A small community woke up to the solemn, shocking news that a 59 year old husband, father and popular restaurant owner had died suddenly from complications during back surgery. After letting that information penetrate the early morning haze, some may have wondered about the cause of death. How can something go so terribly wrong during spine surgery?
The fact of the matter is that millions of surgeries occur per year. Within those millions are thousands of heart attacks that occur around the time of surgery. Up to one quarter of the people that have a heart attack during the time of surgery will die. Those that have diabetes, heart failure, blood loss, or risky surgeries are at the highest risk. As the population ages, people having surgery are more and more likely to be at risk of having the dreaded and often deadly heart attack around the time of surgery.
Heart attacks at the time of surgery are not the usual types of cardiac events that happen during normal circumstances. Normally, a blockage in a heart vessel causes a cardiac muscle to infarct or die. Because surgery places a great deal of stress on the heart, the oxygen demands from the body can outstrip the ability of the heart to supply the life-supporting, oxygenated blood. Once that happens, the heart muscle can literally suffocate and die from the lack of oxygen. Survival rates from these events are still pretty good, over 75% survive. However, the costs and lengths of time in the hospital are at least double what one would normally expect from a routine spine surgery.
Recently investigators looked at some of the trends pertaining to heart attacks during spine surgeries. They discovered that people over the age of 65 were at higher risk and, as expected, those with pervious cardiac or circulatory problems were at higher risk too. The surgery itself is a depending factor as well. The more complex, the more levels being fused, the more likely a cardiac event will occur. In the lumbar spine, the risk quadrupled with fusions that involved 8 levels or more. Overall, the simpler the surgery, the younger the patient, the less likely a heart attack will happen.1, 2
Could this one death have been prevented? Possibly, with proper counseling and screening, he might have been dissuaded from having surgery or a previously unidentified cardiac problem could have been uncovered while going through the pre-operative health tests. "Could have’s" and "should have’s" won’t bring him back. Considering the millions of surgeries that do take place safely and without cardiac events, it is just hard to predict when the worst will happen.