Rates and Causes of Mortality Associated With Spine Surgery Based on 108,419 Procedures

A Review of the Scoliosis Research Society Morbidity and Mortality Database

Justin S. Smith, MD, PhD; Dwight Saulle, MD; Ching-Jen Chen, BA; Lawrence G. Lenke, MD; David W. Polly, Jr, MD; Manish K. Kasliwal, MD; Paul A. Broadstone, MD; Steven D. Glassman, MD; Alexander R. Vaccaro, MD, PhD; Christopher P. Ames, MD; Christopher I. Shaffrey, MD


Spine. 2012;37(23):1975-1982. 

In This Article

Abstract and Introduction


Study Design. A retrospective review of a prospectively collected database.
Objective. To assess rates and causes of mortality associated with spine surgery.
Summary of Background Data. Despite the best of care, all surgical procedures have inherent risks of complications, including mortality. Defining these risks is important for patient counseling and quality improvement.
Methods. The Scoliosis Research Society Morbidity and Mortality database was queried for spinal surgery cases complicated by death from 2004 to 2007, including pediatric (younger than 21 yr) and adult (21 yr or older) patients. Deaths occurring within 60 days and complications within 60 days of surgery that resulted in death were assessed.
Results. A total of 197 mortalities were reported among 108,419 patients (1.8 deaths per 1000 patients). Based on age, rates of death per 1000 patients for adult and pediatric patients were 2.0 and 1.3, respectively. Based on primary diagnosis (available for 107,996 patients), rates of death per 1000 patients were as follows: 0.9 for degenerative (n = 47,393), 1.8 for scoliosis (n = 26,421), 0.9 for spondylolisthesis (n = 11,421), 5.7 for fracture (n = 6706), 4.4 for kyphosis (n = 3600), and 3.3 for other (n = 12,455). The most common causes of mortality included: respiratory/pulmonary causes (n = 83), cardiac causes (n = 41), sepsis (n = 35), stroke (n = 15), and intraoperative blood loss (n = 8). Death occurred prior to hospital discharge for 109 (79%) of 138 deaths for which this information was reported. The specific postoperative day (POD) of death was reported for 94 (48%) patients and included POD 0 (n = 23), POD 1–3 (n = 17), POD 4–14 (n = 30), and POD >14 (n = 24). Increased mortality rates were associated with higher American Society of Anesthesiologists score, spinal fusion, and implants (P < 0.001). Mortality rates increased with age, ranging from 0.9 per 1000 to 34.3 per 1000 for patients aged 20 to 39 years and 90 years or older, respectively.
Conclusion. This study provides rates and causes of mortality associated with spine surgery for a broad range of diagnoses and includes assessments for adult and pediatric patients. These findings may prove valuable for patient counseling and efforts to improve the safety of patient care.


All surgical procedures have inherent risks of complications, and among the most profound is the risk of death. Defining the rates and causes of mortality associated with surgical procedures is valuable for patient counseling, surgical planning, and efforts to improve the safety of patient care. However, estimation of mortality rates is complicated by several factors, the most significant of which is the relative rarity of this event for most procedures. In addition, for data to be generalizable, estimations of mortality rates should include a broad range of surgeons, medical centers, geographic regions, and patient populations in order to mitigate potential confounding effects of these factors.

The spine may be afflicted by a remarkably broad spectrum of pathologies, and a similarly broad range of surgical procedures have been developed to address these conditions. Treatments can range from a relatively straightforward lumbar microdiscectomy to complex reconstructions for spinal deformities, and the acuity can range from purely elective to urgent or emergent. For procedures that are very commonly performed, the literature offers estimates of mortality.[1–13] However, for less common procedures, such as those for spinal deformity, the available literature is limited.[14–18] In addition, estimates of mortality for pediatric patients, especially for less common procedures, are very limited.[19,20]

The Scoliosis Research Society (SRS) has been collecting morbidity and mortality (M&M) data from its members for more than 30 years. Given the relative infancy of modern surgical treatments of spinal deformity, the founding members of the SRS recognized the importance of collecting and assessing M&M as a means of improving future care, and this tradition has continued to the present and has become a hallmark of membership. Our objective in this study was to use the significant breadth and volume of cases reported to the SRS M&M database from a recent time period in order to provide rates and causes of mortality associated with spine surgery.