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Tanaka T, Sasaki M, Katayanagi J, Hirakawa A, Fushimi K, Yoshii T, Jinno T, Inose H. Trends, costs, and complications associated with after-hours surgery and unscheduled hospitalization in spinal surgery. Bone Jt Open 2024; 5:662-670. [PMID: 39117344 PMCID: PMC11309809 DOI: 10.1302/2633-1462.58.bjo-2024-0026.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Aims The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. Methods We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis. Results This investigation included 739,474 spinal surgeries and 739,215 hospitalizations in Japan. There was an average annual increase of 4.6% in the number of spinal surgeries. Scheduled hospitalizations increased by 3.7% per year while unscheduled hospitalizations increased by 11.8% per year. In-hours surgeries increased by 4.5% per year while after-hours surgeries increased by 9.9% per year. Complication rates and costs increased for both after-hours surgery and unscheduled hospitalizations, in comparison to their respective counterparts of in-hours surgery and scheduled hospitalizations. Conclusion This study provides important insights for those interested in improving spine care in an ageing society. The swift surge in after-hours spinal surgeries and unscheduled hospitalizations highlights that the medical needs of an increasing number of patients due to an ageing society are outpacing the capacity of existing medical resources.
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Affiliation(s)
- Tomoyuki Tanaka
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Masanao Sasaki
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junya Katayanagi
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Akihiko Hirakawa
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedics, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
- Department of Orthopedics, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Reyes J, Katiyar P, Greisberg G, Coury JR, Dionne A, Lombardi JM, Sardar ZM. Preoperative nutritional optimization for adult spinal deformity: Review. Spine Deform 2024; 12:257-262. [PMID: 38055123 DOI: 10.1007/s43390-023-00792-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/04/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The main objective of this review article is to examine the role that nutrition has on adult spinal deformity. The information presented in this review aims to provide spine surgeons with a broad overview of screening, assessment, and interventional strategies that may be used for presurgical nutritional optimization. METHODS A comprehensive literature review utilizing three biomedical databases was performed to generate articles of interest. Published articles related to nutrition, adult spinal deformity, spine surgery and orthopaedics were reviewed for the composition of this article. Nutrition may play a role in optimizing postoperative outcomes following adult spinal deformity surgeries, such as limiting delirium, length of stay, blood transfusion, and other medical complications. The use of screening tools, such as the PNI and CONUT score can assess preoperative nutritional status and may provide some utility in evaluating nutrition status in patients undergoing deformity surgery. Balancing both macronutrients and micronutrients, notably, carbohydrates, protein, albumin, and vitamin D can play a role in preoperative optimization. CONCLUSION Adult spinal deformity patients are at an increased risk for malnutrition. These patients should be assessed for nutrition status to prime them for surgery, minimize complications, and maximize their outcomes. However, further studies are needed to determine how nutrition ultimately affects adult spinal deformity patients in the postoperative period and to establish specific nutritional recommendations for this unique population.
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Affiliation(s)
- Justin Reyes
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA.
| | - Prerana Katiyar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Gabriella Greisberg
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Josephine R Coury
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Alexandra Dionne
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Joseph M Lombardi
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Zeeshan M Sardar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
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Katiyar P, Reyes J, Coury J, Lombardi J, Sardar Z. Preoperative Optimization for Adult Spinal Deformity Surgery: A Systematic Review. Spine (Phila Pa 1976) 2024; 49:304-312. [PMID: 37678375 DOI: 10.1097/brs.0000000000004823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for the preoperative optimization of these risk factors. SUMMARY OF BACKGROUND DATA Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the health care system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically. METHODS We searched PubMed for studies that looked at one of the variables of interest (eg, osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use, and psychosocial factors) in adult patients with spinal deformity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines. RESULTS Seventy studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence-based action items for preoperative optimization of modifiable risk factors before adult spinal deformity surgery. CONCLUSIONS While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Prerana Katiyar
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Justin Reyes
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Josephine Coury
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Joseph Lombardi
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Zeeshan Sardar
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
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Arumugam S, Ranganathan R, Narayanasamy VK. Virtual registration of comminuted bone fracture and preoperative assessment of reconstructed bone model using the Procrustes algorithm based on CT dataset. Proc Inst Mech Eng H 2024; 238:219-236. [PMID: 38239062 DOI: 10.1177/09544119231221192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
A research work was undergone in a virtual bone reduction process for reconstruction of the comminuted pelvic bone fracture using a CT scan dataset of patients. This includes segmentation, 3D model optimization and bone registration technique. The accuracy of the reconstructed bone model was validated using Finite Element Method. Analysed and applied various segmentation techniques to segregate the injured bone structure. The ICP (Iterative Closest Point), Procrustes algorithm and Canny edge detection algorithm were applied to understand the bone registration process for surgery in detail. The average RMS error, mean absolute distance, mean absolute deviation, and mean signed distance of the reconstructed bone model using proposed algorithms involving 10 patient datasets in a group were found to be 1.77, 1.48, 1.51 and -0.31 mm respectively. The calculated RMS error value proved minimal error in semi-automatic registration than other existing automatic registration techniques. Therefore, the proposed approach is suitable for virtual bone reduction for comminuted pelvic bone fracture. This method could also be implemented for various other bone fracture reconstruction requirements.
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Affiliation(s)
- Senthilmurugan Arumugam
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| | - Rajesh Ranganathan
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| | - Venkatesh Kumar Narayanasamy
- Department of Orthopaedics & Trauma, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Williamson TK, Passfall L, Ihejirika-Lomedico R, Espinosa A, Owusu-Sarpong S, Lanre-Amos T, Schoenfeld AJ, Passias PG. Assessing the influence of modifiable patient-related factors on complication rates after adult spinal deformity surgery. Bone Joint J 2022; 104-B:1249-1255. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0574.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aims Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. Methods ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders. Results A total of 480 ASD patients met the inclusion criteria. By two years, complication rates were 72% ≥ one complication, 28% major, 21% medical, 27% surgical, 11% major radiological, 8% major mechanical, and 22% required reoperation. Younger LowDef patients with osteoporosis were more likely to suffer either a major mechanical (odds ratio (OR) 5.9 (95% confidence interval (CI) 1.1 to 36.9); p = 0.048) or radiological complication (OR 7.0 (95% CI 1.9 to 25.9); p = 0.003). Younger HighDef patients were much more likely to develop complications if obese, especially major mechanical complications (OR 2.8 (95% CI 1.1 to 8.6); p = 0.044). Older HighDef patients developed more complications when diagnosed with depression, including major radiological complications (OR 3.5 (95% CI 1.1 to 10.6); p = 0.033). Overall, a diagnosis of depression proved to be a risk factor for the development of major radiological complications (OR 2.4 (95% CI 1.3 to 4.5); p = 0.005). Conclusion Certain modifiable patient-related factors, especially osteoporosis, obesity, and mental health status, are associated with an increased risk of complications after surgery for spinal deformity. Surgeons should look for these conditions when assessing a patient for surgery, and optimize them to the fullest extent possible before proceeding to surgical correction so as to minimize the prospect of postoperative morbidity. Cite this article: Bone Joint J 2022;104-B(11):1249–1255.
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Affiliation(s)
- Tyler K. Williamson
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Lara Passfall
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Rivka Ihejirika-Lomedico
- Department of Orthopaedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Annie Espinosa
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Stephane Owusu-Sarpong
- Department of Orthopaedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Tomi Lanre-Amos
- Department of Orthopaedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
| | - Andrew J. Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Peter G. Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, New York, New York, USA
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Bronheim RS, Cotter E, Skolasky RL. Cognitive impairment is associated with greater preoperative symptoms, worse health-related quality of life, and reduced likelihood of recovery after cervical and lumbar spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 10:100128. [PMID: 35706693 PMCID: PMC9189192 DOI: 10.1016/j.xnsj.2022.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 02/03/2023]
Abstract
Background Cognitive impairment (CI) is associated with prolonged hospital stays and increased complications; however, its role in symptom severity and health-related quality of life (HRQoL) among spine patients is unknown. We determined 1) prevalence of preoperative CI; 2) associations between CI and preoperative pain, disability, and HRQoL; and 3) association between CI and postoperative improvements in HRQoL. Methods This is a prospective cohort study of 453 consecutive adult spine surgery patients between October 2019 and March 2021. We compared pain (Numeric Rating Scale, NRS), pain-related disability (Oswestry/Neck Disability Index, O/NDI), and HRQoL (PROMIS-29 profile, version 2.0) among participants having severe (PROMIS-29 Cognitive Abilities score ≤30), moderate (31-35), or mild CI (36-40) or who were unimpaired (score >40), using analysis of variance. Likelihood of clinical improvement given the presence of any CI was estimated using logistic regression. All comparisons were adjusted for age, gender, comorbidity, and use of opioid medication during the last 30 days. Alpha=.05. Results Eighty-five respondents endorsed CI (38 mild; 27 moderate; 20 severe). Preoperatively, those with CI had more severe back pain (p=.005) and neck pain (p=.025) but no differences in leg or arm pain. Those with CI had greater disability on ODI (p<.001) and NDI (p<.001) and worse HRQoL in all domains (all, p<.001). At 6 and 12 months postoperatively, those with CI were less likely to experience clinical improvement in disability and HRQoL (anxiety, pain interference, physical function, and satisfaction with ability to participant in social roles) (all, p<.05). Conclusions CI was present in nearly 20% of spine patients before surgery and was independently associated with worse preoperative back and neck pain, disability, and HRQoL. Those with CI had approximately one-half the likelihood of achieving meaningful clinical improvement postoperatively. These results indicate a need to evaluate spine patients' cognitive impairment prior to surgery. Level of Evidence III.
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Affiliation(s)
- Rachel S Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Emma Cotter
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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