1
|
Spece H, Khachatryan A, Phillips FM, Lanman TH, Andersson GB, Garrigues GE, Bae H, Jacobs JJ, Kurtz SM. Presentation and management of infection in total disc replacement: A review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100320. [PMID: 38590972 PMCID: PMC10999484 DOI: 10.1016/j.xnsj.2024.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
Background Total disc replacement (TDR) is widely used in the treatment of cervical and lumbar spine pathologies. Although TDR infection, particularly delayed infection, is uncommon, the results can be devastating, and consensus on clinical management remains elusive. In this review of the literature, we asked: (1) What are the reported rates of TDR infection; (2) What are the clinical characteristics of TDR infection; and (3) How has infection been managed for TDR patients? Methods We performed a search of the literature using PubMed and Embase to identify studies that reported TDR infection rates, the identification and management of TDR infection, or TDR failures with positive cultures. Twenty database studies (17 focusing on the cervical spine and 3 on the lumbar spine) and 10 case reports representing 15 patients were reviewed along with device Summary of Safety and Effectiveness Data reports. Results We found a lack of clarity regarding how infection was diagnosed, indicating a variation in clinical approach and highlighting the need for a standard definition of TDR infection. Furthermore, while reported infection rates were low, the absence of a clear definition prevented robust data analysis and may contribute to underreporting in the literature. We found that treatment strategy and success rely on several factors including patient symptoms and time to onset, microorganism type, and implant positioning/stability. Conclusions Although treatment strategies varied throughout the extant literature, common practices in eliminating infection and reconstructing the spine emerged. The results will inform future work on the creation of a more robust definition of TDR infection and as well as recommendations for management.
Collapse
Affiliation(s)
- Hannah Spece
- Drexel University Implant Research Core, 3401 Market St., Suite 345, Philadelphia, PA, 19104, USA
| | - Armen Khachatryan
- The Disc Replacement Center, 3584 W 9000 S Suite 209, Salt Lake City, UT 84088, USA
| | - Frank M. Phillips
- Division of Spine Surgery, Rush University Medical Center, 1611 W Harrison St. #400, Chicago, IL 60612, USA
| | - Todd H. Lanman
- Lanman Spinal Neurosurgery, 450 N Roxbury Dr., 3rd Floor, Beverly Hills, CA 90210, USA
| | - Gunnar B.J. Andersson
- Department of Orthopedic Surgery, Rush University, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Grant E. Garrigues
- Department of Orthopedic Surgery, Rush University, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Hyun Bae
- Cedars-Sinai Spine Center, 444 S San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Steven M. Kurtz
- Drexel University Implant Research Core, 3401 Market St., Suite 345, Philadelphia, PA, 19104, USA
| |
Collapse
|
2
|
Dhanjani SA, Gomez G, Rogers D, LaPorte D. Are There Racial and Ethnic Disparities in Management and Outcomes of Surgically Treated Distal Radius Fractures? Hand (N Y) 2024; 19:471-480. [PMID: 36196925 PMCID: PMC11067843 DOI: 10.1177/15589447221124248] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Racial/ethnic disparities have been demonstrated across multiple orthopedic sub-specialties. There is a paucity of literature examining disparities in distal radius fracture (DRF) management. METHODS Using the National Surgical Quality Improvement Program database, we analyzed 15 559 non-Hispanic (NH) White, NH Black, NH Asian, and Hispanic adults who underwent open reduction and internal fixation for DRF from 2013 to 2019. We evaluated time from hospital admission to surgery and length of stay using Poisson regression. Deep venous thrombosis, pulmonary embolism (PE), and wound complications were reported using descriptive statistics. Thirty-day reoperation and readmission were analyzed using binary logistic regression. RESULTS Wait time to surgery was longer for Hispanic patients than NH White patients (incidence rate ratio [IRR]: 2.54, P < .001); this narrowed over time (IRR: 0.944, P = .047). Length of stay was longer for NH Black (IRR: 1.78, P < .001) and Hispanic patients (IRR: 1.83, P < .001), but shorter for NH Asian (IRR: 0.715, P = .019) than NH White patients; this temporally narrowed for NH Black patients (IRR: 0.908, P = .001). Deep venous thrombosis, PE, and wound complications occurred at a rate less than 0.30% across all groups. Hispanic patients were less likely to undergo reoperation than NH White patients (odds ratio [OR]: 0.254, P = .003). While there was no difference in readmission between groups in the aggregated study period, NH Black patients experienced a temporal increase in readmissions relative to NH White patients (OR: 1.40, P = .038). CONCLUSIONS Racial and ethnic disparities exist in DRF management. Further investigation on causes for and solutions to combat these disparities in DRF care may help improve the inequities observed.
Collapse
Affiliation(s)
| | - Gabriela Gomez
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Davis Rogers
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dawn LaPorte
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Nunna RS, Ansari D, Ostrov PB, Dettori JR, Godolias P, Ortiz-Torres M, Elias E, Gruber M, Oskouian RJ, Chapman JR. The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:242-253. [PMID: 36367824 PMCID: PMC9837502 DOI: 10.1177/21925682221110127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Determine if tobacco use is associated with increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery. METHODS Databases were queried to identify cohort studies that directly compared smokers with non-smokers and provided the absolute number of adverse events and the population at risk. Data quality was evaluated using the Quality in Prognosis Studies tool. Risk ratios (RR) and 95% confidence intervals were calculated and compared between studies. The grading of recommendation, assessment, development and evaluation (GRADE) criteria were used to assess the strength of the evidence. RESULTS Seventeen studies assessing 37 897 participants met the inclusion criteria. Of these, 10 031 (26.5%) were smokers and 27 866 (73.5%) were nonsmokers. The mean age for the study population was 58 years, and 45% were males. Smoking was not associated with increased risk of one or more major adverse events within 90 days following spine surgery (seven studies, pooled RR 1.13, 95% CI [.75-1.71], I2 = 41%). However, smoking was significantly associated with one or more major adverse events in ≤2 level fusion (three studies, pooled RR 2.46, 95% CI [1.18-5.12], I2 = 0%), but not in fusions of ≥3 levels (four studies, pooled RR .87, 95% CI [.70-1.08], I2 = 0%). Additionally, there was no statistically significant association between smoking and any adverse event, nor increased reoperation risk due to adverse events. CONCLUSIONS In this meta-analysis, tobacco use was not associated with a statistically significant increased risk of adverse events within 90 days in patients undergoing spinal fusion surgery. Our results are limited by the variable reporting methodology for both complication rates as well as smoking incidence between the included individual studies.
Collapse
Affiliation(s)
- Ravi S. Nunna
- Department of Neurosurgery, University of Missouri, Columbia, MO, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at
Chicago, Chicago, IL, USA
| | - Philip B. Ostrov
- Department of Neurosurgery, University of Illinois at
Chicago, Chicago, IL, USA
| | | | | | | | - Elias Elias
- Department of Neurosurgery, University of
Texas-Southwestern, Dallas, TX, USA
| | - Max Gruber
- Elson S. Floyd College of
Medicine, Spokane, WA, USA
| | | | | |
Collapse
|
4
|
Cui P, Wang P, Wang J, Liu X, Kong C, Lu S. The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis. Clin Interv Aging 2022; 17:1297-1306. [PMID: 36046544 PMCID: PMC9422991 DOI: 10.2147/cia.s378327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age. Methods We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications. Results A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients. Conclusion After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.
Collapse
Affiliation(s)
- Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Jialin Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Xu Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
- Correspondence: Chao Kong; Shibao Lu, Email ;
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People’s Republic of China
| |
Collapse
|