Determinants of Neurological Complications after Degenerative Spine Surgery: a Nationwide Cohort Study based on the French SNDS Database

Purpose – In France, around 160,000 spine surgery procedures are performed yearly for spinal deformities or degenerative, tumoral, or traumatic spine pathologies. This study aimed to describe neurological complications following spine surgery for degenerative pathology and identify their determinants at the national level. Methods – Using the French national health insurance system database (Système National des Données de Santé, SNDS), a cohort was constituted including all French patients aged 18 and older in 2018 who underwent their first surgery for degenerative spine pathology in that year. Complications were identified through hospital diagnoses and surgical procedures within the following 12 months. Patient characteristics and complications were described. A cause-specific Cox model was used to identify the determinants of spine surgery complications. Results – A total of 79,151 patients were identified with incident spine surgery for degenerative pathology (mean patient age 55 years, standard deviation 15; 51.0% women) and 14.8% of them had one or more complications within one year after surgery. Determinants associated with the occurrence of complications were female sex (HR = 1.05, 95%CI=[1.01;1.09]), age > 65 (1.55 [1.46;1.64]), length of stay for initial surgery > 5 days (2.73 [2.58;2.89]), lumbar and cervical spine levels (1.38 [1.13;1.68]), overweight or obesity (1.08 [1.02;1.15]), public institution (1.07 [1.03;1.12]) and previous consultation for the pathology (1.43 [1.38;1.49]). Conclusion – Almost one in six patients with degenerative spine pathology develops a complication after surgery. Main determinants of postoperative complications appear to be associated with disease severity and comorbidities.