Deaths After Back Surgery Are Often Related to Analgesics

Researchers from the University of Washington (Seattle, USA) conducted a retrospective population-based cohort study and analyzed workers' compensation claims filed by lumbar fusion patients between 1994 and 2001. The researchers assessed the frequency, timing, and causes of death, which was ascertained from Washington State vital statistics records and from the workers' compensation claims database. Poisson regression was used to obtain age- and gender-adjusted mortality rates; years of potential life lost, percent of potential life lost, and mean potential life lost were calculated for the leading 5 causes of death and the risk of death was calculated in association with selected predictors.

The study results showed that among the 2,378 lumbar fusion subjects in the study cohort, 103 were deceased by 2004. The 3-year cumulative mortality rate was 1.93%, while the 90-day perioperative mortality rate was 0.29%. The age- and gender-adjusted all-cause mortality rate was 3.1 deaths per 1000 worker-years. There were 22 analgesic-associated deaths (19 accidental poisonings and 3 suicides). These accounted for 21% of all deaths and for 31.4% of all potential life lost. The researchers also found that the use of instrumentation or intervertebral cage devices for fusion, and the presence of degenerative disc disease were both risk factors for analgesic-related death. In fact, in subjects between 45 and 54 years of age, degenerative disc disease increased the odds of analgesic-related death by 7.45-fold. Repeat fusions were found to predict perioperative mortality. The study was published in the April 1, 2009, issue of Spine.

"The most important finding of this study was that analgesic-related deaths, both suicidal and accidental, claimed the highest potential life lost, more than heart disease (9.2%), cancer (9.1%), and liver disease (5.1%), combined," concluded lead author Sham Maghout Juratli, M.D., and colleagues of the division of occupational and environmental medicine.

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