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Baker SC, Lucasti C, Graham BC, Scott MM, Vallee EK, Kowalski D, Patel DV, Hamill CL. Predicting Complications in 153 Lumbar Pedicle Subtraction Osteotomies by a Single Surgeon Over a 6-Year Period. J Am Acad Orthop Surg 2024; 32:e930-e939. [PMID: 38787893 DOI: 10.5435/jaaos-d-23-01263] [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: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Pedicle subtraction osteotomy (PSO) is a complex surgical procedure that provides correction of moderate sagittal imbalance. Surgical complications have adverse effects on patient outcomes and healthcare costs, making it imperative for clinical researchers to focus on minimizing complications. However, when it comes to risk modeling of PSO surgery, there is currently no consensus on which patient characteristics or measures should be used. This study aimed to describe complications and compare the performance of various sociodemographic characteristics, surgical variables, and established risk indices in predicting postoperative complications, infections, and readmissions after lumbar PSO surgeries. METHODS A review was conducted on 191 patients who underwent PSO surgery at a single institution by a single fellowship-trained orthopaedic spine surgeon between January 1, 2018, and December 31, 2021. Demographic, intraoperative, and postoperative data within 30 days, 1 year, and 2 years of the index procedure were evaluated. Descriptive statistics, t -test, chi-squared analysis, and logistic regression models were used. RESULTS Intraoperative complications were significantly associated with coronary artery disease (odds ratios [OR] 3.95, P = 0.03) and operating room time (OR 1.01, P = 0.006). 30-day complications were significantly cardiovascular disease (OR 2.68, P = 0.04) and levels fused (OR 1.10, P = 0.04). 2-year complications were significantly associated with cardiovascular disease (OR 2.85, P = 0.02). 30-day readmissions were significantly associated with sex (4.47, 0.04) and length of hospital stay (χ 2 = 0.07, P = 0.04). 2-year readmissions were significantly associated with age (χ 2 = 0.50, P = 0.03), hypertension (χ 2 = 4.64, P = 0.03), revision surgeries (χ 2 = 5.46, P = 0.02), and length of hospital stay (χ 2 = 0.07, P = 0.03). DISCUSSION This study found that patients with coronary vascular disease and longer fusions were at higher risk of postoperative complications and patients with notable intraoperative blood loss were at higher risk of postoperative infections. In addition, physicians should closely follow patients with extended postoperative hospital stays, with advanced age, and undergoing revision surgery because these patients were more likely to be readmitted to the hospital.
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Affiliation(s)
- Seth C Baker
- From the Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (Baker, Graham, Scott, and Vallee), and the UBMD Orthopaedics and Sports Medicine Doctors, Buffalo, NY (Lucasti, Kowalski, Patel, and Hamill)
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Aguilera C, Wong G, Khan Z, Pivazyan G, Breton JM, Lynes J, Deshmukh VR. Patient outcomes after implementation of transitional care protocols in elective neurosurgery: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:362. [PMID: 39060496 DOI: 10.1007/s10143-024-02612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE 30-day readmissions are a significant burden on the healthcare system. Postoperative transitional care protocols (TCPs) for safe and efficient discharge planning are being more widely adopted to reduce readmission rates. Currently, little evidence exists to justify the utility of TCPs for improving patient outcomes in elective neurosurgery. The objective of this systematic review was to determine the extent to which TCPs reduce adverse outcomes in patients undergoing elective neurosurgical procedures. MATERIALS AND METHODS A systematic review and meta-analysis was conducted after PROSPERO registration. Pubmed, Embase, and Cochrane review databases were searched through February 1, 2024. Keywords included: "transitional care AND neurosurgery", "Discharge planning AND neurosurgery". Articles were included if they assessed postoperative TCPs in an adult population undergoing elective neurosurgeries. Exclusion criteria were pediatric patients, implementation of Enhanced Recovery After Surgery (ERAS) protocols, or non-elective neurosurgical procedures. The primary outcome was readmission rates after implementation of TCPs. RESULTS 16 articles were included in this review. 2 articles found that patients treated with TCPs had significantly higher chances of home discharge. 7 articles found a significant association between implementation of TCP and reduced length of stay and intensive care unit stay. 3 articles reported an increase in patient satisfaction after implementation of TCPs. 3 found that TCP led to a significant decrease in readmissions. After meta-analysis, TCPs were associated with significantly decreased readmission rates (OR: 0.68, p < 0.0001), length of stay (mean difference: -0.57, p < 0.00001), and emergency department visits (OR: 0.33, p < 0.0001). CONCLUSIONS This systematic review and meta-analysis found that an overwhelming majority of the available literature supports the effectiveness of discharge planning on at least one measure of patient outcomes. However, the extent to which each facet of the TCP affects outcomes in elective neurosurgery remains unclear. Future efforts should be made to compare the effectiveness of different TCPs.
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Affiliation(s)
- Carlos Aguilera
- Georgetown University School of Medicine, Washington, DC, USA.
| | - Georgia Wong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ziam Khan
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jeffrey M Breton
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John Lynes
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Vinay R Deshmukh
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Kanna RM, Shafeeq GM, Shetty AP, Rajasekaran S. The incidence and risk factors for unplanned readmission within 90 days after surgical treatment of spinal fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08420-5. [PMID: 39048842 DOI: 10.1007/s00586-024-08420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Unplanned readmissions after spine surgery are undesired, and cause significant functional, and financial distress to the patients and healthcare system. Though critical, knowledge about readmissions after surgery for traumatic spinal injuries (TSI) is scarce and under-evaluated. METHODS Consecutive patients surgically treated for TSI and who had unplanned readmission within 90 days post-discharge were studied. Peri-operative demographic and surgical variables, surgical treatment, level of injury, delay in surgery, ASIA score, other organ injuries, peri-operative complications, smoking, ICU stay, co-morbidity, and the length of hospital stay were studied and correlated with the causes for readmission. RESULTS Among 884 patients, 4.98% (n = 44) had unplanned readmissions within 90 days of discharge. Notably, 50% (n = 22) patients were readmitted within the first 30 days. The common causes of readmissions were urinary tract related problems (27%, n = 12), pressure ulcers (20.4%, n = 9), respiratory problems (13.6%, n = 6), surgical wound related problems (14%, n = 7,) limb injuries (11.4%, n = 5), and others (11%, n = 5). The total beds lost secondary to readmissions was 314 days, and the mean bed-days lost per patient was 7.2 ± 5.1. Thirteen peri-operative risk factors were associated with unplanned readmissions, among which, smoking (OR 2.2), diabetes (OR 2.4), and pressure sore during index admission (OR 16.7) were strong independent predictors. CONCLUSION The incidence of unplanned readmissions after TSI was 5%, which was similar to elective spine surgeries but the causes and risk factors are different. Non-surgical complications related to urinary tract, respiratory care and pressure sores were the most common causes. Pre-operative smoking status, diabetes mellitus and pressure sores noted in the index admission were important independent risk factors.
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Affiliation(s)
- Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - Gulam Muhammed Shafeeq
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Ajoy P Shetty
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Leyendecker J, Prasse T, Park C, Köster M, Rumswinkel L, Shenker T, Bieler E, Eysel P, Bredow J, Zaki MM, Kathawate V, Harake E, Joshi RS, Konakondla S, Kashlan ON, Derman P, Telfeian A, Hofstetter CP. 90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients. Neurosurgery 2024:00006123-990000000-01291. [PMID: 39023273 DOI: 10.1227/neu.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/22/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Emergency department (ED) utilization and readmission rates after spine surgery are common quality of care measures. Limited data exist on the evaluation of quality indicators after full-endoscopic spine surgery (FESS). The objective of this study was to detect rates, causes, and risk factors for unplanned postoperative clinic utilization after FESS. METHODS This retrospective multicenter analysis assessed ED utilization and clinic readmission rates after FESS performed between 01/2014 and 04/2023 for degenerative spinal pathologies. Outcome measures were ED utilizations, hospital readmissions, and revision surgeries within 90 days postsurgery. RESULTS Our cohort includes 821 patients averaging 59 years of age, who underwent FESS. Most procedures targeted the lumbar or sacral spine (85.75%) while a small fraction involved the cervical spine (10.11%). The most common procedures were lumbar unilateral laminotomies for bilateral decompression (40.56%) and lumbar transforaminal discectomies (25.58%). Within 90 days postsurgery, 8.0% of patients revisited the ED for surgical complications. A total of 2.2% of patients were readmitted to a hospital of which 1.9% required revision surgery. Primary reasons for ED visits and clinic readmissions were postoperative pain exacerbation, transient neurogenic bladder dysfunction, and recurrent disk herniations. Our multivariate regression analysis revealed that female patients had a significantly higher likelihood of using the ED (P = .046; odds ratio: 1.77, 95% CI 1.01-3.1 5.69% vs 10.33%). Factors such as age, American Society of Anesthesiologists class, body mass index, comorbidities, and spanned spinal levels did not significantly predict postoperative ED utilization. CONCLUSION This analysis demonstrates the safety of FESS, as evidenced by acceptable rates of ED utilization, clinic readmission, and revision surgery. Future studies are needed to further elucidate the safety profile of FESS in comparison with traditional spinal procedures.
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Affiliation(s)
- Jannik Leyendecker
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christine Park
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Malin Köster
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lena Rumswinkel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tara Shenker
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale-Davie, Florida, USA
| | - Eliana Bieler
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | - Mark M Zaki
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Varun Kathawate
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward Harake
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rushikesh S Joshi
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Albert Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Assi A, Daher M, Zalaquett Z, Aoun M, Youssef B, Kreichati G, Kharrat K, Sebaaly A. Intensive Care Unit Admission After Spine Surgery: A Narrative Review. Int J Spine Surg 2024; 18:231-236. [PMID: 38569930 PMCID: PMC11287800 DOI: 10.14444/8593] [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: 04/05/2024] Open
Abstract
INTRODUCTION Intensive care unit (ICU) admissions constitute a substantial financial challenge for health care systems and patients and are linked to various potentially life-altering complications. A wide range of patient-related, surgical, and medical factors are associated with an increased risk of ICU admission following spine surgery. DISCUSSION The most notable examples include lung, heart, and kidney disease, as well as estimated blood loss and length of surgery. Various scores that include the most significant patient- and procedure-related factors have been described to assess the risk associated with surgery for individual patients. To date, the fusion risk score and the American Society of Anesthesiologists score have been the most useful in predicting postoperative complications and admission to the ICU. However, other risk factors have also been implicated in ICU admission and length of stay. The current scores must further adapt by using the available evidence to fulfill their intended purpose. Moreover, a handful of measures have shown efficacy in decreasing ICU admission and length of stay, with their benefits still to be demonstrated by future research. CONCLUSION This review underscores the risk factors predictive of ICU admission following spine surgery and will help surgeons and clinicians in patient stratification. However, future studies are needed to validate the role of protective measures in preventing ICU admissions and the significance of certain risk factors.
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Affiliation(s)
- Ahmad Assi
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | - Ziad Zalaquett
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Marven Aoun
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Bryan Youssef
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Gaby Kreichati
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
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Wu TC, Kim A, Tsai CT, Gao A, Ghuman T, Paul A, Castillo A, Cheng J, Adogwa O, Ngwenya LB, Foreman B, Wu DT. A Neurosurgical Readmissions Reduction Program in an Academic Hospital Leveraging Machine Learning, Workflow Analysis, and Simulation. Appl Clin Inform 2024; 15:479-488. [PMID: 38897230 PMCID: PMC11186699 DOI: 10.1055/s-0044-1787119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/26/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Predicting 30-day hospital readmissions is crucial for improving patient outcomes, optimizing resource allocation, and achieving financial savings. Existing studies reporting the development of machine learning (ML) models predictive of neurosurgical readmissions do not report factors related to clinical implementation. OBJECTIVES Train individual predictive models with good performance (area under the receiver operating characteristic curve or AUROC > 0.8), identify potential interventions through semi-structured interviews, and demonstrate estimated clinical and financial impact of these models. METHODS Electronic health records were utilized with five ML methodologies: gradient boosting, decision tree, random forest, ridge logistic regression, and linear support vector machine. Variables of interest were determined by domain experts and literature. The dataset was split divided 80% for training and validation and 20% for testing randomly. Clinical workflow analysis was conducted using semi-structured interviews to identify possible intervention points. Calibrated agent-based models (ABMs), based on a previous study with interventions, were applied to simulate reductions of the 30-day readmission rate and financial costs. RESULTS The dataset covered 12,334 neurosurgical intensive care unit (NSICU) admissions (11,029 patients); 1,903 spine surgery admissions (1,641 patients), and 2,208 traumatic brain injury (TBI) admissions (2,185 patients), with readmission rate of 13.13, 13.93, and 23.73%, respectively. The random forest model for NSICU achieved best performance with an AUROC score of 0.89, capturing potential patients effectively. Six interventions were identified through 12 semi-structured interviews targeting preoperative, inpatient stay, discharge phases, and follow-up phases. Calibrated ABMs simulated median readmission reduction rates and resulted in 13.13 to 10.12% (NSICU), 13.90 to 10.98% (spine surgery), and 23.64 to 21.20% (TBI). Approximately $1,300,614.28 in saving resulted from potential interventions. CONCLUSION This study reports the successful development and simulation of an ML-based approach for predicting and reducing 30-day hospital readmissions in neurosurgery. The intervention shows feasibility in improving patient outcomes and reducing financial losses.
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Affiliation(s)
- Tzu-Chun Wu
- Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Abraham Kim
- Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Medical Sciences Baccalaureate Program, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Ching-Tzu Tsai
- Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Andy Gao
- Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Medical Sciences Baccalaureate Program, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Taran Ghuman
- Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Medical Sciences Baccalaureate Program, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anne Paul
- UCHealth, Cincinnati, Ohio, United States
| | | | - Joseph Cheng
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- UCHealth, Cincinnati, Ohio, United States
| | - Owoicho Adogwa
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- UCHealth, Cincinnati, Ohio, United States
| | - Laura B. Ngwenya
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- UCHealth, Cincinnati, Ohio, United States
| | - Brandon Foreman
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- UCHealth, Cincinnati, Ohio, United States
| | - Danny T.Y. Wu
- Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Neuroinformatics Laboratory, Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Medical Sciences Baccalaureate Program, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
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Moniz-Garcia D, Odeh N, Genel O, Montaser A, Sousa-Pinto B, De Biase G, Otamendi-Lopez A, Nottmeier E, Bydon M, McClendon J, Buchanan IA, Pirris S, Abode-Iyamah K, Chen S. Frailty as a Predictor of Postoperative Morbidity and Mortality in Patients Aged 80 Years and Older Undergoing Instrumented Fusion. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01019. [PMID: 38189376 DOI: 10.1227/ons.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Degenerative spine disease is a leading cause of disability, with increasing prevalence in the older patients. While age has been identified as an independent predictor of outcomes, its predictive value is limited for similar older patients. Here, we aimed to determine the most predictive frailty score of adverse events in patients aged 80 and older undergoing instrumented lumbar fusion. METHODS We proceeded with a multisite (3 tertiary academic centers) retrospective review including patients undergoing instrumented fusion aged 80 and older from January 2010 to present. A composite end point encompassing 30-day return to operating room, readmission, and mortality was created. We estimated the area under the receiver operating characteristic curve for frailty scores (Modified Frailty Index-5 [MFI-5], Modified Frailty Index-11 [MFI-11], and Charlson Comorbidity Index [CCI]) in relation to that composite score. In addition, we estimated the association between each score and the composite end point by means of logistic regression. RESULTS A total of 153 patients with an average age of 85 years at the time of surgery were included. We observed a 30-day readmission rate of 11.1%, reoperation of 3.9%, and mortality of 0.6%. The overall rate of the composite end point at 30 days was 25 (15.1%). The AUC for MFI-5 was 0.597 (0.501-0.693), for MFI-11 was 0.620 (0.518-0.723), and for CCI was 0.564 (0.453-0.675). The association between the scores and composite end point did not reach statistical significance for MFI-5 (odds ratio [OR] = 1.45 [0.98-2.15], P = .061) and CCI (OR = 1.13 [0.97-1.31], P = .113) but was statistically significant for MFI-11 (OR = 1.46 [1.07-2.00], P = .018). CONCLUSION This is the largest study comparing frailty index scores in octogenarians undergoing instrumented lumbar fusion. Our findings suggest that while MFI-11 score correlated with adverse events, the predictive ability of existing scores remains limited, highlighting the need for better approaches to identify select patients at age extremes.
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Affiliation(s)
- Diogo Moniz-Garcia
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Nour Odeh
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Oktay Genel
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
- School of Medicine, King's College London, London, UK
| | - Alaa Montaser
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Gaetano De Biase
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Eric Nottmeier
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamal McClendon
- Department of Neurologic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Ian A Buchanan
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephen Pirris
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Selby Chen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Cheung ATM, Kurland DB, Neifert S, Mandelberg N, Nasir-Moin M, Laufer I, Pacione D, Lau D, Frempong-Boadu AK, Kondziolka D, Golfinos JG, Oermann EK. Developing an Automated Registry (Autoregistry) of Spine Surgery Using Natural Language Processing and Health System Scale Databases. Neurosurgery 2023; 93:1228-1234. [PMID: 37345933 DOI: 10.1227/neu.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/25/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical registries are critical for modern surgery and underpin outcomes research, device monitoring, and trial development. However, existing approaches to registry construction are labor-intensive, costly, and prone to manual error. Natural language processing techniques combined with electronic health record (EHR) data sets can theoretically automate the construction and maintenance of registries. Our aim was to automate the generation of a spine surgery registry at an academic medical center using regular expression (regex) classifiers developed by neurosurgeons to combine domain expertise with interpretable algorithms. METHODS We used a Hadoop data lake consisting of all the information generated by an academic medical center. Using this database and structured query language queries, we retrieved every operative note written in the department of neurosurgery since our transition to EHR. Notes were parsed using regex classifiers and compared with a random subset of 100 manually reviewed notes. RESULTS A total of 31 502 operative cases were downloaded and processed using regex classifiers. The codebase required 5 days of development, 3 weeks of validation, and less than 1 hour for the software to generate the autoregistry. Regex classifiers had an average accuracy of 98.86% at identifying both spinal procedures and the relevant vertebral levels, and it correctly identified the entire list of defined surgical procedures in 89% of patients. We were able to identify patients who required additional operations within 30 days to monitor outcomes and quality metrics. CONCLUSION This study demonstrates the feasibility of automatically generating a spine registry using the EHR and an interpretable, customizable natural language processing algorithm which may reduce pitfalls associated with manual registry development and facilitate rapid clinical research.
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Affiliation(s)
| | - David B Kurland
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Sean Neifert
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Mustafa Nasir-Moin
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Ilya Laufer
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Darryl Lau
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Eric Karl Oermann
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
- Department of Radiology, NYU Langone Health, New York , New York , USA
- Center for Data Science, New York University, New York , New York , USA
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Owolo E, Petitt Z, Charles A, Baëta C, Poehlein E, Green C, Cook C, Sperber J, Chandiramani A, Roman M, Goodwin CR, Erickson M. The Association Between Sociodemographic Factors, Social Determinants of Health, and Spine Surgical Patient Portal Utilization. Clin Spine Surg 2023; 36:301-309. [PMID: 37081673 DOI: 10.1097/bsd.0000000000001458] [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: 08/22/2022] [Accepted: 03/09/2023] [Indexed: 04/22/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To examine patient portal use among the surgical spine patient population across different sociodemographic groups and assess the impact of patient portal use on clinical outcomes. SUMMARY OF BACKGROUND DATA Patient portals (PP) have been shown to improve outcomes and quality of care. Engaging them requires internet access, technological literacy, and dexterity, which may serve as access barriers. METHODS After exclusion criteria were applied, the study included data for 9211 encounters from 7955 patients. PP utilization was defined as having activated and used the Duke University Medical Center patient portal system, MyChart, at least once. Sociodemographic characteristics included urbanicity, age, race, ethnicity, language, employment, and primary insurer. Clinical outcomes included the length of hospital stay during the procedure, 30-day return to the emergency department, 30-day readmission, and being discharged somewhere other than home. RESULTS Being older than 65, non-White, unemployed, non-English-speaking, male, not-partnered, uninsured or publicly insured (Medicaid, Medicare and under 65 years of age, or other government insurance), and living in a rural environment were all risk factors for decreased PP utilization among surgical spine patients. A one-risk factor decrease in the number of social risk factors was associated with a 78% increase in the odds of PP utilization [odds ratio (OR): 1.78; 95% Confidence interval (CI): 1.69-1.87; P <0.001]. Patients not utilizing the portal at the time of their procedure had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26-2.00), discharge somewhere other than home (OR: 2.41, 95% CI: 1.95-2.99), and an increased length of hospital stay (geometric mean ratio: 1.21; 95% CI: 1.12-1.30) compared with those who utilized it. CONCLUSIONS In patients undergoing spine procedures, PPs are not equally utilized among different sociodemographic groups. PP utilization is also associated with better outcomes. Interventions aimed at increasing PP uptake may improve care for certain patients.
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Affiliation(s)
| | | | | | | | | | | | - Chad Cook
- Department of Biostatistics and Bioinformatics
| | | | - Anisha Chandiramani
- Division of General Internal Medicine; Department of Medicine
- Duke Health Technology Solutions
| | - Matthew Roman
- Duke Health Technology Solutions
- Duke Network Services
| | | | - Melissa Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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10
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Wang DP, Hu HS, Zheng XZ, Lei XL, Guo HH, Liao WQ, Wang J. Risk Factors for Thirty-Day Readmission Following Lumbar Surgery: A Meta-Analysis. World Neurosurg 2023; 172:e467-e475. [PMID: 36682531 DOI: 10.1016/j.wneu.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Thirty-day readmission is one of the common complications after lumbar surgery. More 30-day readmission increases the total hospitalization, economic burden, and physical pain of patients, delays the progress of postoperative rehabilitation, and even lead to die. Therefore, it is necessary to analyze the risk factors of 30-day readmission following lumbar surgery. METHODS We searched for all the clinical trials published from the establishment of the database to May 1, 2022 through the Cochrane Library, Web of Science, Embase, and PubMed. Data including age, American Society of Anesthesiology physical status class, preoperative hematocrit (Hct), diabetes mellitus (DM), current smoker, chronic obstructive pulmonary disease (COPD), length of hospital stay (LHS), operation time, and surgical site infection (SSI) were extracted. We used Review Manager 5.4 for data analysis. RESULTS Six studies with 30,989 participants were eligible for this meta-analysis. The analysis revealed that there were statistically significant differences in the age (95% confidence interval [CI]: -3.35-2.90, P < 0.001), preoperative Hct (95% CI: 0.75-1.33, P < 0.001), DM (95% CI: 0.56-0.74, P < 0.001), COPD (95% CI: 0.38-0.58, P < 0.001), operation time (95% CI: -35.54-16.18, P < 0.001), LHS (95% CI: -0.54-0.50, P < 0.001), and SSI (95% CI: 0.02-0.03, P < 0.001) between no readmission and readmission groups. In terms of the American Society of Anesthesiology physical status class and current smoker, there was no significant effect on the 30-day readmission (P = 0.16 and P = 0.35 respectively). CONCLUSIONS Age, preoperative Hct, DM, COPD, operation time, LHS, and SSI are the danger factors of 30-day readmission following lumbar surgery.
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Affiliation(s)
- Dong Ping Wang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Shi Hu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xin Ze Zheng
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiao Ling Lei
- Department of Physical Medicine and Rehabilitation, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, China
| | - Hao Hua Guo
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wen Qing Liao
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jian Wang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
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11
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Lee SB, Oh YT, Yang SW, Kim JB. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. SENSORS (BASEL, SWITZERLAND) 2023; 23:2761. [PMID: 36904962 PMCID: PMC10006891 DOI: 10.3390/s23052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system-"The Elephant"-as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.
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Affiliation(s)
- Seung Bok Lee
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
| | - Yim Taek Oh
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Frontier Research Institute for Convergence Sports Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Seung Wan Yang
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
| | - Jong Bae Kim
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju 26493, Republic of Korea
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12
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Lee SB, Oh YT, Yang SW, Kim JB. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. SENSORS 2023; 23:2761. [DOI: https:/doi.org/10.3390/s23052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system—“The Elephant”—as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.
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Affiliation(s)
- Seung Bok Lee
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
| | - Yim Taek Oh
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Frontier Research Institute for Convergence Sports Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Seung Wan Yang
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
| | - Jong Bae Kim
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju 26493, Republic of Korea
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13
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Chen LY, Chang Y, Wong CE, Chi KY, Lee JS, Huang CC, Lee PH. Risk Factors for 30-day Unplanned Readmission following Surgery for Lumbar Degenerative Diseases: A Systematic Review. Global Spine J 2023; 13:563-574. [PMID: 36040160 PMCID: PMC9972270 DOI: 10.1177/21925682221116823] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Surgical procedures for lumbar degenerative diseases (LDD), which have emerged in the 21-century, are commonly practiced worldwide. Regarding financial burdens and health costs, readmissions within 30days following surgery are inconvenient. We performed a systematic review to integrate real-world evidence and report the current risk factors associated with 30-day readmission following surgery for LDD. METHODS The Cochrane Library, Embase, and Medline electronic databases were searched from inception to April 2022 to identify relevant studies reporting risk factors for 30-day readmission following surgery for LDD. RESULTS Thirty-six studies were included in the review. Potential risk factors were identified in the included studies that reported multivariate analysis results, including age, race, obesity, higher American Society of Anesthesiologists score, anemia, bleeding disorder, chronic pulmonary disease, heart failure, dependent status, depression, diabetes, frailty, malnutrition, chronic steroid use, surgeries with anterior approach, multilevel spinal surgeries, perioperative transfusion, presence of postoperative complications, prolonged operative time, and prolonged length of stay. CONCLUSIONS There are several potential perioperative risk factors associated with unplanned readmission following surgery for LDD. Preoperatively identifying patients that are at increased risk of readmission is critical for achieving the best possible outcomes.
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Affiliation(s)
- Liang-Yi Chen
- Section of Neurosurgery, Department
of Surgery, College of Medicine, National Cheng Kung University, National Cheng Kung University
Hospital, Tainan, Taiwan
| | - Yu Chang
- Section of Neurosurgery, Department
of Surgery, College of Medicine, National Cheng Kung University, National Cheng Kung University
Hospital, Tainan, Taiwan
| | - Chia-En Wong
- Section of Neurosurgery, Department
of Surgery, College of Medicine, National Cheng Kung University, National Cheng Kung University
Hospital, Tainan, Taiwan
| | - Kuan-Yu Chi
- Department of Education, Center for
Evidence-Based Medicine, Taipei Medical University
Hospital, Taipei, Taiwan
| | - Jung-Shun Lee
- Institute of Basic Medical
Sciences, College of Medicine, National Cheng Kung
University, Tainan, Taiwan,Department of Cell Biology and
Anatomy, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Chi-Chen Huang
- Section of Neurosurgery, Department
of Surgery, College of Medicine, National Cheng Kung University, National Cheng Kung University
Hospital, Tainan, Taiwan,Chi-Chen Huang, Attending Doctor, Section
of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital,
College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Po-Hsuan Lee
- Section of Neurosurgery, Department
of Surgery, College of Medicine, National Cheng Kung University, National Cheng Kung University
Hospital, Tainan, Taiwan,Po-Hsuan Lee, Attending Doctor, Section of
Neurosurgery, Department of Surgery, National Cheng Kung University Hospital,
College of Medicine, National Cheng Kung University, No. 138, Shengli Rd, North
District, Tainan 704, Taiwan.
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14
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Nie JW, Hartman TJ, Oyetayo OO, Zheng E, MacGregor KR, Massel DH, Sayari AJ, Singh K. Influence of Preoperative Disability on Clinical Outcomes in Patients Undergoing Anterior Lumbar Interbody Fusion. World Neurosurg 2023; 171:e412-e421. [PMID: 36509327 DOI: 10.1016/j.wneu.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have examined the influence of preoperative disability through the Oswestry Disability Index (ODI) on clinical outcomes in patients undergoing anterior lumbar interbody fusion (ALIF). METHODS Patients undergoing ALIF were separated into 2 groups based on ODI<41 (lower disability) versus ODI≥41% (higher disability). Patient-reported outcomes (PROs) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year/2-year time points. Physical function PROs were Patient-Reported Outcomes Measurement Information System Physical Function and 12-item Short Form Physical Component Score. Mental function PROs were 12-item Short Form Mental Component Score and Patient Health Questionnaire-9. Pain PROs were visual analog scale back and visual analog scale leg. ODI was the disability PRO. RESULTS A total of 148 patients were identified, with 52 patients with lower disability. Higher disability patients demonstrated significant improvement in mental function (P ≤ 0.010, all). Lower disability patients demonstrated superior postoperative PROs in physical function, mental function, back pain, and disability outcomes (P ≤ 0.034, all). Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower for mental function and disability outcomes (P ≤ 0.041, all). CONCLUSIONS Independent of preoperative disability, patients undergoing ALIF reported significant postoperative improvement in physical function, pain, and disability outcomes. Patients with lower preoperative disability continued to report superior PROs in mental function, back pain, and disability postoperatively. Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower in mental function and disability outcomes. Patients undergoing ALIF with higher preoperative disability may experience greater clinically meaningful improvement in mental function and disability.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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15
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Effect of Fellow Involvement and Experience on Patient Outcomes in Spine Surgery. J Am Acad Orthop Surg 2022; 30:831-840. [PMID: 35421018 DOI: 10.5435/jaaos-d-21-01019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/06/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Investigations in spine surgery have demonstrated that trainee involvement correlates with increased surgical time, readmissions, and revision surgeries; however, the specific effects of spine fellow involvement remain unelucidated. This study aims to investigate the isolated effect of fellow involvement on surgical timing and patient-reported outcomes measures (PROMs) after spine surgery and evaluate how surgical outcomes differ by fellow experience. METHODS All patients aged 18 years or older who underwent primary or revision decompression or fusion for degenerative diseases and/or spinal deformity between 2017 and 2019 at a single academic institution were retrospectively identified. Patient demographics, surgical factors, intraoperative timing, transfusion status, length of stay (LOS), readmissions, revision rate, and preoperative and postoperative PROMs were recorded. Surgeries were divided based on spine fellow participation status and occurrence in the start or end of fellowship training. Univariate and multivariate analyses compared outcomes across fellow involvement and fellow experience groups. RESULTS A total of 1,108 patients were included. Age, preoperative diagnoses, number of fusion levels, and surgical approach differed markedly by fellow involvement. Fellow training experience groups differed by patient smoking status, preoperative diagnosis, and surgical approach. On univariate analysis, spine fellow involvement was associated with extended total theater time, induction start to cut time, cut to close time, and LOS. Increased spine fellow training was associated with reduced cut to close time and LOS. On regression, fellow involvement predicted cut to close extension while increased fellow training experience predicted reduction in cut to close time, both independent of surgical factors and assisting residents or physician assistants. Transfusions, readmissions, revision rate, and PROMs did not differ markedly by fellow involvement or experience. CONCLUSION Spine fellow participation predicted extended procedural duration. However, the presence of a spine fellow did not affect long-term postoperative outcomes. Furthermore, increased fellow training experience predicted decreased procedural time, underscoring a learning effect. AVAILABILITY OF DATA AND MATERIAL The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. LEVEL OF EVIDENCE Level 3.
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16
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Singh K, Cha EDK, Lynch CP, Nolte MT, Parrish JM, Jenkins NW, Jacob KC, Patel MR, Vanjani NN, Pawlowski H, Prabhu MC, Myers JA. Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions. Clin Spine Surg 2022; 35:E601-E609. [PMID: 35344514 DOI: 10.1097/bsd.0000000000001322] [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: 10/07/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE Develop an evidence-based preoperative risk assessment scoring system for patients undergoing anterior lumbar interbody fusion (ALIF). SUMMARY OF BACKGROUND DATA ALIF may hold advantages over other fusion techniques in sagittal restoration and fusion rates, though it introduces unique risks to vascular and abdominal structures and thus possibly increased risk of operative morbidity. METHODS Primary, 1 or 2-level ALIFs were identified in a surgical registry. Baseline characteristics were recorded. Axial magnetic resonance imagings at L4-L5 and L5-S1 were reviewed for vascular confluence/bifurcation or anomalous structures, and measured for operative window size/slope. To assess favorable outcomes, a clinical grade was calculated: (clinical grade=blood loss×operative duration), higher value indicating poorer outcome. To establish a risk scoring system, a base risk score algorithm was established and stratified into 5 categories: high, high to intermediate, intermediate, intermediate to low, and low. Modifiers to base risk score included age, body mass index, operative level, history of bone morphogenic protein use, calcified vasculature, spondylolisthesis grade, working window size and slope, and abnormal vasculature. Modifiers were weighted for contribution to surgical risk. A total risk score was calculated and evaluated for strength of association with clinical outcome grades by Pearson correlation coefficient. RESULTS A total of 65 patients were included. Mean clinical outcome grade was 5.6, mean total risk score 21.3±21.5. Multilevel procedures (L4-S1) mean total risk score was 57.3±7.8. L4-L5 mean total risk score was 23.6±5.2; L5-S1 mean total risk score 8.3±6.6. Correlation analysis demonstrated a significant and strong relationship (| r |=0.753; P <0.001) between total risk scores and clinical outcome grades. CONCLUSION Calculated ALIF risk scores significantly correlated with operative duration and blood loss. This scoring system represents a potential framework to facilitate clinical decision-making and risk assessment for potential ALIF candidates with degenerative spinal pathologies.
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17
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Turcotte JJ, King PJ, Patton CM. Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00280. [PMID: 35303736 PMCID: PMC8932478 DOI: 10.5435/jaaosglobal-d-21-00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Few studies have examined the effect of hip or knee osteoarthritis, together described as lower extremity osteoarthritis (LEOA) on patient outcomes after lumbar fusion. The purpose of this study was to evaluate the effect of LEOA on postoperative outcomes and resource utilization in patients undergoing single-level lumbar fusion. METHODS Using a national deidentified database, TriNetX, a retrospective observational study of 17,289 patients undergoing single-level lumbar fusion with or without a history of LEOA before September 1, 2019, was conducted. The no-LEOA and LEOA groups were propensity score matched, and 2-year outcomes were compared using univariate statistical analysis. RESULTS After propensity score matching, 2289 patients with no differences in demographics or comorbidities remained in each group. No differences in the rate of repeat lumbar surgery were observed between groups (all P > 0.30). In comparison with patients with no LEOA, patients with LEOA experienced higher rates of overall and new onset depression or anxiety, prolonged opioid use, hospitalizations, emergency department visits, and ambulatory visits over the 2-year postoperative period (all P < 0.02). CONCLUSION Patients with LEOA undergoing single-level lumbar fusion surgery are at higher risk for suboptimal outcomes and increased resource utilization postoperatively. This complex population may benefit from additional individualized education and multidisciplinary management.
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Affiliation(s)
- Justin J Turcotte
- From the Department of Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD
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18
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The Impact of Nurse Navigator-Led Preoperative Education on Hospital Outcomes Following Posterolateral Lumbar Fusion Surgery. Orthop Nurs 2021; 40:281-289. [PMID: 34583373 DOI: 10.1097/nor.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Beyond the spine-specific pathology, patient factors such as associated medical and psychosocial conditions, understanding of the treatment process, and the degree of patient activation-defined as the ability of the individual to utilize the available information and actively engage in making their healthcare decisions-can influence outcomes after posterolateral lumbar fusion (PLF) surgery. A retrospective observational cohort study of 177 patients undergoing PLF at a single institution was conducted. Patient demographics, medical and psychosocial risk factors, and outcomes were compared between patients who attended a nurse navigator-led group preoperative education course and those who did not. Patients attending the course were younger, more likely to undergo one-level fusion, less likely to undergo 5- or more-level fusion, and had less comorbidity burden as measured by the hierarchical condition categories score. No differences in psychosocial risk factors were observed between groups. Course attendees had a significantly shorter length of stay (2.12 vs. 2.60 days, p = .042) and decreased average hospital cost (U.S. $10,149 vs. U.S. $14,792, p < .001) than those who did not attend; no differences in other outcomes were observed. After controlling for differences in risk factors, patients enrolled in a preoperative education course demonstrated a statistically significant reduction in hospital cost (β=-4,143, p < .001). Preoperative education prior to PLF surgery may reduce hospital cost, possibly through increased patient activation. Given the relatively high prevalence of psychosocial risk factors in this and similar patient populations, optimizing patient activation and engagement is important to achieve high value care. Based on our findings, nurse navigator-led preoperative education appears to be valuable in this patient population and should be included in enhanced recovery protocols.
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19
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Connolly J, Borja AJ, Kvint S, Detchou DKE, Glauser G, Strouz K, McClintock SD, Marcotte PJ, Malhotra NR. Outcomes Following Discectomy for Far Lateral Disc Herniation Are Not Predicted by Obstructive Sleep Apnea. Cureus 2021; 13:e14921. [PMID: 34123620 PMCID: PMC8189272 DOI: 10.7759/cureus.14921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with adverse postoperative outcomes, but few studies have examined OSA in a purely spine surgery population. This study investigates the association of the STOP-Bang questionnaire, a screening tool for undiagnosed OSA, with adverse events following discectomy for far lateral disc herniation (FLDH). Methods All adult patients (n = 144) who underwent FLDH surgery at a single, multihospital, academic medical center (2013-2020) were retrospectively enrolled. Univariate logistic regression was performed to evaluate the relationship between risk of OSA (low- or high-risk) according to STOP-Bang score and postsurgical outcomes, including unplanned hospital readmissions, ED visits, and reoperations. Results Ninety-two patients underwent open FLDH surgery, while 52 underwent endoscopic procedures. High risk of OSA according to STOP-Bang score did not predict risk of readmission, ED visit, outpatient office visit, or reoperation of any kind within either 30 days or 30-90 days of surgery. High risk of OSA also did not predict risk of reoperation of any kind or repeat neurosurgical intervention within 30 days or 90 days of the index admission (either during the same admission or after discharge). Conclusion The STOP-Bang questionnaire is not a reliable tool for predicting post-operative morbidity and mortality for FLDH patients undergoing discectomy. Additional studies are needed to assess the impact of OSA on morbidity and mortality in other spine surgery populations.
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Affiliation(s)
- John Connolly
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Austin J Borja
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Svetlana Kvint
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Donald K E Detchou
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Gregory Glauser
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Krista Strouz
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, USA.,Department of Mathematics, West Chester University, West Chester, USA
| | | | - Paul J Marcotte
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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