University of Wisconsin–Madison Medical College of Wisconsin

Outcomes of Anterior Exposure for Spinal Surgery at an Independent Academic Medical Center

Travis J. Smith, MD, FACS; Amelia T. Bauer, BS; Kara J. Kallies, MS; Mohammed Al-Hamadani, MBCHB, MPH; Sigurd B. Gundersen III, MD, FACS

WMJ. 2017;116(1):15-21.

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Introduction: Anterior exposure for spinal surgery has expanded and is used for common spinal procedures, including anterior lumbar interbody fusion, disc replacement, and vertebral corpectomy. With this approach, vascular injuries have been reported ranging from 1% to 25%. The impact of resident participation on intraoperative and postoperative outcomes within an independent academic medical center has not been widely reported. The objective of this study was to determine the incidence of complications during anterior exposure spinal surgery at an independent academic medical center.

Methods: After institutional review board approval, we conducted a retrospective review of medical records of patients who underwent elective anterior exposure for spinal surgery from 2000 through 2014.

Results: The study included 335 patients; 60.3% were female. Thirty-day postoperative complications included surgical site infection (4.2%), urinary tract infection (2.7%), need for blood transfusion (2.1%), retrograde ejaculation (1.2%), and deep vein thrombosis (0.9%). There were 12 vascular injuries overall (3.6%); 2.7% were major vascular injuries. Surgery residents participated in 34% of cases. Resident involvement increased over the course of the study. There was no difference in operative time or complications with resident involvement.

Conclusions: The overall incidence of major vascular injury was 2.7%. Levels of exposure and blood loss were associated with vascular injury. Overall postoperative complication rates as well as major vascular injury rates compared favorably to published benchmarks. Complication rates were unaffected by surgical resident involvement.

Author Affiliations: Department of General and Vascular Surgery, Gundersen Health System, La Crosse, Wis (Smith, Gundersen); Department of Medical Research, Gundersen Medical Foundation, Gundersen Health System, La Crosse, Wis (Bauer, Kallies, Al-Hamadani).
Corresponding Author: Travis J. Smith, MD, FACS, Department of General and Vascular Surgery, Gundersen Health System, 1900 S Ave C05-001, La Crosse, WI 54601; phone 608. 775.2331; fax 608.775.4460; e-mail
Funding/Support: None declared.
Financial Disclosures: None declared.
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