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Comparison of Cost and Perioperative Outcome Profiles for Primary and Revision Posterior Cervical Fusion Procedures. Spine (Phila Pa 1976) 2021; 46:1295-1301. [PMID: 34517398 DOI: 10.1097/brs.0000000000004019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To compare perioperative outcomes and hospitalization costs between patients undergoing primary or revision posterior cervical discectomy and fusion (PCDF). SUMMARY OF BACKGROUND DATA While prior studies found differences in outcomes between primary and revision anterior cervical discectomy and fusion (ACDF), risk, and outcome profiles for posterior cervical revision procedures have not yet been elucidated. METHODS Institutional records were queried for cases involving isolated PCDF procedures to evaluate preoperative characteristics and outcomes for patients undergoing primary versus revision PCDF between 2008 and 2016. The primary outcome was perioperative complications, while perioperative and resource utilization measures such as hospitalization length, required stay in the intensive care unit (ICU), direct hospitalization costs, and 30-day emergency department (ED) admissions were explored as secondary outcomes. RESULTS One thousand one hundred twenty four patients underwent PCDF, with 218 (19.4%) undergoing a revision procedure. Patients undergoing revision procedures were younger (53.0 vs. 60.5 yrs), but had higher Elixhauser scores compared with the non-revision cohort. Revision cases tended to involve fewer spinal segments (3.6 vs. 4.1 segments) and shorter surgical durations (179.3 vs. 206.3 min), without significant differences in estimated blood loss. There were no significant differences in the overall complication rates (P = 0.20), however, the primary cohort had greater rates of required ICU stays (P = 0.0005) and non-home discharges (P = 0.0003). The revision cohort did experience significantly increased odds of 30-day ED admission (P = 0.04) and had higher direct hospitalization (P = 0.03) and surgical (P < 0.0001) costs. CONCLUSION Complication rates, including incidental durotomy, were similar between primary and revision PCDF cohorts. Although prior surgery status did not predict complication risk, comorbidity burden did. Nevertheless, patients undergoing revision procedures had decreased risk of required ICU stay but greater risk of 30-day ED admission and higher direct hospitalization and surgical costs.Level of Evidence: 3.
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Glauser G, Winter E, Caplan IF, Goodrich S, McClintock SD, Srinivas SK, Malhotra NR. Composite Score for Outcome Prediction in Gynecologic Surgery Patients. J Healthc Qual 2021; 43:163-173. [PMID: 32134807 DOI: 10.1097/jhq.0000000000000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The LACE+ index is a well-studied metric that compacts patient data in an effort to assess readmission risk. PURPOSE Assess the capacity of LACE+ scores for predicting short-term undesirable outcomes in an entire single-center population of patients undergoing gynecologic surgery. IMPORTANCE AND RELEVANCE TO HEALTHCARE QUALITY Proactive identification of high-risk patients, with tools such as the LACE+ index, may serve as the first step toward appropriately engaging resources for reducing readmissions. METHODS This study was a retrospective analysis that used coarsened exact matching. All gynecologic surgery cases over 2 years within a single health system (n = 12,225) were included for analysis. Outcomes of interest were unplanned readmission, emergency room (ER) evaluation, and return to surgery. Composite LACE+ scores were separated into quartiles and matched. For outcome comparison, matched patients were assessed by LACE+ quartile, using Q4 as the reference group. RESULTS Increasing LACE+ score reflected a higher rate of readmission (p = .003, p = .001) and visits to the ER at 30 postoperative days (p < .001). CONCLUSION The data presented here suggest that LACE+ index is a viable metric for patient outcome prediction following gynecologic surgery.
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Predicting short-term outcomes following supratentorial tumor surgery. Clin Neurol Neurosurg 2020; 196:106016. [DOI: 10.1016/j.clineuro.2020.106016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022]
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Winter E, Haldar D, Glauser G, Caplan IF, Shultz K, McClintock SD, Chen HCI, Yoon JW, Malhotra NR. The LACE+ Index as a Predictor of 90-Day Supratentorial Tumor Surgery Outcomes. Neurosurgery 2020; 87:1181-1190. [DOI: 10.1093/neuros/nyaa225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/28/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population.
OBJECTIVE
To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery.
METHODS
LACE+ scores were retrospectively calculated for all patients (n = 624) who underwent surgery for supratentorial tumors at the University of Pennsylvania Health System (2017-2019). Confounding variables were controlled with coarsened exact matching. The frequency of unplanned hospital readmission, ED visits, and death was compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, and Q4).
RESULTS
A total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 and Q4; and 192 patients were matched between Q3 and Q4. Patients with higher LACE+ scores were significantly more likely to be readmitted within 90 d (90D) of discharge for Q1 vs Q4 (21.88% vs 46.88%, P = .005) and Q2 vs Q4 (27.03% vs 55.41%, P = .001). Patients with larger LACE+ scores also had significantly increased risk of 90D ED visits for Q1 vs Q4 (13.33% vs 30.00%, P = .027) and Q2 vs Q4 (22.54% vs 39.44%, P = .039). LACE+ score also correlated with death within 90D of surgery for Q2 vs Q4 (2.63% vs 15.79%, P = .003) and with death at any point after surgery/during follow-up for Q1 vs Q4 (7.46% vs 28.36%, P = .002), Q2 vs Q4 (15.79% vs 31.58%, P = .011), and Q3 vs Q4 (18.75% vs 31.25%, P = .047).
CONCLUSION
LACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.
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Affiliation(s)
- Eric Winter
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debanjan Haldar
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian F Caplan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kaitlyn Shultz
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Han-Chiao Isaac Chen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania
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The LACE+ Index as a Predictor of 30-Day Patient Outcomes in a Plastic Surgery Population: A Coarsened Exact Match Study. Plast Reconstr Surg 2020; 146:296e-305e. [DOI: 10.1097/prs.0000000000007064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Glauser G, Osiemo B, Goodrich S, McClintock SD, Weber KL, Levin LS, Malhotra NR. Assessment of Short-Term Patient Outcomes Following Overlapping Orthopaedic Surgery at a Large Academic Medical Center. J Bone Joint Surg Am 2020; 102:654-663. [PMID: 32058352 DOI: 10.2106/jbjs.19.00554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Overlapping surgery is a long-standing practice that has not been well studied. The aim of this study was to assess whether overlapping surgery is associated with untoward outcomes for orthopaedic patients. METHODS Coarsened exact matching was used to assess the impact of overlap on outcomes among elective orthopaedic surgical interventions (n = 18,316) over 2 years (2014 and 2015) at 1 health-care system. Overlap was categorized as any overlap, and subcategories of exclusively beginning overlap and exclusively end overlap. Study subjects were matched on the Charlson comorbidity index score, duration of surgery, surgical costs, body mass index, length of stay, payer, and race, among others. Serious unanticipated events were studied. RESULTS A total of 3,395 patients had any overlap and were matched (a match rate of 90.8% of 3,738). For beginning and end overlap, matched groups were created, with a match rate of 95.2% of 1043 and 94.7% of 863, respectively. Among matched patients, any overlap did not predict an unanticipated return to surgery at 30 days (8.2% for any overlap and 8.3% for no overlap; p = 0.922) or 90 days (14.1% and 14.1%, respectively; p = 1.000). Patients who had surgery with any overlap demonstrated no difference compared with controls with respect to reoperation, readmission, or emergency room (ER) visits at 30 or 90 days (a reoperation rate of 3.1% and 3.2%, respectively [p = 0.884] at 30 days and 4.2% and 3.5% [p = 0.173] at 90 days; a readmission rate of 10.3% and 11.0% [p = 0.352] at 30 days and 5.5% and 5.2% [p = 0.570] at 90 days; and an ER visit rate of 5.2% and 4.6% [p = 0.276] at 30 days and 4.8% and 4.3% [p = 0.304] at 90 days). Patients with surgical overlap showed reduced mortality compared with controls during follow-up (1.8% and 2.6%, respectively; p = 0.029). Patients with beginning and/or end overlap had a similar lack of association with serious unanticipated events; however, patients with end overlap showed an increased unexpected rate of return to the operating room after reoperation at 90 days (13.3% versus 9.7%; p = 0.015). CONCLUSIONS Nonconcurrent overlapping surgery was not associated with adverse outcomes in a large, matched orthopaedic surgery population across 1 academic health system. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gregory Glauser
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Stephen Goodrich
- McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Kristy L Weber
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L Scott Levin
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Glauser G, Goodrich S, McClintock SD, Szeto WY, Atluri P, Acker MA, Malhotra NR. Association of overlapping cardiac surgery with short-term patient outcomes. J Thorac Cardiovasc Surg 2020; 162:155-164.e2. [PMID: 32014329 DOI: 10.1016/j.jtcvs.2019.11.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study seeks to assess the safety of overlap in cardiac surgery. METHODS Coarsened exact matching was used to assess the impact of overlap on outcomes among cardiac surgical interventions (n = 4463) over 2 years (2014-2016). Overlap was categorized as any, beginning, or end overlap. Study subjects were matched 1:1 on 11 variables, including Charlson comorbidity score, surgical costs, body mass index, length of postoperative hospitalization, and race, among others. Serious unanticipated events were studied, including readmission, unplanned return to the operating room, and mortality. RESULTS A total of 984 patients had any overlap and were matched to similar patients without overlap (n = 1501). For beginning/end overlap, separate matched groups were created (n = 462, n = 329 patients, respectively). Among matched patients, any overlap did not predict unanticipated return to surgery at 30 or 90 days. Any overlap did not predict increased readmission, reoperation, or emergency department visits at 30 or 90 days. Overlap did not predict higher rates of death over follow-up. Beginning/end overlap had results similar to any overlap. CONCLUSIONS Nonconcurrent, overlapping surgery is not associated with an increase in adverse outcomes in a large, matched cardiac surgery population.
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Stephen Goodrich
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pa; The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pa
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Michael A Acker
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
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Association of Overlapping, Nonconcurrent, Surgery With Patient Outcomes at a Large Academic Medical Center. Ann Surg 2019; 270:620-629. [DOI: 10.1097/sla.0000000000003494] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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