Publication:

Postoperative morbidity and mortality in patients with vertigo undergoing elective laminectomy

Background Vertigo is frequently encountered in patients undergoing elective spine surgery, yet its association with postoperative morbidity and mortality after laminectomy remains poorly defined. We evaluated short- and long-term postoperative outcomes among patients with preoperative vertigo undergoing elective laminectomy after rigorous adjustment for comorbid disease burden.

Methods We performed a retrospective propensity score-matched cohort study comparing adults undergoing elective laminectomy with preoperative peripheral vertigo to those without. Vertigo was identified using ICD-10 codes (H81.x), excluding central neurologic, cerebrovascular, autonomic, traumatic, and infectious etiologies. Cohorts were matched 1:1 (6,031 per group) on demographics, comorbidities, laboratory values, and medication exposures. Outcomes were assessed at 90 days and 1 year with falls serving as the primary outcome. To account for multiple secondary outcome comparisons, a Bonferroni correction was applied, with statistical significance set at p<0.002.

Results Postoperative falls was significantly elevated at 90 days (OR=1.97) and 1 year (OR=1.75). Among secondary outcomes, the vertigo cohort demonstrated significantly higher rates of stroke (OR=2.31 at 90 days; OR=2.33 at 1 year), nausea or vomiting (OR=1.86; OR=1.98), fall-related fractures (OR=1.70 at 90 days), somnolence or stupor (OR=2.44; OR=2.21), myocardial infarction (OR=1.85 at 1 year), urinary tract infection (OR=1.57 at 1 year), amnesia (OR=2.36 at 1 year), and emergency department utilization (OR=1.45 at 1 year). Trends toward elevated venous thromboembolism, myocardial infarction at 90 days, and all-cause mortality at 1 year (OR=1.52; p=0.0037) were observed.

Conclusions Preoperative peripheral vertigo is associated with increased postoperative morbidity across neurologic, cardiovascular, functional, and healthcare utilization domains following elective laminectomy, with a trend toward elevated 1-year mortality. These findings suggest vertigo may represent a clinically meaningful risk modifier and support prospective evaluation of enhanced preoperative optimization and fall-prevention protocols in this population.