1
|
Aggad M, Terrier LM, Nidal Salah C, Zemmoura I, Planty-Bonjour A, Francois P, Amelot A. Are There Still Any Benefits to Drainage for Anterior Cervical Arthrodesis/Arthroplasty by Cervicotomy? Spine (Phila Pa 1976) 2024; 49:1092-1097. [PMID: 38362711 DOI: 10.1097/brs.0000000000004964] [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: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
STUDY DESIGN A retrospective single-center study between January 2019 and January 2023. OBJECTIVE The role and contribution of drainage in the anterior approach to the cervical spine (cervicotomy) is much debated, motivated primarily by the prevention of retropharyngeal hematoma, so are there still any benefits to drainage? BACKGROUND The anterior approach to the cervical spine is a widespread and common procedure performed in almost all spine surgery departments for the replacement of cervical intervertebral discs and medullar or radicular decompression. The primary endpoint was the occurrence of symptomatic postoperative cervical hematoma. PATIENTS AND METHODS Four hundred thirty-one patients who had undergone cervical spine surgery by anterior cervicotomy for cervicarthrosis or cervical disc herniation (anterior cervical discectomy and fusion and anterior cervical disc replacement) were consecutively included. Patients were separated into 2 groups: (1) Group A, 140 patients (with postoperative drainage) and (2) Group B, 291 patients (without drainage). RESULTS The mean follow-up was 2.8 months. The 2 groups were comparable on all criteria, but there was a predominance of arthroplasty ( P < 0.0001), use of anticoagulants/antiaggregants ( P < 0.0001) and a greater number of stages ( P < 0.0001) in group A. There were a total of 4/431 symptomatic postoperative hematomas (0.92%) in this study. Two hematomas occurred in group A (2/140, 1.4%) and 2 in group B (2/291, 0.68%; P < 0.0001). One patient in group A (0.71%) required surgical drainage for cavity hematoma revealed by marked dyspnea, swallowing, and neurological disorders. One case of hematoma diagnosed by dysphonia and neurological deficit was reported in group B (0.34%; P < 0.0001). CONCLUSIONS The placement of a drain during anterior cervicotomy (anterior cervical discectomy and fusion/anterior cervical disc replacement) did not limit the occurrence of symptomatic postoperative hematoma.
Collapse
Affiliation(s)
- Mourad Aggad
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | | | | | | | | | - Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, Tours, France
| |
Collapse
|
2
|
Colón LF, Barber L, Soffin E, Albert TJ, Katsuura Y. Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors. Global Spine J 2023; 13:2526-2540. [PMID: 36892830 PMCID: PMC10538311 DOI: 10.1177/21925682231160072] [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: 03/10/2023] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVE To provide an overview of etiology and risk factors of airway complications after anterior cervical spine surgery (ACSS). METHODS A search was performed in PubMed and adapted for use in other databases, including Embase, Cochrane Library, Cochrane Register of Controlled Trials, Health Technology Assessment database, and NHS Economic Evaluation Database. RESULTS 81 full-text studies were reviewed. A total of 53 papers were included were included in the review and an additional four references were extracted from other references. 39 papers were categorized as etiology and 42 as risk factors. CONCLUSIONS Most of the literature on airway compromise after ACSS is level III or IV evidence. Currently, there are no systems in place to risk-stratify patients undergoing ACSS regarding airway compromise or guidelines on how to manage patients when these complications do occur. This review focused on theory, primarily etiology and risk factors.
Collapse
Affiliation(s)
- Luis Felipe Colón
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine in Chattanooga, Chattanooga, TN, USA
| | - Lauren Barber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ellen Soffin
- Department of Anesthesiology, Critical Care, and Pain Management; Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yoshihiro Katsuura
- Department of Orthopaedic and Spine Surgery, Adventist Health Howard Memorial Hospital, Willits, CA, USA
| |
Collapse
|
3
|
Latka K, Kołodziej W, Rajski R, Pawuś D, Chowaniec J, Latka D. Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives. Risk Manag Healthc Policy 2023; 16:1839-1848. [PMID: 37719687 PMCID: PMC10505014 DOI: 10.2147/rmhp.s425465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
Objective This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland. Materials and Methods An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses. Results The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures. Conclusion Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.
Collapse
Affiliation(s)
- Kajetan Latka
- Department of Neurosurgery, The St. Hedwig’s Regional Specialist Hospital, Opole, Poland
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, Opole, Poland
| | - Waldemar Kołodziej
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, Opole, Poland
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Rafal Rajski
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dawid Pawuś
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, Opole, Poland
| | - Jacek Chowaniec
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dariusz Latka
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, Opole, Poland
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
| |
Collapse
|
4
|
Phayal G, Chiluwal A, Zavarella SM. Long-Term Complication of Three-Level Cervical Artificial Total Disc Replacement: A Case Report. Cureus 2023; 15:e42380. [PMID: 37621799 PMCID: PMC10445663 DOI: 10.7759/cureus.42380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) has long been the standard surgical treatment for cervical degenerative disc disease (DDD); however, cervical artificial total disc replacement (cTDR) has gained increasing recognition in recent years due to its ability to maintain a natural range of motion and lower the rate of adjacent segment disease. Although cTDR is only approved for one or two levels in the United States, it has been used for three or more levels in other countries. We present a case of a 59-year-old male patient who underwent three-level cTDR (C4-C7) in Germany and presented 10 years later with progressive paracervical pain and worsening dysphagia. Magnetic resonance imaging (MRI) and computed tomography (CT) scan showed hardware loosening, progressive loss of bone around the device, and a cyst ventral to C4-C5 with mass effect on the hypopharynx. The patient was successfully treated with posterior cervical fusion and showed improvement in neck pain. This case underscores the significance of long-term follow-up and thoughtful consideration when selecting an appropriate treatment modality for patients afflicted with cervical DDD.
Collapse
Affiliation(s)
- Ganesh Phayal
- Neurological Surgery, SpineCare Long Island, Long Island, USA
- Neurological Surgery, College of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Amrit Chiluwal
- Neurological Surgery, SpineCare Long Island, Long Island, USA
| | | |
Collapse
|
5
|
Wang H, Yu H, Zhang N, Xiang L. Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases. Neurospine 2023; 20:525-535. [PMID: 37401070 PMCID: PMC10323355 DOI: 10.14245/ns.2245066.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases. METHODS Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT. RESULTS Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058-25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104-2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663-85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038). CONCLUSION Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.
Collapse
Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Ning Zhang
- Department of Orthopedics, The Second Hospital of Chaoyang, Chaoyang, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| |
Collapse
|
6
|
Epstein NE. Can anterior cervical diskectomy/fusion (ACDF) be safely performed in ambulatory surgical centers (ASC’s)? Surg Neurol Int 2023; 14:110. [PMID: 37151427 PMCID: PMC10159315 DOI: 10.25259/sni_175_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023] Open
Abstract
Background:
Can anterior cervical diskectomy/fusion (ACDF) be safely performed in ambulatory surgical centers (ASC’s: i.e. discharges 4-7.5 hr. postoperatively) that meet the following stringent “exclusion criteria”; elevated Body Mass Index (BMI), major comorbidities, age > 65, American Society of Anesthesiology (ASA) scores > II, and largely multilevel ACDF.
Materials:
Presently, most ACDF are still being performed in hospital-based outpatient surgical centers (HBSC: utilizing 23-hour stays), or as inpatients.
Results:
Notably, unreliable disparate study designs involving very different patient populations resulted in nearly comparable, but implausible outcomes for 1-level vs. multilevel ACDF series performed in ASC. A summary of these outcome data included the following rates of; i.e. postoperative hospital transfers (0-6%), 30-day (up to 2.2%), and up to 90 day (2.2%) emergency department (ED) visits, readmissions, and reoperations.
Conclusion:
Nevertheless, it is just common sense that “less should be less”, that 1-level ACDF should involve less risk compared with multilevel ACDF procedures performed in ASC.
Collapse
|
7
|
Mjåset C, Solberg TK, Zwart JA, Småstuen MC, Kolstad F, Grotle M. Anterior surgical treatment for cervical degenerative radiculopathy: a prediction model for non-success. Acta Neurochir (Wien) 2023; 165:145-157. [PMID: 36481873 PMCID: PMC9840586 DOI: 10.1007/s00701-022-05440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE By using data from the Norwegian Registry for Spine Surgery, we wanted to develop and validate prediction models for non-success in patients operated with anterior surgical techniques for cervical degenerative radiculopathy (CDR). METHODS This is a multicentre longitudinal study of 2022 patients undergoing CDR surgery and followed for 12 months to find prognostic models for non-success in neck disability and arm pain using multivariable logistic regression analysis. Model performance was evaluated by area under the receiver operating characteristic curve (AUC) and a calibration test. Internal validation by bootstrapping re-sampling with 1000 repetitions was applied to correct for over-optimism. The clinical usefulness of the neck disability model was explored by developing a risk matrix for individual case examples. RESULTS Thirty-eight percent of patients experienced non-success in neck disability and 35% in arm pain. Loss to follow-up was 35% for both groups. Predictors for non-success in neck disability were high physical demands in work, low level of education, pending litigation, previous neck surgery, long duration of arm pain, medium-to-high baseline disability score and presence of anxiety/depression. AUC was 0.78 (95% CI, 0.75, 0.82). For the arm pain model, all predictors for non-success in neck disability, except for anxiety/depression, were found to be significant in addition to foreign mother tongue, smoking and medium-to-high baseline arm pain. AUC was 0.68 (95% CI, 0.64, 0.72). CONCLUSION The neck disability model showed high discriminative performance, whereas the arm pain model was shown to be acceptable. Based upon the models, individualized risk estimates can be made and applied in shared decision-making with patients referred for surgical assessment.
Collapse
Affiliation(s)
- Christer Mjåset
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, P.O. Box 4956, 0424, Oslo, Nydalen, Norway.
| | - Tore K Solberg
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and The Norwegian Registry for Spine Surgery (NORspine), The University Hospital of North Norway, Tromsø, Norway
| | - John-Anker Zwart
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, P.O. Box 4956, 0424, Oslo, Nydalen, Norway
| | - Milada C Småstuen
- Department of Rehabilitation and Technology, Faculty of Health Science, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Margreth Grotle
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, P.O. Box 4956, 0424, Oslo, Nydalen, Norway
- Department of Rehabilitation and Technology, Faculty of Health Science, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| |
Collapse
|
8
|
Cha EDK, Lynch CP, Hrynewycz NM, Geoghegan CE, Mohan S, Jadczak CN, Parrish JM, Jenkins NW, Singh K. Spine Surgery Complications in the Ambulatory Surgical Center Setting: Systematic Review. Clin Spine Surg 2022; 35:118-126. [PMID: 34183543 DOI: 10.1097/bsd.0000000000001225] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review study. PURPOSE This study aims to review current literature to determine the rates of complications in relation to spine surgery in ambulatory surgery centers (ASC). BACKGROUND Recent improvements in anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ASC. Despite the benefits and lower costs associated with ASCs, there is inconsistent reporting of complication rates. METHODS This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and PubMed databases using the search string ((("ambulatory surgery center") AND "spine surgery") AND "complications"). Articles were excluded if they did not report outpatient surgery in an ASC, did not define complications, were in a language other than English, were non-human studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series (≤10 patients). The primary outcome was the frequency of complications with respect to various categories. RESULTS Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for 2 studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While 5 studies did not list their surgical technique, studies reported techniques including open (6), minimally invasive surgery (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 0.29% (3/1027), vascular 0.25% (18/7116), pulmonary 0.60% (11/1839), gastrointestinal 1.12% (2/179), musculoskeletal/spine/operative 0.59% (24/4053), urologic 0.80% (2/250), transient neurological 0.67% (31/4616), persistent neurological 0.61% (9/1479), pain related 0.57% (20/3479), and wound site 0.68% (28/4092). CONCLUSIONS After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC spine surgery procedures. The most common complications were gastrointestinal (1.12%) and the most infrequent were vascular (0.25%). Case reports varied significantly with regard to the type and rate of complications reported. This study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Bohl M, Kakarla UK, Chang SW, Sethi R, Farrokhi F, Leveque JC. Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process Improvement. Cureus 2022; 14:e22615. [PMID: 35371809 PMCID: PMC8958152 DOI: 10.7759/cureus.22615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Surgical process improvement strategies are increasingly being applied to specific procedures to improve value. A critical step in any process improvement strategy is the identification of performance benchmarks. Procedure length is a performance benchmark for anterior cervical discectomy and fusion (ACDF) procedures; therefore, we sought to establish reference procedure lengths for 1-level, 2-level, and 3-level ACDFs at both teaching and non-teaching institutions and to describe methods for using this information to advance surgical process improvement initiatives. We performed a retrospective analysis of consecutive ACDFs performed at a resident teaching institution (RT) and a non-teaching institution (NT) for all 1-level, 2-level, and 3-level ACDFs. Mean case lengths and patient outcomes were calculated for individual surgeons and institutions. After limiting cases to 1-level, 2-level, and 3-level ACDFs and applying all exclusion criteria, 991 cases at the RT institution and 131 cases at the NT institution (a total of 1122 cases) were available for analysis. The mean (SD) procedure length for 1-level, 2-level, and 3-level ACDFs at the RT versus NT institutions were 121.9 min (36.3 min) and 73.6 min (29.7 min) (p<0.001), 172.7 min (44.8 min) and 112.0 min (43.0 min) (p<0.001), and 218.3 min (54.9 min) and 167.6 min (54.2 min) (p<0.001), respectively. Thirty-day outcomes were the same between institutions, except that the RT institution had a shorter mean hospital length of stay for 2-level ACDFs (1.6 days versus 2.9 days, p=0.001). This study is the first to attempt to establish a standard reference procedure length for 1-level, 2-level, and 3-level ACDFs. These data can guide efforts in surgical process improvement.
Collapse
|
10
|
Epstein N. Perspective on morbidity and mortality of cervical surgery performed in outpatient/same day/ambulatory surgicenters versus inpatient facilities. Surg Neurol Int 2021; 12:349. [PMID: 34345489 PMCID: PMC8326133 DOI: 10.25259/sni_509_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background: This is an updated analysis of the morbidity and mortality of cervical surgery performed in outpatient/same day (OSD) (Postoperative care unit [PACU] observation 4–6 h), and ambulatory surgicenters (ASC: PACU 23 h) versus inpatient facilities (IF). Methods: We analyzed 19 predominantly level III (retrospective) and IV (case series) studies regarding the morbidity/mortality of cervical surgery performed in OSC/ASC versus IF. Results: A “selection bias” clearly favored operating on younger/healthier patients to undergo cervical surgery in OSD/ASC centers resulting in better outcomes. Alternatively, those selected for cervical procedures to be performed in IF classically demonstrated multiple major comorbidities (i.e. advanced age, diabetes, high body mass index, severe myelopathy, smoking, 3–4 level disease, and other comorbidities) and had poorer outcomes. Further, within the typical 4–6 h. PACU “observation window,” OSD facilities “picked up” most major postoperative complications, and typically showed 0% mortality rates. Nevertheless, the author’s review of 2 wrongful death suits (i.e. prior to 2018) arising from OSD ACDF cervical surgery demonstrated that there are probably many more mortalities occurring following discharges from OSD where cervical operations are being performed that are going underreported/unreported. Conclusion: “Selection bias” favors choosing younger/healthier patients to undergoing cervical surgery in OSD/ ASC facilities resulting in better outcomes. Atlernatively, choosing older patients with greater comorbidities for IF surgery correlated with poorer results. Although most OSD cervical series report 0% mortality rates, a review of 2 wrongful death suits by just one neurosurgeon prior to 2018 showed there are probably many more mortalities resulting from OSD cervical surgery than have been reported.
Collapse
Affiliation(s)
- Nancy Epstein
- Clinical Prof. of Neurosurgery, School of Medicine, State University of New York at Stony Brook, NY, and c/o Dr. Marc Aglulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA
| |
Collapse
|
11
|
Epstein N. Frequency, recognition, and management of postoperative hematomas following anterior cervical spine surgery: A review. Surg Neurol Int 2020; 11:356. [PMID: 33194289 PMCID: PMC7656048 DOI: 10.25259/sni_669_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: We reviewed the frequency, recognition, and management of postoperative hematomas (HT) (i.e. retropharyngeal [RFH], wound [WH], and/or spinal epidural hematomas [SEH]) following anterior cervical discectomy/fusion (ACDF), anterior corpectomy fusion (ACF), and/or anterior cervical spine surgery (ACSS). Methods: Postoperative cervical hematomas following ACDF, ACF, and ACSS ranged from 0.4% to 1.2% in a series of 11 studies involving a total of 44, 030 patients. These included; 4 single case reports, 2 small case series (6 and 30 cases), 4 larger series (758–2375 for a total of 6729 patients), an a large NSQUIP (National Surgical Quality Improvement Program ) Database involving 37,261 ACDF patients. Results: Risk factors contributing to postoperative cervical hematomas included; DISH (diffuse idiopathic skeletal hyperostosis), ossification of the posterior longitudinal ligament (OPLL), therpeutic heparin levels, longer operative times, multilevel surgery, ASA Scores of +/= 3, (American Society of Anesthesiologists), prone surgery, operative times > 4 hours, smoking, higher/lower body mass index (BMI), anemia, age >65, > medical comorbidities, and male gender. Notably, the use of drains did not prevent HT, and did not increase the infection, or reoperation rates. Conclusion: In our review of 11 studies focused on anterior cervical surgery, the incidence of postoperative hematomas ranged from 0.4 to 1.2%. Early recognition of these postoperative hemorrhages, and appropriate management (surgical/non-surgical) are critical to optimize recovery, and limit morbidity, and mortality.
Collapse
Affiliation(s)
- Nancy Epstein
- Clinical Professor of Neurological Surgery, School of Medicine, State University of NY at Stony Brook, New York, United States
| |
Collapse
|
12
|
York PJ, Gang CH, Qureshi SA. Patient education in an ambulatory surgical center setting. JOURNAL OF SPINE SURGERY 2019; 5:S206-S211. [PMID: 31656877 DOI: 10.21037/jss.2019.04.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Philip J York
- Department of Orthopedics, Hospital for Special Surgery, New York, USA
| | | | - Sheeraz A Qureshi
- Department of Orthopedics, Hospital for Special Surgery, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, USA
| |
Collapse
|
13
|
Vaishnav AS, McAnany SJ. Future endeavors in ambulatory spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S139-S146. [PMID: 31656867 DOI: 10.21037/jss.2019.09.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to the high societal and financial burden of spinal disorders, spine surgery is thought to be one of the most impactful targets for healthcare cost reduction. One avenue for cost-reduction that is increasingly being explored not just in spine surgery but across specialties is the performance of surgeries in ambulatory surgery centers (ASCs). Despite potential cost-savings, the utilization of ASCs for spine surgery remains largely limited to high-volume centers in the US, and predominantly for single- or two-level lumbar microdiscectomy and anterior cervical discectomy and fusion (ACDF) procedures. Factors most commonly cited for the lack of wider adoption include the risk of life-threatening complications, paucity of guidelines, and limited accessibility of these procedures to various patient populations. Thus, the future growth and adoption of ambulatory spine surgery depends on addressing these concerns by developing evidence-based guidelines for patient- and procedure selection, creating risk-stratification tools, devising appropriate discharge recommendations, and optimizing care protocols to ensure that safety, efficacy and outcomes are maintained. Other avenues that may allow for more widespread use of ASCs include the use of electronic health tools for post-operative monitoring after discharge from the ASC, increasing accessibility of ambulatory procedures to eligible populations, and identifying systemic inefficiencies and implementing process-improvement measures to optimize patient-selection, scheduling and peri-operative management. The success of ambulatory surgery ultimately depends not only on the surgical procedure, but also on its organization upstream and downstream. It provides an exciting and burgeoning avenue for innovation, cost-reduction and value-creation.
Collapse
Affiliation(s)
| | - Steven J McAnany
- Hospital for Special Surgery, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
14
|
Congnard D, Vincendeau S, Lahjaouzi A, Neau AC, Chaize C, Estèbe JP, Mathieu R, Beloeil H. Outpatient Robot-assisted Radical Prostatectomy: A Feasibility Study. Urology 2019; 128:16-22. [DOI: 10.1016/j.urology.2019.01.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 12/29/2022]
|
15
|
Balogun JA, Kayode Idowu O, Obanisola Malomo A. Challenging the myth of outpatient craniotomy for brain tumor in a Sub-Saharan African setting: A case series of two patients in Ibadan, Nigeria. Surg Neurol Int 2019; 10:71. [PMID: 31528409 PMCID: PMC6744755 DOI: 10.25259/sni-47-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/25/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The concept of modern neuro-oncology hinges on strategic innovation and refinement of procedures with the intention to enhance safety, optimize extent of tumor resection, and improve not only survival but also the quality of life as well. One of such refinements includes same-day hospital admission, as well as early discharge following brain tumor surgeries. The latter has been further stretched to same-day discharge in particular settings to reduce the risk of nosocomial infections, cut brain tumor surgery costs, and improve patients' satisfaction. We highlight the challenges and possible benefits of outpatient craniotomy in a sub-Saharan African setting portrayed by the presence of lean resources and a predominant "out of pocket" health-care financing. CASE DESCRIPTION Outpatient craniotomy was performed in two selected patients harboring intra-axial tumors: a right temporal low-grade glioma and a left frontal metastasis. The clinical outcome proved successful at short- and long-term in both patients; complications related to surgery and same-day discharge were not reported. CONCLUSION Outpatient craniotomy is practicable and safe in resource-challenged environments and can further make brain tumor surgery cost effective and acceptable in carefully selected patients. Further prospective studies in similar settings but involving larger groups of patients are warranted.
Collapse
Affiliation(s)
- James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Adefolarin Obanisola Malomo
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| |
Collapse
|