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Daher M, Nassar JE, Balmaceno-Criss M, Diebo BG, Daniels AH. Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes. Spine (Phila Pa 1976) 2024; 49:E193-E199. [PMID: 38570919 DOI: 10.1097/brs.0000000000004999] [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: 02/23/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE This meta-analysis aims to compare same-day versus staged spine surgery, assessing their effects on patient care and health care system efficiency. BACKGROUND In spinal surgery, the debate between whether same-day and staged surgeries are better for patients continues, as the decision may impact patient-related outcomes, health care resources, and overall costs. While some surgeons advocate for staged surgeries, citing reduced risks of complications, others proclaim same-day surgeries may minimize costs and length of hospital stays. METHODS PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until February 2024. The studied outcomes were operative room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), overall complications, venous thromboembolism (VTE), death, operations, and nonhome discharge. RESULTS Sixteen retrospective studies were included in this meta-analysis, representing a total of 2346 patients, of which 644 underwent staged spinal fusion surgeries and 1702 same-day surgeries. No statistically significant difference was observed in EBL between staged and same-day surgery groups. However, the staged group exhibited a statistically significant longer OR time ( P =0.05) and LOS ( P =0.004). A higher rate of overall complications ( P =0.002) and VTE ( P =0.0008) was significantly associated with the staged group. No significant differences were found in the rates of death, reoperations, and nonhome discharge between the 2 groups. CONCLUSIONS Both staged and same-day spinal fusion surgeries showed comparable rates of death, operations, and nonhome discharges for patients undergoing spinal surgeries. However, given the increased OR time, LOS, and complications associated with staged spinal surgeries, this study supports same-day surgeries when possible to minimize the burden on healthcare resources and enhance efficiency.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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Jiang YQ, Wang LY, Hu SQ, Li XL, Zhou J, Qi Q, Dong J. Is it safe for the spinal metastasis patients with preoperative deep vein thrombosis to use low-molecular-weight heparin before surgery? A prospective study. J Clin Neurosci 2023; 114:32-37. [PMID: 37290140 DOI: 10.1016/j.jocn.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
Spine surgeons should weigh the risks of anticoagulants against their benefits in preventing deep venous thrombosis (DVT), as they may increase the risk of bleeding. Spinal metastasis patients undergoing decompression with fixation are at a high risk for DVT, which may occur preoperatively. Therefore, anticoagulants should be administered preoperatively. This study aimed to evaluate the safety of the administration of anticoagulants in treating spinal metastasis patients with preoperative DVT. Therefore, we prospectively investigated the prevalence of DVT in these patients. Patients who were diagnosed with preoperative DVT were included in an anticoagulant group. Subcutaneous low-molecular-weight heparin (LMWH) was administered. Patients without DVT were included in a non-anticoagulant group. Data on patient information, clinical parameters, blood test results, and bleeding complications were also collected. Moreover, the safety of anticoagulants was analyzed. The prevalence of preoperative DVT was 8.0%. None of the patients developed pulmonary thromboembolism. Furthermore, no significant differences in blood loss, drainage volume, hemoglobin levels, number of transfusions, or preoperative trans-catheter arterial embolization were observed between the two groups. None of the patients developed major bleeding. However, two patients experienced wound hematoma and one experienced incisional bleeding in the non-anticoagulant group. Therefore, LMWH is safe for spinal metastasis patients. Future randomized controlled trials should be conducted to evaluate the validity of perioperative prophylactic anticoagulation therapy in these patients.
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Affiliation(s)
- Yun-Qi Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, PR China
| | - Ling-Yan Wang
- Clinical Science Institute, Zhongshan Hospital, Fudan University, PR China
| | - Shun-Qi Hu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, PR China
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, PR China
| | - Jian Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, PR China
| | - Qing Qi
- Department of Ultrasonography, Zhongshan Hospital, Fudan University, PR China.
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, PR China.
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Louie PK, Urakawa H, Manzur MK, Craig CM, Qureshi SA. Narrative Review of Antiplatelet and Anticoagulant Medications for Venous Thromboembolism Prevention in Spine Surgery. Clin Spine Surg 2022; 35:63-75. [PMID: 34694260 DOI: 10.1097/bsd.0000000000001260] [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: 07/15/2020] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE The objective of this study was to identify commonly utilized venous thromboembolism (VTE) prophylactic measures, spine surgeon perspective, and provide pharmacologic recommendations from the literature. SUMMARY OF BACKGROUND DATA Considered a preventable cause of morbidity and mortality, VTE remains an important iatrogenic diagnosis of concern. Reported rates of VTE following spine surgery vary widely (0.3%-31.0%). MATERIALS AND METHODS A MEDLINE query identified literature reporting on VTE prevention and outcomes in the setting of spine surgery. Findings extracted from the included articles were summarized in a narrative review format to identify salient aspects of the current literature. RESULTS Sixty articles were summarized. Many anticoagulation medications that are described in the literature target factors involved in the coagulation cascade common pathway including aspirin and other antiplatelet medications, heparins, and warfarin. Newer direct inhibitors of thrombin and factor Xa are now being utilized for VTE prevention, although with limited use specifically in spine surgery. CONCLUSIONS Perioperative management of antiplatelet and anticoagulation medications in spine surgery requires evidence-based protocols that can account for patient comorbidities and surgery-specific features. Future studies should prospectively focus on establishing stronger recommendations based on pathology, surgical indications, patient comorbidities, region of the spine, and broad surgical intervention to enable effective prophylaxis for VTE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | | | - Mustfa K Manzur
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Chad M Craig
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
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Abstract
STUDY DESIGN Review. OBJECTIVE Venothromboembolic (VTE) complications, composed of deep vein thrombosis and pulmonary embolism are commonly observed in the perioperative setting. There are approximately 500 000 postoperative VTE cases annually in the United States and orthopedic procedures contribute significantly to this incidence. Data on the use of VTE prophylaxis in elective spinal surgery is sparse. This review aims to provide an updated consensus within the literature defining the risk factors, diagnosis, and the safety profile of routine use of pharmacological prophylaxis for VTE in elective spine surgery patients. METHODS A comprehensive review of the literature and compilation of findings relating to current identified risk factors for VTE, diagnostic methods, and prophylactic intervention and safety in elective spine surgery. RESULTS VTE prophylaxis use is still widely contested in elective spine surgery patients. The outlined benefits of mechanical prophylaxis compared with chemical prophylaxis varies among practitioners. CONCLUSION The benefits of any form of VTE prophylaxis continues to remain a controversial topic in the elective spine surgery setting. A specific set of guidelines for implementing prophylaxis is yet to be determined. As more risk factors for thromboembolic events are identified, the complexity surrounding intervention selection increases. The benefits of prophylaxis must also continue to be balanced against the increased risk of bleeding events and neurologic injury.
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Affiliation(s)
| | - Ram K. Alluri
- Keck School of Medicine of the University of Southern California, Orthopaedic Surgery, CA, USA
| | | | - Raymond J. Hah
- University of Southern California Keck School of Medicine, Orthopaedic Surgery, CA, USA
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Single-Stage Versus Multistage Surgical Management of Single- and Two-Level Lumbar Degenerative Disease. World Neurosurg 2021; 152:e449-e454. [PMID: 34087456 DOI: 10.1016/j.wneu.2021.05.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine postoperative complications and quality outcomes of single-stage and multistage surgical management for lumbar degenerative disease (LDD). METHODS This retrospective cohort study using a national administrative database identified patients who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether their surgeon chose to perform single-stage or multistage LDD surgery, and these cohorts were mutually exclusive. Propensity score matching was used to mitigate intergroup differences between single-stage and multistage patients. Patients who underwent ≥3 levels of surgical correction, who were <18 years old, or who had any prior history of trauma or tumor were excluded from the study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined. RESULTS Primary surgery for LDD was performed in 47,190 patients; 9438 (20%) of these patients underwent multistage surgery. After propensity score matching, baseline covariates of the 2 cohorts were similar. The complication rate was 6.1% in the single-stage cohort and 11.0% in the multistage cohort. Rates of posthemorrhagic anemia, infection, wound complication, deep vein thrombosis, and hematoma all were higher in the multistage cohort. Length of stay, revisions, and readmissions were also significantly higher in the multistage cohort. Through 2 years of follow-up, multistage surgery was associated with higher payments throughout the 2-year follow-up period ($57,036 vs. $39,318, P < 0.05). CONCLUSIONS Single-stage surgery for LDD demonstrated improved outcomes and lower health care utilization. Spine surgeons should carefully consider single-stage surgery when treating patients with LDD requiring <3 levels of correction.
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Yamato Y, Hasegawa T, Yoshida G, Yasuda T, Banno T, Oe S, Arima H, Mihara Y, Ushirozako H, Yamada T, Ide K, Watanabe Y, Matsuyama Y. Planned two-stage surgery using lateral lumbar interbody fusion and posterior corrective fusion: a retrospective study of perioperative complications. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2368-2376. [PMID: 34046729 DOI: 10.1007/s00586-021-06879-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the effect of planned two-stage surgery using lateral lumbar interbody fusion (LLIF) on the perioperative complication rate following corrective fusion surgery in patients with kyphoscoliosis. METHODS Consecutive patients with degenerative scoliosis who underwent corrective fusion were divided into a control group that underwent single-stage posterior-only surgery and a group that underwent planned two-staged surgery with LLIF and posterior corrective fusion. We collected the patient background and surgical data and assessed the perioperative complication rates. We also investigated spinopelvic parameters and patient-reported outcome measurements (PROMs). RESULTS One hundred and thirty-eight patients of mean age 69.8 (range, 50-84) years who met the study inclusion criteria were included. The two-stage group (n = 75) underwent a staged anterior-posterior surgical procedure, and the control group (n = 63) underwent single-stage surgery. There was no significant between-group difference in the incidence of perioperative complications, except for deep wound infection (reoperation is necessary for surgical site infection). Revision surgery within 3 months of the initial surgery was more common in the control group (n = 8, 12.7%) than in the two-stage group (n = 3, 4.0%). Spinopelvic parameters and PROMs were significantly better in the two-stage group at 2 years postoperatively. CONCLUSION The complication rate for planned two-stage surgery was similar to that of previous posterior-only single-stage surgery. However, early reoperation was less common, and the degree of spinal correction and clinical results were significantly better after two-stage surgery.
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Affiliation(s)
- Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan. .,Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Tatsuya Yasuda
- Department of Orthopaedic Surgery, Iwata City Hospital, Iwata City, Shizuoka, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.,Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yuki Mihara
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yuh Watanabe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
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Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the Society for Neuroscience in Anesthesiology and Critical Care. Anesthesiology 2019; 130:12-30. [PMID: 30531555 DOI: 10.1097/aln.0000000000002503] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text.
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Rockson HB, DiPaola CP, Connolly PJ, Stauff MP. Venous Thromboembolism Prophylaxis for Patients Having Elective Spine Surgery: When, Why, and How Much. J Bone Joint Surg Am 2019; 101:1220-1229. [PMID: 31274725 DOI: 10.2106/jbjs.18.00849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hayden B Rockson
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Christian P DiPaola
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Patrick J Connolly
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Michael P Stauff
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
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Roth S, Moss HE. Update on Perioperative Ischemic Optic Neuropathy Associated With Non-ophthalmic Surgery. Front Neurol 2018; 9:557. [PMID: 30042726 PMCID: PMC6048244 DOI: 10.3389/fneur.2018.00557] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/21/2018] [Indexed: 01/16/2023] Open
Abstract
Perioperative visual loss (POVL) is a rare, serious complication of non-ophthalmic surgeries. Ischemic optic neuropathy (ION), and retinal arterial occlusion (RAO) are the main causes (1, 2). Less frequent are cortical blindness (3), acute glaucoma (4), and choroidal and vitreous hemorrhage (5). ION is the most common cause for which the neurologist or neuro-ophthalmologist is consulted as it is associated either with a normal ophthalmic exam (posterior ION, PION), or less often, with optic nerve (ON) head swelling (anterior ION, AION). The presumed cause is impaired blood supply to the optic nerve (Figure 1). The most common surgical procedures complicated by ION are cardiac surgery and spinal fusion. Retrospective studies, surveys, and case reports are the basis of most knowledge regarding peri-operative ION (poION), with cohort and case-control studies helping to identify candidate risk factors (6, 7). Animal models have provided insight regarding mechanisms (8). This mini-review is an update on the latest advancements regarding poION in non-ophthalmic surgeries in epidemiological, clinical, and animal studies.
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Affiliation(s)
- Steven Roth
- Department of Anesthesiology, and Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, United States
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Zuckerman SL, Lakomkin N, Smith JS, Shaffrey CI, Devin CJ. Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery. JOURNAL OF SPINE SURGERY 2018; 4:333-341. [PMID: 30069526 DOI: 10.21037/jss.2018.05.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgery for adult spinal deformity (ASD) can significantly improve quality of life but is associated with significant risk of morbidity. Among the most devastating potential complications after these operations is death. The current study aims to report the incidence, preoperative factors, and postoperative complications associated with all-cause mortality within 1 year following ASD surgery. Methods Adults who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Demographic characteristics were extracted. The primary outcome was death within 1 year of ASD surgery. Propensity score matching was used to control for confounding factors, followed by univariate/multivariable logistic regression to predict the odds of death within 1 year of ASD surgery. Results A total of 6,158 patients underwent ASD surgery and 61 (0.99%) died within one year of surgery. Preoperative factors: controlling for age, gender, American Society of Anesthesiologists (ASA) score and postoperative complications, four independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: increased age (OR =1.03; 95% CI, 1.01-1.06; P=0.012), ASA score (OR =4.32; 95% CI, 2.68-6.94; P<0.001), cancer history (OR =7.91; 95% CI, 4.23-14.78; P<0.001) and unintentional weight loss (OR =4.65; 95% CI, 1.68-12.89; P=0.003). Postoperative complications: using propensity score matching and multivariable logistic regression, three independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: pneumonia (OR =4.00; 95% CI, 1.68-9.53), deep venous thrombosis (DVT) (OR =3.12; 95% CI, 1.20-8.10) and unplanned intubation (OR =3.13; 95% CI, 1.15-8.50). Discussion Death after elective ASD surgery is a devastating yet uncommon event with an incidence of 1%. Preoperative factors of age, ASA score, cancer history, and unexpected weight loss, along with postoperative complications of pneumonia, DVT, and unplanned intubation were independently associated with all-cause mortality within 1 year of ASD surgery. Interestingly, the potentially more severe complications of sepsis, PE, and MI did not independently predict death.
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Affiliation(s)
- Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
| | - Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - Clinton J Devin
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA.,Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA
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