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Nin DZ, Chen YW, Kim DH, Niu R, Powers A, Chang DC, Hwang RW. Health Care Costs Following Anterior Cervical Discectomy and Fusion or Cervical Disc Arthroplasty. Spine (Phila Pa 1976) 2024; 49:530-535. [PMID: 38192187 DOI: 10.1097/brs.0000000000004917] [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: 10/16/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Observational cohort study. OBJECTIVE To describe the postoperative costs associated with both anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in the two-year period following surgery. SUMMARY OF BACKGROUND DATA CDA has become an increasingly common alternative to ACDF for the treatment of cervical disc disorders. Although a number of studies have compared clinical outcomes between both procedures, much less is known about the postoperative economic burden of each procedure. MATERIALS AND METHODS By analyzing a commercial insurance claims database (Marketscan, Merative), patients who underwent one-level or two-level ACDF and CDA procedures between January 1, 2017 and December 31, 2017 were identified and included in the study. The primary outcome was the cost of payments for postoperative management in the two-year period following ACDF or CDA. Identified postoperative interventions included in the study were: (i) physical therapy, (ii) pain medication, (iii) injections, (iv) psychological treatment, and (iv) subsequent spine surgeries. RESULTS Totally, 2304 patients (age: 49.0±9.4 yr; male, 50.1%) were included in the study. In all, 1723 (74.8%) patients underwent ACDF, while 581 (25.2%) underwent CDA. The cost of surgery was similar between both groups (ACDF: $26,819±23,449; CDA: $25,954±20,620; P =0.429). Thirty-day, 90-day, and two-year global costs were all lower for patients who underwent CDA compared with ACDF ($31,024 vs. $34,411, $33,064 vs. $37,517, and $55,723 vs. $68,113, respectively). CONCLUSION Lower two-year health care costs were found for patients undergoing CDA compared with ACDF. Further work is necessary to determine the drivers of these findings and the associated longer-term outcomes.
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Affiliation(s)
- Darren Z Nin
- Department of Orthopedic Surgery, New England Baptist Hospital
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School
| | - David H Kim
- Department of Orthopedic Surgery, New England Baptist Hospital
- Tufts University School of Medicine
| | - Ruijia Niu
- Department of Orthopedic Surgery, New England Baptist Hospital
| | - Andrew Powers
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Raymond W Hwang
- Department of Orthopedic Surgery, New England Baptist Hospital
- Tufts University School of Medicine
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Touponse G, Theologitis M, Beach I, Rangwalla T, Li G, Zygourakis C. Socioeconomic Influence on Cervical Fusion Outcomes. Clin Spine Surg 2024; 37:E65-E72. [PMID: 37691156 DOI: 10.1097/bsd.0000000000001533] [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: 08/29/2022] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE The aim of this study was to compare postoperative outcomes following cervical fusion based on socioeconomic status (SES) variables including race, education, net worth, and homeownership status. SUMMARY OF BACKGROUND DATA Previous studies have demonstrated the effects of patient race and income on outcomes following cervical fusion procedures. However, no study to date has comprehensively examined the impact of multiple SES variables. We hypothesized that race, education, net worth, and homeownership influence important outcomes following cervical fusion. MATERIALS AND METHODS Optum's de-identified Clinformatics Data Mart (CDM) database was queried for patients undergoing first-time inpatient cervical fusion from 2003 to 2021. Patient demographics, SES variables, and the Charlson comorbidity index were obtained. Primary outcomes were hospital length of stay and 30-day rates of reoperation, readmission, and postoperative complications. Secondary outcomes included postoperative emergency room visits, discharge status, and total hospital charges. RESULTS A total of 111,914 patients underwent cervical spinal fusion from 2003 to 2021. Multivariate analysis revealed that after controlling for age, sex, and Charlson comorbidity index, Black race was associated with a higher rate of 30-day readmissions [odds ratio (OR): 1.11, 95% CI: 1.03-1.20]. Lower net worth (vs. >$500K) and renting (vs. owning a home) were significantly associated with both higher rates of 30-day readmissions (OR: 1.29, 95% CI: 1.17-1.41; OR: 1.34, 95% CI: 1.22-1.49), and emergency room visits (OR: 1.29, 95% CI: 1.18-1.42; OR: 1.11, 95% CI: 1.00-1.23). Lower net worth (vs. >$500K) was also associated with increased complications (OR: 1.22, 95% CI: 1.14-1.31). CONCLUSION Socioeconomic variables, including patient race, education, and net worth, influence postoperative metrics in cervical spinal fusion surgery. Future studies should focus on developing and implementing targeted interventions based on patient SES to reduce disparity.
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Affiliation(s)
- Gavin Touponse
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | | | - Isidora Beach
- Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Taiyeb Rangwalla
- Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Guan Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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Ottesen TD, Bagi PS, Malpani R, Galivanche AR, Varthi AG, Grauer JN. Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100041. [PMID: 35141608 PMCID: PMC8820029 DOI: 10.1016/j.xnsj.2020.100041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
Background Body Mass Index (BMI) is a weight-for-height metric that is used to quantify tissue mass and weight levels. Past studies have mainly focused on the association of high BMI on spine surgery outcomes and shown variable conclusions. Prior results may have varied due to insufficient power or inconsistent categorical separation of BMI groups (e.g. underweight, overweight, or obese). Additionally, few studies have considered outcomes of patients with low BMI. The aim of the current study was to analyze patients along the entirety of the BMI spectrum and to establish specific granular BMI categories for which patients become at risk for complication and mortality following posterior cervical spine surgery. Methods Patients undergoing elective posterior cervical spine surgery were abstracted from the 2005–2016 National Surgical Quality Improvement Program (NSQIP) databases. Patients were aggregated into pre-established WHO BMI categories and adverse outcomes were normalized to average risk of normal-weight subjects (BMI 18.5–24.9 kg/m2). Risk-adjusted multivariate regressions were performed controlling for patient demographics and overall health. Results A total of 16,806 patients met inclusion criteria. Odds for adverse events for underweight patients (BMI < 18.5 kg/m2) were the highest among any category of patients along the BMI spectrum. These patients experienced increased odds of any adverse event (Odds Ratio (OR) = 1.67, p = 0.008, major adverse events (OR=2.08, p = 0.001), post-operative infection (OR = 1.95, p = 0.002), and reoperation (OR = 1.84, p = 0.020). Interestingly, none of the overweight or obese categories were found to be correlated with increased risk of adverse event categories other than super-morbidly obese patients (BMI>50.0 kg/m2) for post-operative infection (OR = 1.54, p = 0.041). Conclusions The current study found underweight patients to have the highest risk of adverse events after posterior cervical spine surgery. Increased pre-surgical planning and resource allocation for this population should be considered by physicians and healthcare systems, as is often already done for patients on the other end of the BMI spectrum.
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Bregman DE, Cook T, Thorne C. Estimated National and Regional Impact of COVID-19 on Elective Case Volume in Aesthetic Plastic Surgery. Aesthet Surg J 2021; 41:358-369. [PMID: 32729892 PMCID: PMC7454284 DOI: 10.1093/asj/sjaa225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background In efforts to help alleviate the strain placed on healthcare during the COVID-19 pandemic, The American Society of Plastic Surgery (ASPS) recommended suspending elective procedures on March 19, 2020. When this suspension was enacted, it was unknown when cases would resume. Objectives This analysis aims to estimate the regional economic impact of the pandemic specifically with regards to elective, aesthetic surgical procedures. As knowledge regarding the effects of the pandemic has grown, the authors then evaluated the accuracy of our projected estimates when compared to actual events. Methods Using the ASPS 2018 Plastic Surgery Statistics Report, regional case volume and surgeons’ fees were obtained for the top five aesthetic procedures. Models developed by the Institute for Health Metrics and Evaluation (IHME) were used to estimate the anticipated duration of suspension by using the date that no ventilators would be required to for COVID-19 patients. This duration was used to calculate the volume of cases that would not occur. Results These estimates predict up to 1.3 billion fewer dollars will be collected in surgeons’ fees, representing a 20% loss compared to 2018. The South Atlantic region is predicted to have the greatest number of OR days lost; However, the Mountain and Pacific regions are estimated to have the greatest loss in case volume and surgeons’ fees. Conclusions The cumulative impact of the pandemic on life, society, and the economy is tremendous. This analysis may help guide surgeons’ responses during and after the crisis.
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Affiliation(s)
- Dana E Bregman
- Division of Plastic and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Tracey Cook
- Division of Plastic and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Charles Thorne
- Division of Plastic and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
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Neifert SN, Martini ML, Yuk F, McNeill IT, Caridi JM, Steinberger J, Oermann EK. Predicting Trends in Cervical Spinal Surgery in the United States from 2020 to 2040. World Neurosurg 2020; 141:e175-e181. [PMID: 32416237 DOI: 10.1016/j.wneu.2020.05.055] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to predict surgical volumes for 2 common cervical spine procedures from 2020 to 2040. METHODS Using the National Inpatient Sample from 2003-2016, nationwide estimates of anterior cervical diskectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) volumes were calculated using International Classification of Diseases, Ninth and Tenth Revision (ICD-9, ICD-10) procedure codes. With data from the U.S. Census Bureau, estimates of the U.S. population were used to create Poisson models controlling for age and sex. Age was categorized into ranges (<25 years old, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and >85), and estimates of surgical volume for each age group were created. RESULTS From 2020-2040, increases in surgical volume from 13.3% (153,288-173,699) and 19.3% (29,620-35,335) are expected for ACDF and PCDF, respectively. For ACDF, the largest increases are expected in the 45-54 (42,077-49,827) and 75-84 (8065-14,862) age groups, whereas for PCDF, the largest increases will be seen in the 75-84 (3710-6836) age group. In accordance with an aging population, modest increases will be seen for ACDF (858-1847) and PCDF (730-1573) in the >85-year-old cohort. CONCLUSIONS As expected, large growth in cervical spine surgical volumes is likely to be seen, which could indicate a need for increased numbers of spinal neurosurgeons and orthopedic surgeons. Further studies are needed to investigate the needs of the field in light of these expected increases in volume.
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Affiliation(s)
- Sean N Neifert
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Michael L Martini
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Frank Yuk
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Eric Karl Oermann
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
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National Trends and Complications in the Surgical Management of Ossification of the Posterior Longitudinal Ligament (OPLL). Spine (Phila Pa 1976) 2019; 44:1550-1557. [PMID: 31232979 DOI: 10.1097/brs.0000000000003127] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective database analysis. OBJECTIVE The aim of this study was to analyze US trends in surgical approaches for ossification of the posterior longitudinal ligament (OPLL); and to compare US patient and hospital characteristics, length of stay, total charges, and 30-day complications by surgical approach in OPLL management. SUMMARY OF BACKGROUND DATA A robust literature on surgical management of OPLL in East Asian countries, where OPLL has a higher prevalence, exists. However, there is a paucity of literature evaluating the surgical management of OPLL in non-Asian countries. METHODS Using the Nationwide Inpatient Sample (NIS), we identified surgically treated OPLL patients from 2003 to 2014. Data on patient characteristics, surgical approaches, complications, hospital characteristics, length of stay, and hospital charges were extracted and analyzed. Analysis of variance (ANOVA) and Chi-squared tests were used to assess variation across categorical variables. Linear regression was used to evaluate the trend of surgical management for OPLL over the study timeframe. RESULTS Five thousand two hundred twelve patients fit our inclusion criteria. The overall complication rate was 21.5%, but the highest complication rate was for patients undergoing a combined anterior-posterior decompression/fusion (44.7%). Patients undergoing a combined anterior-posterior decompression/fusion had a longer length of stay and higher total charges (P < 0.01). Overall, surgical OPLL cases significantly increased from 2003 to 2014 (336-920; P < 0.01). CONCLUSION To our knowledge, this is the largest study examining the surgical treatment of OPLL in a non-Asian country. OPLL surgical cases increased over the study timeframe and the overall surgical complication rate was 21.5%. The percentage of Asians or Pacific Islanders with OPLL undergoing surgical intervention was 10.8%, which is higher than the prevalence in the US population (4.9%). This suggests a potential genetic component to OPLL. Future work is warranted to determine how best to decrease the high complication rate. LEVEL OF EVIDENCE 4.
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Li HZ, Lin Z, Li ZZ, Yang ZY, Zheng Y, Li Y, Lu HD. Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:441. [PMID: 30596071 DOI: 10.21037/atm.2018.10.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The relationship between surgeon volume and outcomes in spine surgery is unclear and published studies report inconsistent results. Therefore, a dose-response meta-analysis was conducted to clarify the influence of surgeon volume on outcomes in spine surgery. Methods PubMed, Embase, and The Cochrane Library were systematically searched without language limitation for observational studies which investigated the relationship between surgeon volume and outcomes in spine surgery. The primary outcome was postoperative morbidity and the secondary outcomes consisted of mortality, length of hospital stay, readmission, and hospital costs. For binary variable and continuous variable, odds ratios (ORs) with 95% CIs and weighted mean differences (WMDs) with 95% CIs were pooled respectively. Additionally, a dose-response meta-analysis was performed for the primary outcome. Results Eleven studies with 1,986,545 patients were included in the current meta-analysis. Pooled estimate indicated that a higher surgeon volume was associated with lower postoperative morbidity (OR, 0.62; 95% CI: 0.52-0.75; I2=93.9%), lower mortality (OR, 0.76; 95% CI: 0.66-0.87; I2=0), shorter length of hospital stay (WMD, -7.07; 95% CI: -7.08 to -7.06; I2=100%), less readmission (OR, 0.78; 95% CI: 0.72-0.85; I2=93.1%), and lower hospital costs (WMD, -25,497.47; 95% CI: -25,528.43 to -25,466.51; I2=100%). Dose-response analysis suggested a nonlinear relationship between surgeon volume and postoperative morbidity (P for nonlinearity less than 0.00001). Conclusions The current evidence indicate that higher surgeon volume is associated with lower morbidity and mortality, shorter length of hospital stay, less readmission, and lower hospital costs in spine surgery.
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Affiliation(s)
- Hui-Zi Li
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Zhong Lin
- Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.,Center for Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Zong-Ze Li
- Department of Orthopaedics, The People's Hospital of Ruijin City, Ruijin 342500, China
| | - Zeng-Yan Yang
- Department of Orthopaedics, The People's Hospital of Ruijin City, Ruijin 342500, China
| | - Yang Zheng
- Department of General Surgery, the Fourth Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yong Li
- Department of Orthopaedics, The People's Hospital of Ruijin City, Ruijin 342500, China
| | - Hua-Ding Lu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
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DE LA Garza Ramos R, Nakhla J, Bhashyam N, Ammar AE, Scoco AN, Kinon MD, Yassari R. Trends in the Use of Bone Morphogenetic Protein-2 in Adult Spinal Deformity Surgery: A 10-Year Analysis of 54 054 Patients. Int J Spine Surg 2018; 12:453-459. [PMID: 30276105 DOI: 10.14444/5054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusion surgery. The purpose of this study is to investigate the trends of BMP-2 utilization in adult spinal deformity (ASD) surgery. Methods The Nationwide Inpatient Sample database from 2002 to 2011 was reviewed. Inclusion criteria were patients over 18 years of age who underwent spinal fusion for ASD. Trends of BMP-2 use were examined over time, as well as stratified based on patient and surgical characteristics. All analyses were done after application of discharge weights to produce national estimates. Results There were 54 054 patients who met inclusion criteria and were included in this study. The overall rate of BMP-2 use was 39.7% (95% confidence interval 35.0%- 44.3%). Overall, there was steady increase in its use over time, with the highest peak in 2009 (55.3% of all cases used BMP-2), and then a decrease up to 37.9% in 2011 (P < .001). The rate of BMP-2 use was significantly higher for patients older than 54 years of age (compared to patients <54, P < .001). It was also higher in females (P = .009), Caucasian patients (P = .006), and Medicare patients (P = .006). Its use was 28.6% in the Northeast, 38.1% in the South, 45.2% in the Midwest, and 48.2% in the West (P = .035). Circumferential procedures had the highest rate of BMP-2 use (44.3%, P = .045). Average total hospital charges were $152,403 ± 117,454 for patients who did not receive BMP-2 and $205,426 ± 137,561 for patients who did (P < .001). Conclusion After analysis of a large nationwide database, it was found that the rate of BMP-2 use in ASD surgery is approximately 40%. There was a significant increase in use from 2002 to 2009, and a decrease thereafter. The highest rates of use were found in older patients, female patients, white patients, Medicare patients, circumferential approaches, and patients undergoing surgery in the Midwest and West regions.
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Affiliation(s)
- Rafael DE LA Garza Ramos
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Nakhla
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Niketh Bhashyam
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Adam E Ammar
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Aleka N Scoco
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Merrit D Kinon
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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McLynn RP, Ondeck NT, Cui JJ, Swanson DR, Shultz BN, Bovonratwet P, Grauer JN. The Rothman Index as a predictor of postdischarge adverse events after elective spine surgery. Spine J 2018; 18:1149-1156. [PMID: 29155251 DOI: 10.1016/j.spinee.2017.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/02/2017] [Accepted: 11/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Rothman Index (RI) is a comprehensive rating of overall patient condition in the hospital setting. It is used at many medical centers and calculated based on vital signs, laboratory values, and nursing assessments in the electronic medical record. Previous research has demonstrated an association with adverse events, readmission, and mortality in other fields, but it has not been investigated in spine surgery. PURPOSE The present study aims to determine the potential utility of the RI as a predictor of adverse events after discharge following elective spine surgery. STUDY DESIGN/SETTING This retrospective cohort study was carried out at a large academic medical center. PATIENT SAMPLE A total of 2,687 patients who underwent elective spine surgery between 2013 and 2016 were included in the present study. OUTCOME MEASURES The occurrence of adverse events and readmission after discharge from the hospital, within postoperative day 30, was determined in the present study. METHODS Patient characteristics and 30-day perioperative outcomes were characterized, with events being classified as "major adverse events" or "minor adverse events" using standardized criteria. Rothman Index scores from the hospitalization were analyzed and compared for those who did or did not experience adverse events after discharge. The association of lowest and latest scores on adverse events was determined with multivariate regression, controlling for demographics, comorbidities, surgical procedure, and length of stay. RESULTS Postdischarge adverse events were experienced by 7.1% of patients. The latest and lowest RI values were significantly inversely correlated with any adverse events, major adverse events, minor adverse events and readmissions after controlling for age, gender, body mass index, American Society of Anesthesiologists (ASA) class, surgical site, and hospital length of stay. Rates of readmission and any adverse event consistently had an inverse correlation with lowest and latest RI scores, with patients at increased risk with lowest score below 65 or latest score below 85. CONCLUSIONS The RI is a tool that can be used to predict postdischarge adverse events after elective spine surgery that adds value to commonly used indices such as patient demographics and ASA. It is found that this can help physicians identify high-risk patients before discharge and should be able to better inform clinical decisions.
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Affiliation(s)
- Ryan P McLynn
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St., New Haven, CT 06510, USA
| | - Nathaniel T Ondeck
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St., New Haven, CT 06510, USA
| | - Jonathan J Cui
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St., New Haven, CT 06510, USA
| | - David R Swanson
- Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
| | - Blake N Shultz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St., New Haven, CT 06510, USA
| | - Patawut Bovonratwet
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St., New Haven, CT 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St., New Haven, CT 06510, USA.
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Clinical effectiveness of treatment of combined upper thoracic spinal stenosis and multilevel cervical spinal stenosis with different posterior decompression surgeries. Int J Surg 2018. [PMID: 29535014 DOI: 10.1016/j.ijsu.2018.02.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore the clinical effectiveness of various posterior decompression surgeries in the treatment of upper thoracic spinal stenosis combined with multilevel cervical spinal stenosis. METHODS From January 2010 to December 2015, 22 consecutive patients with combined upper thoracic spinal stenosis and multilevel cervical spinal stenosis were treated with two different approaches of posterior decompression surgeries. In group A with 10 patients, both cervical and thoracic spinal decompression surgeries were performed simultaneously (one-stage surgery); in group B with 8 patients, cervical and thoracic spinal decompression surgeries were performed separately within three months (two-stage surgery). Based on Japanese Orthopedic Association (JOA) scores, improvement rate and extent of neurological function were calculated and the difference was compared between the two groups. RESULTS There was no significant difference in demographic data between the two groups. However, compared with those of group B, both short-term and long-term improvement rate of neurological function in group A was higher (P < 0.05). In addition, the hospitalization cost was also lower in group A. CONCLUSION Both one-stage and two-stage posterior decompression surgeries were effective in treating patient with upper thoracic spinal stenosis combined with multilevel cervical spinal stenosis; however, one-stage combined surgery was superior to two-stage surgery.
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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