Are Patient-Reported drug allergies associated with perioperative complications following adult cervical deformity correction?

Prior studies have demonstrated a correlation between patient-reported drug allergies and postoperative complications in the adult reconstruction literature. It is unclear if these reported allergies have similar associations in spine surgery. The purpose of this study was to assess the relationship between patient-reported drug allergies and perioperative complications in patients undergoing corrective surgery for adult cervical deformity (ACD). Adult patients undergoing ACD correction (at least four levels crossing the cervicothoracic junction) were enrolled. Patients preoperatively reported drug allergies and related symptoms (e.g., rash, anaphylaxis, etc.) upon administration of the medication. Perioperative complications, namely wound and infection-related complications, and readmission were the primary outcomes assessed. Chi-square tests, binary and multivariable logistic regression analyses were used to evaluate the effect of the type of drug allergy as well as the number of allergies on the rate and incidence of perioperative complications. 219 ACD patients were enrolled, with 38 % of patients reporting at least one drug allergy (mean 0.9 ± 1.3). Within 90 days of surgery, 17.7 % of patients had at least one complication overall. Patients with any reported drug allergies had higher rates of perioperative complications (24.4 % vs. 13.5 %, p = 0.043), particularly rates of surgical site infection (7.9 % vs. 1.5 %, p = 0.022). Controlling for age, BMI, gender, surgical approach, radiographic deformity, and number of levels fused, adjusted analysis revealed that patients with any reported allergies were more likely to suffer any type of complication (OR: 3.0, [1.4–6.8]; p = 0.007). Cervical deformity patients who report drug allergies, especially those to antibiotics, may be at an increased risk of developing perioperative complications after deformity correction, especially surgical site infections. Preoperative testing is necessary to mitigate alternative, ineffective antibiotic prophylaxis and prevent these troublesome complications following cervical deformity surgery. • Cervical deformity correction is a high-risk surgery with postoperative courses often affected by complications. • Patients reporting drug allergies may be at risk for increased risk for complications when undergoing cervical deformity correction, most notably surgical site infection. • Future studies should further delve into appropriate antibiotic use for patients with reported allergies to inform clinical management of these specific patients and mitigate additional risk.