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Shen X, Gao Y, Zhang P, Zhu L, Jiang Z, Shi H, Xuan W, Qian Y, Gao Z. Subcutaneous Lumbar Spine Index (SLSI) as a Risk Factor for Surgical Site Infection After Lumbar Fusion Surgery: A Retrospective Matched Case-Control Study. Global Spine J 2024; 14:1498-1503. [PMID: 36529679 DOI: 10.1177/21925682221146503] [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: 12/23/2022] Open
Abstract
STUDY DESIGN A retrospective matched case-control study. OBJECTIVE This study aims to investigate the value of Subcutaneous Lumbar Spine Index (SLSI) as a predictor of early surgical site infection (SSI) after lumbar intervertebral fusion surgery. METHODS A retrospective case-control study was performed on patients who underwent transforaminal lumbar interbody fusion (TLIF) from January 1, 2014 to December 31, 2019 in a single institution. Cases were defined as those who developed early SSI according to the US Center for Disease Control and Prevention criteria, and controls were matched from those patients without early SSI using the following matched criteria: gender, age, time of surgery and diabetes. Subcutaneous fat thickness (SFT) and SLSI were measured on preoperative MRI mid-sagittal T2 weighted images. RESULTS A total of 3615 patients who underwent TLIF were enrolled in this study. Thirty-three patients were included in early SSI, and sixty-six patients were selected as matched controls. Univariate analysis indicated that fusion levels (P = .007), operation time (P = .022), obesity (P = .013), SFT (P = .002) and SLSI (P = .001) were significantly associated with early SSI. Multiple logistic regression analysis revealed that multilevel fusion levels (P = .021), obesity (P = .035), a large SFT (P = .026) and a high SLSI (P = .012) were independent risk factors. Body mass index (BMI) and SLSI were moderately correlated (r2 = .55). ROC curve demonstrated that SLSI was more sensitive than SFT to predict the early SSI. CONCLUSION SLSI is a novel radiological risk factor for early SSI development and is a better indicator than SFT to predict early SSI risk after lumbar intervertebral fusion.
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Affiliation(s)
- Xu Shen
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yucheng Gao
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pei Zhang
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lei Zhu
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zanli Jiang
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hang Shi
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wenbin Xuan
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yulei Qian
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zengxin Gao
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Brach, Nanjing, China
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Nasrollahi TS, Shahrestani S, Borrelli M, Hopp ML, Wu AW, Tang DM, Yu JS. The Influence of Modifiable Risk Factors on Postoperative Outcomes in Patients Receiving Surgery for Resection for Acoustic Neuroma. EAR, NOSE & THROAT JOURNAL 2023:1455613231191020. [PMID: 37605484 DOI: 10.1177/01455613231191020] [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: 08/23/2023] Open
Abstract
Acoustic neuromas are the most common tumor of the cerebellopontine angle that are associated with a number of symptoms that negatively impact a patient's quality of life. While the mainstay of treatment for these benign tumors remains microsurgical resection, there is limited research exploring how certain modifiable risk factors (MRFs) may affect the perioperative course. The purpose of this study was to investigate how MRFs including malnutrition, obesity, dyslipidemia, uncontrolled hypertension, and smoking may affect postoperative rates of readmission and nonroutine discharges. We utilized the 2016 and 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database. MRFs were queried using appropriate International Classification of Diseases, Tenth Revision (ICD-10) coding for categories including malnutrition, obesity, dyslipidemia, smoking, alcohol, and hypertension. The statistical analysis was done using RStudio (Version 1.3.959). Chi-squared tests were done to evaluate differences between categorical variables. The Mann-Whitney U-testing was utilized to evaluate for statistically significant differences in continuous data. The "Epitools" package was used to develop logistic regression models for postoperative complications and post hoc receiver operating characteristic curves were developed. Pertaining to nonroutine discharge, predictive models using malnutrition outperformed all other MRFs as well as those with no MRFs (P < .05). In the case of readmission, models using malnutrition outperformed those of obesity and smoking (P < .05). Again, an increase in predictive power is seen in models using dyslipidemia when compared to obesity, smoking, or uncontrolled hypertension. Lastly, models using no MRFs outperformed those of obesity, smoking, and uncontrolled hypertension (P < .05). This is the first study of its kind to evaluate the role of MRFs in those undergoing surgical resection of their acoustic neuroma. We concluded that certain MRFs may play a role in complicating a patient's perioperative surgical course.
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Affiliation(s)
- Tasha S Nasrollahi
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shane Shahrestani
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michela Borrelli
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martin L Hopp
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arthur W Wu
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis M Tang
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Sinus Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John S Yu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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