grade of extension of the pathology. A complex vascular assistance was defined as necessity of vessel exposure, ligation of segmental arteries or veins, surgical bypass or preventive endovascular protection. The intraoperative and postoperative vascular and access-related complications were evaluated, as well as hospitalization time, 30-day and mid-term mortality. DD and OD patients were also compared. Statistical analysis was by Fisher's exact, Mann-Whitney, univariate and Kaplan-Maier tests were used.
Results:
From 2018 to 2021, 2387 patients underwent spine surgery. Eighty-eight/2387 (3.7%) cases, 53.4% male, with a median age of 50 (23.2) years, required vascular assistance. Thirty-seven/88 (42%) patients had DD, 51/88 (58%) had an OD, malignant in 80.4% of cases. The thoracic, the thoraco-lumbar, the lumbar, and the sacral segments were involved in 17/88 (19.3%), 12/88 (13.7%), 58/88 (65.9%) and 1/88 (1.1%) cases, respectively. A supraclavicular access was performed in 1/88 (1.1%) case, a thoracotomy in 8/88 (9.1%), a thoraco-phreno-laparotomy in 8/88 (9.1%), a median laparotomy in 10/88 (11.4%), a pararectal extraperitoneal incision in 59/88 (67%), an inguinal in 1/88 (1.1%) and a posterior access 1/88 (1.1%) were performed by the vascular surgeon. The vascular assistance consisted in vessel exposure in 65/88 (73.9%) cases, vessel exposure and ligation of segmental arteries or veins in 20/88 (22.7%) cases, preventive thoracic endovascular protection in 2/88 (2.3%) cases and an aorto-bisiliac bypass in 1/88 (1.1%) case. Intraoperative vascular complications occurred in 5/88 (5.7%) cases (all hemorrhages requiring revision); access-related complications occurred in 3/88 (3.4%) cases (1 bowel diverticulum perforation, 2 ureter lesions). Among 18/88 (20.5%) postoperative complications (5 wound dehiscence, 3 hematoma, 2 spinal cord compression, 2 gastrointestinal, 1 respiratory), 5/18 (27.7%) were vascular (deep venous thrombosis). The median hospitalization time was 12.5 (10) days with a postoperative mortality of 1/88 (1.1%) case, due to an oncological patient who developed pulmonary embolism, esophageal fistula and peritonitis. At a mean follow-up time of 11 ± 4.2 months, the overall survival rate was 96.6 ± 2.4%. In almost all DD patients (97.6%) a retroperitoneal anterior approach was performed, due to the predominant localization of the disease in the lower spine, with a postoperative complication rate of 5.4% (1 case of temporary brachial apraxia due to the position in the operating room and 1 case of iliac hematoma with no consequences). The vascular assistance was significantly more challenging in the OD subgroup [Complex assistance: 5/37 (13.5%) DD vs. 18/51 (35.3%) OD, p=.02]; OD was also a risk factor for complexity of vascular surgery procedure at univariate [HR 3.5 (1.1-10.5), p=.02]. Moreover, the OD group had a significantly higher rate of postoperative complications [postoperative complications: 3/37 (8.1%) DD vs. 15/51 (29.4%) OD, p=.02] and a significantly longer hospitalization [17 (11) days ST vs 7 (3) DD days, p=<.001] compared with DD.
Conclusion:
The presence of a vascular team during vertebral orthopedic surgery allows to maintain an acceptable rate of major complication A retroperitoneal anterior approach to the spine is appropriate and warrants minimal complication rate in the treatment of degenerative diseases. The spinal OD has an increased surgical complexity and is related with longer hospitalization time and a higher rate of postoperative complications.
References:
1) Mohme M, Mende KC, Pantel T, et al. Intraoperative blood loss in oncological spine surgery. Neurosurg Focus. 2021 May 1;50(5):E14. 2) Barbanti-Brodano G, Griffoni C, Halme J, et al. Spinal surgery complications: an unsolved problem-Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them? Eur Spine J. 2020 May;29(5):927-936.