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Ng MK, Tracey O, Vasireddi N, Emara A, Lam A, Wellington IJ, Ford B, Ahn NU, Houten JK, Saleh A, Razi AE. Operative Time Associated With Increased Length of Stay After Single-level Cervical Disk Arthroplasty: An Analysis of 3681 Surgeries. Clin Spine Surg 2024:01933606-990000000-00325. [PMID: 38864523 DOI: 10.1097/bsd.0000000000001652] [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] [Received: 09/26/2022] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
STUDY DESIGN Level III evidence-retrospective cohort. OBJECTIVE The purpose of this study was to (1) determine whether longer CDA operative time increases the risk of 30-day postoperative complications, (2) analyze the association between operative time and subsequent health care utilization, and (3) discharge disposition. BACKGROUND Cervical disk arthroplasty (CDA) most commonly serves as an alternative to anterior cervical discectomy and fusion (ACDF) to treat cervical spine disease, however, with only 1600 CDAs performed annually relative to 132,000 ACDFs, it is a relatively novel procedure. METHODS A retrospective query was performed identifying patients who underwent single-level CDA between January 2012 and December 2018 using a nationwide database. Differences in baseline patient demographics were identified through univariate analysis. Multivariate logistic regression was performed to identify associations between operative time (reference: 81-100 min), medical/surgical complications, and health care utilization. RESULTS A total of 3681 cases were performed, with a mean patient age of 45.52 years and operative time of 107.72±49.6 minutes. Higher odds of length of stay were demonstrated starting with operative time category 101-120 minutes (odds ratio: 2.164, 95% CI: 1.247-3.754, P=0.006); however, not among discharge destination, 30-day unplanned readmission, or reoperation. Operative time <40 minutes was associated with 10.7x odds of nonhome discharge, while >240 minutes was associated with 4.4 times higher odds of LOS>2 days (P<0.01). Increased operative time was not associated with higher odds of wound complication/infection, pulmonary embolism, deep venous thrombosis, or urinary tract infections. CONCLUSIONS Prolonged CDA operative time above the reference 81-100 minutes is independently associated with increased length of stay, but not other significant health care utilization parameters, including discharge disposition, readmission, or reoperation. There was no association between prolonged operative time and 30-day medical/surgical complications, including wound complications, infections, pulmonary embolism, or urinary tract infection.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center
| | - Olivia Tracey
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY
| | - Nikhil Vasireddi
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center
| | - Ahmed Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center
| | - Ian J Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT
| | - Brian Ford
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT
| | - Nicholas U Ahn
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center
| | - John K Houten
- Department of Neurosurgery, Maimonides Medical Center and the Zucker School of Medicine at Hofstra-Northwell, Brooklyn, NY
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center
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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.
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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
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Miller AK, Zakko P, Park DK, Chang VW, Schultz L, Springer K, Hamilton TM, Abdulhak MM, Schwalb JM, Nerenz DR, Aleem IS, Khalil JG. Cervical disc arthroplasty versus anterior cervical discectomy and fusion: an analysis of the Michigan Spine Surgery Improvement Collaborative Database. Spine J 2024; 24:791-799. [PMID: 38110089 DOI: 10.1016/j.spinee.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/08/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are established surgical options for the treatment of cervical radiculopathy, myelopathy, and cervical degenerative disc disease. However, current literature does not demonstrate a clear superiority between ACDF and CDA. PURPOSE To investigate procedural and patient-reported outcomes of ACDF and CDA among patients included in the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. DESIGN Retrospective study of prospectively collected outcomes registry data. PATIENT SAMPLE Individuals within the MSSIC database presenting with radiculopathy, myelopathy, or cervical spondylosis refractory to typical conservative care undergoing primary ACDF or CDA from January 4, 2016, to November 5, 2021. OUTCOME MEASURES Perioperative measures (including surgery length, length of stay, return to OR, any complications), patient-reported functional outcomes at 2-year follow-up (including return to work, patient satisfaction, PROMIS, EQ-5D, mJOA). METHODS Patients undergoing ACDF were matched 4:1 with those undergoing CDA; propensity analysis performed on operative levels (1- and 2- level procedures), presenting condition, demographics, and comorbidities. Initial comparisons performed with univariate testing and multivariate analysis performed with Poisson generalized estimating equation models clustering on hospital. RESULTS A total of 2,208 patients with ACDF and 552 patients with CDA were included. Baseline demographics were similar, with younger patients undergoing CDA (45.6 vs 48.6 years; p<.001). Myelopathy was more frequent in ACDF patients (30% vs 25%; p=.015). CDA was more frequently planned as an outpatient procedure. Length of stay was increased in ACDF (1.3 vs 1.0 days; p<.001). Functional outcomes were similar, with comparable proportions of patients meeting minimal clinically important difference thresholds in neck pain, arm pain, PROMIS, EQ-5D, and mJOA score. After multivariate regression, no significant differences were seen in surgical or functional outcomes. CONCLUSIONS This study demonstrates similar outcomes for those undergoing ACDF and CDA at 2 years. Previous meta-analyses of CDA clinical trial data adhere to strict inclusion and exclusion criteria required by clinical studies; this registry data provides "real world" clinical outcomes reflecting current practices for ACDF and CDA patient selection.
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Affiliation(s)
- Alex K Miller
- Department of Orthopaedic Surgery, Corewell Health East William Beaumont University Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA.
| | - Philip Zakko
- Department of Orthopaedic Surgery, Corewell Health East William Beaumont University Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA
| | - Daniel K Park
- Department of Orthopaedic Surgery, Corewell Health East William Beaumont University Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Dr., Rochester, MI 48309, USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA
| | - Lonni Schultz
- Michigan Spine Surgery Improvement Collaborative, 3A Ford Pl., Detroit, MI 48202, USA
| | - Kylie Springer
- Michigan Spine Surgery Improvement Collaborative, 3A Ford Pl., Detroit, MI 48202, USA
| | - Travis M Hamilton
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA
| | - Muwaffak M Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA; Michigan Spine Surgery Improvement Collaborative, 3A Ford Pl., Detroit, MI 48202, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA; Michigan Spine Surgery Improvement Collaborative, 3A Ford Pl., Detroit, MI 48202, USA
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA; Michigan Spine Surgery Improvement Collaborative, 3A Ford Pl., Detroit, MI 48202, USA
| | - Ilyas S Aleem
- Department of Orthopaedic Surgery, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Jad G Khalil
- Department of Orthopaedic Surgery, Corewell Health East William Beaumont University Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Dr., Rochester, MI 48309, USA
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Bakaes Y, Gonzalez T, Hardin JW, Jackson JB. Body Mass Index, Sex, and Age Are Predictors of Discharge to a Post-acute Care Facility Following Total Ankle Arthroplasty. Foot Ankle Spec 2024:19386400241246936. [PMID: 38660997 DOI: 10.1177/19386400241246936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The utilization of total ankle arthroplasty (TAA) continues to increase. Discharge to a post-acute care (PAC) facility can increase patient morbidity and postoperative costs. The purpose of this study is to investigate the effects of age and body mass index (BMI) on discharge to a PAC facility and hospital length of stay (LOS) following TAA. METHODS A retrospective review of patients who underwent TAA from the National Surgical Quality Improvement Program (NSQIP) database was performed. Using overweight patients as the reference BMI group, sex- and age-adjusted log-binomial regression models were utilized to estimate risk ratios of BMI categories for being discharged to a PAC facility. A linear regression was utilized to estimate the effect of BMI category on hospital LOS. RESULTS Obese patients had 1.36 times the risk of overweight patients (P = .040), and morbidly obese patients had 2 times risk of overweight patients (P = .001) of being discharged to a PAC facility after TAA. Men had 0.48 times the risk of women (P < .001). Compared with patients aged 18 to 44 years, patients aged ≥65 years had 4.13 times the risk (P = .012) of being discharged to a PAC facility after TAA. Relative to overweight patients, on average there was no difference in hospital LOS for underweight patients, but healthy weight patients stayed an additional 0.30 days (P=.003), obese patients stayed an additional 0.18 days (P = .011), and morbidly obese patients stayed an additional 0.33 days (P = .009). Men stayed 0.29 fewer hospital days than women (P < .001) on average. CONCLUSION Women and patients who are obese or morbidly obese have a longer hospital LOS and an increased chance of being discharged to a PAC facility. Increasing age is also associated with an increased risk of being discharged to a PAC. These may be important factors when developing and discussing the postoperative plan with patients prior to TAA. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Yianni Bakaes
- School of Medicine Columbia, University of South Carolina, Columbia, South Carolina
| | - Tyler Gonzalez
- Department of Orthopaedics, University of South Carolina, Columbia, South Carolina
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - J Benjamin Jackson
- Department of Orthopaedics, University of South Carolina, Columbia, South Carolina
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Nunna RS, Ryoo JS, Ostrov PB, Patel S, Godolias P, Daher Z, Price R, Chapman JR, Oskouian RJ. Single-level cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF): A Nationwide matched analysis of complications, 30- and 90-day readmission rates, and cost. World Neurosurg X 2024; 21:100242. [PMID: 38221950 PMCID: PMC10787284 DOI: 10.1016/j.wnsx.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Ravi S. Nunna
- Department of Neurosurgery, University of Missouri Columbia Health Care, Columbia, MO, USA
| | - James S. Ryoo
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Philip B. Ostrov
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Zeyad Daher
- Swedish Neuroscience Institute, Seattle, WA, USA
- Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
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Berry KM, Govindarajan V, Berger C, Maddy K, Roman RJP, Luther EM, Levi AD. Effects of Obesity on Cervical Disc Arthroplasty Complications. Neurospine 2023; 20:1399-1406. [PMID: 38171306 PMCID: PMC10762409 DOI: 10.14245/ns.2346788.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE High body mass index is a well-established modifiable comorbidity that is known to increase postoperative complications in all types of surgery, including spine surgery. Obesity is increasing in prevalence amongst the general population. As this growing population of obese patients ages, understanding how they faire undergoing cervical disc arthroplasty (CDA) is important for providing safe and effective evidence-based care for cervical degenerative pathology. METHODS Our study used the Healthcare Cost and Utilization Project's National Inpatient Sample to assess patients undergoing CDA comparing patient characteristics and outcomes in nonobese patients to obese patients from 2004 to 2014. RESULTS Our study found a significant increase in the overall utilization of CDA as a treatment modality (p = 0.012) and a statistically significant increase in obese patients undergoing CDA (p < 0.0001) from 2004 to 2014. Obesity was identified as an independent risk factor associated with increased rates of inpatient neurologic complications (odds ratio [OR], 6.99; p = 0.03), pulmonary embolus (OR, 5.41; p = 0.05), and wound infection (OR, 6.97; p < 0.001) in patients undergoing CDA from 2004 to 2014. CONCLUSION In patients undergoing CDA, from 2004 to 2014, obesity was identified as an independent risk factor with significantly increased rates of inpatient neurologic complications, pulmonary embolus and wound infection. Large prospective trials are needed to validate these findings.
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Affiliation(s)
- Katherine M. Berry
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Vaidya Govindarajan
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Connor Berger
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Krisna Maddy
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Roberto J. Perez Roman
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Evan M. Luther
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Allan D. Levi
- Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA
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Khandalavala KR, Boochoon K, Schissel M, Heckman WW, Geelan-Hansen K. Age, ASA-status, and Changes in NSQIP Comorbidity Indices Reporting in Facial Fracture Repair. Laryngoscope 2023; 133:2572-2577. [PMID: 36625305 DOI: 10.1002/lary.30559] [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: 08/15/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the impact of age and the American Society of Anesthesiologists (ASA) classification on post operative outcomes as well as the changes in the National Surgical Quality Improvement Program (NSQIP) database reporting of comorbidity index variables in patients with facial fractures. METHODS The NSQIP database was queried for facial fracture repair CPT codes between 2012 and 2019 and for modified Frailty Index (mFI) and modified Charlson Comorbidity Index (mCCI) variables between years 2006 and 2018. The predominant question analyzed two preoperative risk factors: patient and ASA classification. Chi-square analysis, Kruskal-Wallis, Mann-Whitney, Spearman correlation, and multivariable logistic regression were used to evaluate age and ASA classification with wound dehiscence, superficial surgical site infection (SSSI), deep wound infection (DWI), readmission status, and return to the OR. The reporting of indices variables was evaluated with descriptive statistics. CONCLUSION In this large database with univariate analysis, patients with a higher ASA classification and older patients experience significantly increased risks of readmission, return to the OR, and longer hospital stays. On multivariate analyses, ASA classes II, III, and IV are independently associated with increased risk of readmission and return to the OR, while controlling for patient age. The reporting of all mFI and mCCI variables were consistent from 2006 to 2010, but after 2011, there has been inconsistent or absent reporting of variables, therefore, conclusions on the impact of comorbidities on facial fracture repair are unreliable. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2572-2577, 2023.
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Affiliation(s)
- Karl R Khandalavala
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kieran Boochoon
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Makayla Schissel
- Department of Biostatics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - W Wesley Heckman
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Katie Geelan-Hansen
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Gokhale S, Taylor D, Gill J, Hu Y, Zeps N, Lequertier V, Prado L, Teede H, Enticott J. Hospital length of stay prediction tools for all hospital admissions and general medicine populations: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1192969. [PMID: 37663657 PMCID: PMC10469540 DOI: 10.3389/fmed.2023.1192969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
Background Unwarranted extended length of stay (LOS) increases the risk of hospital-acquired complications, morbidity, and all-cause mortality and needs to be recognized and addressed proactively. Objective This systematic review aimed to identify validated prediction variables and methods used in tools that predict the risk of prolonged LOS in all hospital admissions and specifically General Medicine (GenMed) admissions. Method LOS prediction tools published since 2010 were identified in five major research databases. The main outcomes were model performance metrics, prediction variables, and level of validation. Meta-analysis was completed for validated models. The risk of bias was assessed using the PROBAST checklist. Results Overall, 25 all admission studies and 14 GenMed studies were identified. Statistical and machine learning methods were used almost equally in both groups. Calibration metrics were reported infrequently, with only 2 of 39 studies performing external validation. Meta-analysis of all admissions validation studies revealed a 95% prediction interval for theta of 0.596 to 0.798 for the area under the curve. Important predictor categories were co-morbidity diagnoses and illness severity risk scores, demographics, and admission characteristics. Overall study quality was deemed low due to poor data processing and analysis reporting. Conclusion To the best of our knowledge, this is the first systematic review assessing the quality of risk prediction models for hospital LOS in GenMed and all admissions groups. Notably, both machine learning and statistical modeling demonstrated good predictive performance, but models were infrequently externally validated and had poor overall study quality. Moving forward, a focus on quality methods by the adoption of existing guidelines and external validation is needed before clinical application. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021272198.
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Affiliation(s)
- Swapna Gokhale
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Eastern Health, Box Hill, VIC, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Box Hill, VIC, Australia
| | - Jaskirath Gill
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nikolajs Zeps
- Monash Partners Academic Health Sciences Centre, Clayton, VIC, Australia
- Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, Australia
| | - Vincent Lequertier
- Univ. Lyon, INSA Lyon, Univ Lyon 2, Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Luis Prado
- Epworth Healthcare, Academic and Medical Services, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Monash Partners Academic Health Sciences Centre, Clayton, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, VIC, Australia
- Monash Partners Academic Health Sciences Centre, Clayton, VIC, Australia
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9
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Mason EM, Henderson WG, Bronsert MR, Colborn KL, Dyas AR, Lambert-Kerzner A, Meguid RA. Development and validation of a multivariable preoperative prediction model for postoperative length of stay in a broad inpatient surgical population. Surgery 2023; 174:66-74. [PMID: 37149424 PMCID: PMC10272088 DOI: 10.1016/j.surg.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/16/2023] [Accepted: 02/23/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Postoperative length of stay is a meaningful patient-centered outcome and an important determinant of healthcare costs. The Surgical Risk Preoperative Assessment System preoperatively predicts 12 postoperative adverse events using 8 preoperative variables, but its ability to predict postoperative length of stay has not been assessed. We aimed to determine whether the Surgical Risk Preoperative Assessment System variables could accurately predict postoperative length of stay up to 30 days in a broad inpatient surgical population. METHODS This was a retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program adult database from 2012 to 2018. A model using the Surgical Risk Preoperative Assessment System variables and a 28-variable "full" model, incorporating all available American College of Surgeons' National Surgical Quality Improvement Program preoperative nonlaboratory variables, were fit to the analytical cohort (2012-2018) using multiple linear regression and compared using model performance metrics. Internal chronological validation of the Surgical Risk Preoperative Assessment System model was conducted using training (2012-2017) and test (2018) datasets. RESULTS We analyzed 3,295,028 procedures. The adjusted R2 for the Surgical Risk Preoperative Assessment System model fit to this cohort was 93.3% of that for the full model (0.347 vs 0.372). In the internal chronological validation of the Surgical Risk Preoperative Assessment System model, the adjusted R2 for the test dataset was 97.1% of that for the training dataset (0.3389 vs 0.3489). CONCLUSION The parsimonious Surgical Risk Preoperative Assessment System model can preoperatively predict postoperative length of stay up to 30 days for inpatient surgical procedures almost as accurately as a model using all 28 American College of Surgeons' National Surgical Quality Improvement Program preoperative nonlaboratory variables and has shown acceptable internal chronological validation.
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Affiliation(s)
- Emily M Mason
- Clinical Science Program, University of Colorado Anschutz Medical Campus, Graduate School, Colorado Clinical and Translational Sciences Institute, Aurora, CO.
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO
| | - Adam R Dyas
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO.
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10
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Arora A, Demb J, Cummins DD, Callahan M, Clark AJ, Theologis AA. Predictive models to assess risk of extended length of stay in adults with spinal deformity and lumbar degenerative pathology: development and internal validation. Spine J 2023; 23:457-466. [PMID: 36892060 DOI: 10.1016/j.spinee.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND CONTEXT Postoperative recovery after adult spinal deformity (ASD) operations is arduous, fraught with complications, and often requires extended hospital stays. A need exists for a method to rapidly predict patients at risk for extended length of stay (eLOS) in the preoperative setting. PURPOSE To develop a machine learning model to preoperatively estimate the likelihood of eLOS following elective multi-level lumbar/thoracolumbar spinal instrumented fusions (≥3 segments) for ASD. STUDY DESIGN/SETTING Retrospectively from a state-level inpatient database hosted by the Health care cost and Utilization Project. PATIENT SAMPLE Of 8,866 patients of age ≥50 with ASD undergoing elective lumbar or thoracolumbar multilevel instrumented fusions. OUTCOME MEASURES The primary outcome was eLOS (>7 days). METHODS Predictive variables consisted of demographics, comorbidities, and operative information. Significant variables from univariate and multivariate analyses were used to develop a logistic regression-based predictive model that use six predictors. Model accuracy was assessed through area under the curve (AUC), sensitivity, and specificity. RESULTS Of 8,866 patients met inclusion criteria. A saturated logistic model with all significant variables from multivariate analysis was developed (AUC=0.77), followed by generation of a simplified logistic model through stepwise logistic regression (AUC=0.76). Peak AUC was reached with inclusion of six selected predictors (combined anterior and posterior approach, surgery to both lumbar and thoracic regions, ≥8 level fusion, malnutrition, congestive heart failure, and academic institution). A cutoff of 0.18 for eLOS yielded a sensitivity of 77% and specificity of 68%. CONCLUSIONS This predictive model can facilitate identification of adults at risk for eLOS following elective multilevel lumbar/thoracolumbar spinal instrumented fusions for ASD. With a fair diagnostic accuracy, the predictive calculator will ideally enable clinicians to improve preoperative planning, guide patient expectations, enable optimization of modifiable risk factors, facilitate appropriate discharge planning, stratify financial risk, and accurately identify patients who may represent high-cost outliers. Future prospective studies that validate this risk assessment tool on external datasets would be valuable.
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Affiliation(s)
- Ayush Arora
- Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA
| | - Joshua Demb
- Division of Gastroenterology, Department of Medicine, University of California - San Diego, La Jolla, 9500 Gilman Drive, La Jolla, CA 92093, CA, USA
| | - Daniel D Cummins
- Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA
| | - Matt Callahan
- Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, 400 Parnassus Ave, San Francisco, CA 94143, San Francisco, CA, USA
| | - Alekos A Theologis
- Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA.
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Factors contributing to a longer length of stay in adults admitted to a quaternary spinal care center. 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 2023; 32:824-830. [PMID: 36708396 PMCID: PMC9883608 DOI: 10.1007/s00586-023-07547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Longer hospital length of stay (LOS) has been associated with worse outcomes and increased resource utilization. However, diagnostic and patient-level factors associated with LOS have not been well studied on a large scale. The goal was to identify patient, surgical and organizational factors associated with longer patient LOS for adult patients at a high-volume quaternary spinal care center. METHODS We performed a retrospective analysis of 13,493 admissions from January 2006 to December 2019. Factors analyzed included age, sex, admission status (emergent vs scheduled), ASIA grade, operative vs non-operative management, mean blood loss, operative time, and adverse events. Specific adverse events included surgical site infection (SSI), other infection (systemic or UTI), neuropathic pain, delirium, dural tear, pneumonia, and dysphagia. Diagnostic categories included trauma, oncology, deformity, degenerative, and "other". A multivariable linear regression model was fit to log-transformed LOS to determine independent factors associated with patient LOS, with effects expressed as multipliers on mean LOS. RESULTS Mean LOS for the population (SD) was 15.8 (34.0) days. Factors significantly (p < 0.05) associated with longer LOS were advanced patient age [multiplier on mean LOS 1.011/year (95% CI: 1.007-1.015)], emergency admission [multiplier on mean LOS 1.615 (95% CI: 1.337-1.951)], ASIA grade [multiplier on mean LOS 1.125/grade (95% CI: 1.051-1.205)], operative management [multiplier on mean LOS 1.211 (95% CI: 1.006-1.459)], and the occurrence of one or more AEs [multiplier on mean LOS 2.613 (95% CI: 2.188-3.121)]. Significant AEs included postoperative SSI [multiplier on mean LOS 1.749 (95% CI: 1.250-2.449)], other infections (systemic infections and UTI combined) [multiplier on mean LOS 1.650 (95% CI: 1.359-2.004)], delirium [multiplier on mean LOS 1.404 (95% CI: 1.103-1.787)], and pneumonia [multiplier on mean LOS 1.883 (95% CI: 1.447-2.451)]. Among the diagnostic categories explored, degenerative patients experienced significantly shorter LOS [multiplier on mean LOS 0.672 (95%CI: 0.535-0.844), p < 0.001] compared to non-degenerative categories. CONCLUSION This large-scale study taking into account diagnostic categories identified several factors associated with patient LOS. Future interventions should target modifiable factors to minimize LOS and guide hospital resource allocation thereby improving patient outcomes and quality of care and decreasing healthcare-associated costs.
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Oezel L, Memtsoudis SG, Moser M, Zhong H, Adl Amini D, Liu J, Poeran J, Shue J, Sama AA. Trends in use, outcomes, and revision procedures of anterior cervical disc replacement in the United States: a premiere database analysis from 2006-2019. 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 2023; 32:667-681. [PMID: 36542166 DOI: 10.1007/s00586-022-07465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures. METHODS In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor. RESULTS A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034). CONCLUSION PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research.
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Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Stavros G Memtsoudis
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Haoyan Zhong
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jashvant Poeran
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/ Department of Orthopedics/ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L.Levy Pl, New York, NY, 10029, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Gokhale S, Taylor D, Gill J, Hu Y, Zeps N, Lequertier V, Teede H, Enticott J. Hospital length of stay prediction for general surgery and total knee arthroplasty admissions: Systematic review and meta-analysis of published prediction models. Digit Health 2023; 9:20552076231177497. [PMID: 37284012 PMCID: PMC10240873 DOI: 10.1177/20552076231177497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/06/2023] [Indexed: 06/08/2023] Open
Abstract
Objective Systematic review of length of stay (LOS) prediction models to assess the study methods (including prediction variables), study quality, and performance of predictive models (using area under receiver operating curve (AUROC)) for general surgery populations and total knee arthroplasty (TKA). Method LOS prediction models published since 2010 were identified in five major research databases. The main outcomes were model performance metrics including AUROC, prediction variables, and level of validation. Risk of bias was assessed using the PROBAST checklist. Results Five general surgery studies (15 models) and 10 TKA studies (24 models) were identified. All general surgery and 20 TKA models used statistical approaches; 4 TKA models used machine learning approaches. Risk scores, diagnosis, and procedure types were predominant predictors used. Risk of bias was ranked as moderate in 3/15 and high in 12/15 studies. Discrimination measures were reported in 14/15 and calibration measures in 3/15 studies, with only 4/39 externally validated models (3 general surgery and 1 TKA). Meta-analysis of externally validated models (3 general surgery) suggested the AUROC 95% prediction interval is excellent and ranges between 0.803 and 0.970. Conclusion This is the first systematic review assessing quality of risk prediction models for prolonged LOS in general surgery and TKA groups. We showed that these risk prediction models were infrequently externally validated with poor study quality, typically related to poor reporting. Both machine learning and statistical modelling methods, plus the meta-analysis, showed acceptable to good predictive performance, which are encouraging. Moving forward, a focus on quality methods and external validation is needed before clinical application.
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Affiliation(s)
- Swapna Gokhale
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Quality Planning and Innovation Unit, Eastern Health, Box Hill, Victoria, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Box Hill, Victoria, Australia
| | - Jaskirath Gill
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Yanan Hu
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Nikolajs Zeps
- Graduate Research Industry Partnerships (GRIP) Program, Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
- Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Box Hill, Australia
| | - Vincent Lequertier
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France
- Univ. Lyon, INSA Lyon, Univ Lyon 2, Université Claude Bernard Lyon 1, Lyon, France
| | - Helena Teede
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Graduate Research Industry Partnerships (GRIP) Program, Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Joanne Enticott
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Graduate Research Industry Partnerships (GRIP) Program, Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
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Kang KC, Jang TS, Jung CH. Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques. Asian Spine J 2022; 16:995-1012. [PMID: 36599372 PMCID: PMC9827215 DOI: 10.31616/asj.2022.0445] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
For patients with cervical radiculopathy, most studies have recommended conservative treatment as the first-line treatment; however, when conventional treatment fails, surgery is considered. A better understanding of the prognosis of cervical radiculopathy is essential to provide accurate information to the patients. If the patients complain of persistent and recurrent arm pain/numbness not respond to conservative treatment, or exhibit neurologic deficits, surgery is performed using anterior or posterior approaches. Anterior cervical discectomy and fusion (ACDF) has historically been widely used and has proven to be safe and effective. To improve surgical outcomes of ACDF surgery, many studies have been conducted on types of spacers, size/height/position of cages, anterior plating, patients' factors, surgical techniques, and so forth. Cervical disc replacement (CDR) is designed to reduce the incidence of adjacent segment disease during long-term follow-up by maintaining cervical spine motion postoperatively. Many studies on excellent indications for the CDR, proper type/size/shape/height of the implants, and surgical techniques were performed. Posterior cervical foraminotomy is a safe and effective surgical option to avoid complications associated with anterior approach and fusion surgery. Most recent literature demonstrated that all three surgical techniques for patients with cervical radiculopathy have clear advantages and disadvantages and reveal satisfactory surgical outcomes under a proper selection of patients and application of appropriate surgical methods. For this, it is important to fully understand the factors for better surgical outcomes and to adequately practice the operative techniques for patients with cervical radiculopathy.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae Su Jang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea,Corresponding author: Tae Su Jang Department of Orthopaedic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8346, Fax: +82-2-964-3865, E-mail:
| | - Cheol Hyun Jung
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Gordon AM, Golub IJ, Ng MK, Lam AW, Houten JK, Saleh A. Primary and Revision Cervical Disc Arthroplasty from 2010–2020: Patient Demographics, Utilization Trends, and Health Care Reimbursements. World Neurosurg 2022; 168:e344-e349. [DOI: 10.1016/j.wneu.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
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Lee YJ, Cho PG, Kim KN, Kim SH, Noh SH. Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis. Yonsei Med J 2022; 63:842-849. [PMID: 36031784 PMCID: PMC9424775 DOI: 10.3349/ymj.2022.63.9.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs. MATERIALS AND METHODS We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, "readmission" and "ACDF." A total of 10 studies were included. RESULTS Among the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30-5.56; p<0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10-1.36; p<0.001], and private insurance (OR, 0.34; 95% CI, 0.17-0.69; p<0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41-3.25; p<0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20-2.11; p=0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13-3.86; p<0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68-2.72; p<0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29-1.51; p<0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21-70.41; p<0.001) was significantly associated with unplanned readmission. CONCLUSION Male, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.
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Affiliation(s)
- Young Ju Lee
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
| | - Pyung Goo Cho
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Kim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
| | - Sung Hyun Noh
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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Crutchfield CR, Zhong JR, Lee NJ, Fortney TA, Ahmad CS, Lynch TS. Operative Time Less Than 1.5 Hours, Male Sex, Dependent Functional Status, Presence of Dyspnea, and Reoperations Within 30 days Are Independent Risk Factors for Readmission After ACLR. Arthrosc Sports Med Rehabil 2022; 4:e1305-e1313. [PMID: 36033184 PMCID: PMC9402418 DOI: 10.1016/j.asmr.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The purposes of this study are to use a large, patient-centered database to describe the 30-day readmission rate and to identify predictive risk factors for readmission after elective isolated ACLR. Methods The National Surgical Quality Improvement Program Database was retrospectively queried for isolated ACLR procedures between 2011 and 2017. Current Procedural Terminology (CPT) codes were used to identify isolated ACLR patients. Those undergoing additional procedures such as meniscectomy or multi-ligamentous reconstruction were excluded. Readmissions were analyzed against demographic variables with bivariate analysis. Multivariate logistic regression was used to find independent risk factors for 30-day readmissions after ACLR. Results A total of 11,060 patients (37.2% female) were included with an average age of 32.2 ± 10.6 years and mean body mass index (BMI) of 27.9 ± 6.5 kg/m2 (29.2% were >30). The overall readmission rate was 0.59%. The most reported reason for readmission was infection 0.22 (24 out of 11,060). The following variables were associated with significantly higher readmission rates: male sex (P = .001), history of severe chronic obstructive pulmonary disease (COPD) (P = .025), cardiac comorbidity (P = .034), operative time >1.5 hours (P <.001), partially dependent functional health status (P = .002), high preoperative creatinine (P = .009), normal preoperative albumin (P = .020), hypertension (P = .034), and reoperations (P < .001). Operative time >1.5 hours, male sex, dependent functional status, the presence of dyspnea, and undergoing a reoperation were identified as independent risk factors for 30-day readmissions (P < .05 for all). Conclusions Isolated ACLR is associated with low 30-day readmission rates. Operative time >1.5 hours, male sex, dependent functional status, the presence of dyspnea, and 30-day reoperations are independent risk factors for readmission that should be considered in patient selection and addressed with preoperative counseling. Level of Evidence Level III, retrospective cohort study.
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Roth SG, Chanbour H, Gupta R, O'Brien A, Davidson C, Archer KR, Pennings JS, Devin CJ, Stephens BF, Abtahi AM, Zuckerman SL. Optimal hemoglobin A1C target in diabetics undergoing elective cervical spine surgery. Spine J 2022; 22:1149-1159. [PMID: 35257839 DOI: 10.1016/j.spinee.2022.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Diabetes mellitus (DM) is a well-established risk factor for suboptimal outcomes following cervical spine surgery. Hemoglobin A1C (HbA1c), a surrogate for long-term glycemic control, is a valuable assessment tool in diabetic patients. PURPOSE In patients undergoing elective cervical spine surgery, we sought to identify optimal HbA1c levels to: (1) maximize 1-year postoperative patient-reported outcomes (PROs), and (2) predict the occurrence of medical and surgical complications. STUDY DESIGN/SETTING A retrospective cohort study using prospectively collected data was performed in a single academic center. PATIENT SAMPLE Diabetic patients undergoing elective anterior cervical fusion and posterior cervical laminectomy and fusion (PCLF) between October 2010-March 2021 were included. OUTCOME MEASURES Primary outcomes included Numeric Rating Scale (NRS)-Neck pain, NRS-Arm pain, and Neck Disability Index (NDI). Secondary outcomes included surgical site infection (SSI), complications, readmissions, and reoperations within 90-days postoperatively. METHODS HbA1c, demographic, comorbidity, and perioperative variables were gathered in diabetic patients only. PROs were analyzed as continuous variables and minimum clinically difference (MCID) was set at 30% improvement from baseline. RESULTS Of 1992 registry patients undergoing cervical surgery, 408 diabetic patients underwent cervical fusion surgery. Anterior: A total of 259 diabetic patients underwent anterior cervical fusion, 141 of which had an available HbA1c level within one year prior to surgery. Mean age was 55.8±10.1, and mean HbA1c value was 7.2±1.4. HbA1c levels above 6.1 were associated with failure to achieve MCID for NDI (AUC=0.77, 95%CI 0.70-0.84, p<.001), and HbA1c levels above 6.8 may be associated with increased odds of reoperation (AUC=0.61, 95%CI 0.52-0.69, p=.078). Posterior: A total of 149 diabetic patients underwent PCLF, 65 of which had an available HbA1c level within 1 year. Mean age was 63.6±9.2, and mean HbA1c value was 7.2±1.5. Despite a low AUC for NRS-Arm pain and readmission, HbA1c levels above 6.8 may be associated with failure to achieve MCID for NRS-Arm pain (AUC=0.61, 95%CI 0.49-0.73, p=.094), and HbA1c levels above 7.6 may be associated with higher readmission rate (AUC=0.63, 95%CI 0.50-0.75, p=.185). CONCLUSIONS In a cohort of diabetic patients undergoing elective cervical spine surgery, HbA1c levels above 6.1 were associated with decreased odds of achieving MCID for NDI in anterior cervical fusion surgery. Though only moderate associations were seen for the select outcomes of reoperation (6.8), readmission (7.6), and MCID for NRS-Arm pain (6.8), preoperative optimization of HbA1c using these levels as benchmarks should be considered to reduce the risk of complications and maximize PROs for patients undergoing elective cervical spine surgery.
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Affiliation(s)
- Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rishabh Gupta
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex O'Brien
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopedic Surgery, Steamboat Orthopedics and Spine Institute, Steamboat Springs, CO, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Maielli LF, Tebet MA, Rosa AF, Lima MC, Mistro Neto S, Cavali PTM, Pasqualini W, Risso Neto MÍ. IDENTIFICATION OF RISK FACTORS ASSOCIATED WITH 30-DAY READMISSION OF PATIENTS SUBMITTED TO ANTERIOR OR POSTERIOR ACCESS CERVICAL SPINE SURGERY. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222103262527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aim: To conduct a systematic review of the literature to identify risk factors associated with 30-day readmission of patients submitted to anterior or posterior access cervical spine surgery. Methods: The databases used to select the papers were PubMed, Web of Science, and Cochrane, using the following search strategy: patient AND readmission AND (30 day OR “thirty day” OR 30-day OR thirty-day) AND (spine AND cervical). Results: Initially, 179 papers that satisfied the established search stringwere selected. After reading the titles and abstracts, 46 were excluded from the sample for not effectively discussing the theme proposed for this review. Of the 133 remaining papers, 109 were also excluded after a detailed reading of their content, leaving 24 that were included in the sample for the meta-analysis. Conclusions: The average readmission rate in the studies evaluated was 4.85%. Only the occurrence of infections, as well as the presence of patients classified by the American Society of Anesthesiology (ASA) assessment system with scores greater than III, were causal factors that influenced the readmission of patients. No significant differences were noted when comparing the anterior and posterior surgical access routes. Level of evidence II; Systematic Review of Level II or Level I Studies with discrepant results.
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Ansari D, DesLaurier JT, Patel S, Chapman JR, Oskouian RJ. Predictors of Extended Hospitalization and Early Reoperation After Elective Lumbar Disc Arthroplasty. World Neurosurg 2021; 154:e797-e805. [PMID: 34389528 DOI: 10.1016/j.wneu.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lumbar disc arthroplasty (LDA) has emerged as a motion-sparing alternative to lumbar fusion. Although LDA may be amenable to the ambulatory surgical setting, to date no study has identified the factors predisposing patients to extended hospital stay. METHODS A national surgical quality improvement database was queried from 2011 to 2019 for patients undergoing elective, single-level, primary LDA. Univariate and multivariate logistic regression analyses were performed to elucidate predictors of length of stay (LOS) at or above the 90th percentile of the study population (3 days). Secondary study endpoints included rates of complications, as well as predictors and reasons for unplanned reoperation within 30 days. RESULTS A total of 630 patients met eligibility criteria for the study, of whom 517 (82.1%) had LOS <3 days and 113 (17.9%) had LOS ≥3 days. Multivariate logistic regression revealed associations between prolonged hospitalization and postoperative diagnosis of degenerative disk disease, obesity, Hispanic identity, and operation length >120 minutes. Before discharge, patients with LOS ≥3 days were more likely to have venous thromboembolisms, pneumonia, surgical site infections, and reoperations. Independent predictors of reoperation were wound infections, diabetes, and smoking. CONCLUSIONS Complications following elective single-level LDA are relatively rare, with few extended hospitalizations being attributable to any specific complication. Risk factors for prolonged LOS appear to be related to diagnosis and surgical time rather than to modifiable preoperative comorbidities. Conversely, unplanned reoperations within 30 days are associated with optimizable perioperative factors such as smoking, diabetes, and surgical site infection.
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Affiliation(s)
- Darius Ansari
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Justin T DesLaurier
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Saavan Patel
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA.
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