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Chehrassan M, Nikouei F, Shakeri M, Behnamnia A, Mahabadi EA, Ghandhari H. The role of environmental and seasonal factors in spine deep surgical site infection: the air pollution, a factor that may be underestimated. 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; 33:3148-3153. [PMID: 38461454 DOI: 10.1007/s00586-024-08183-z] [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: 10/20/2023] [Revised: 12/13/2023] [Accepted: 02/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Different strategies have been described in order to reduce spine deep surgical site infection (SSI); however, non-intervenable items such as environmental factors remain as one of the main concerns for spine surgeons. METHODS A retrospective cohort study was designed in order to evaluate the effect of environmental factors such as temperature, humidity and particularly the air pollution index (PM 2.5) on spine surgical site infection. The files of 3609 patients who underwent spinal surgery from April 2019 to March 2022 were reviewed, and 121 patients with spine SSI were detected. RESULTS There was no significant relationship between mean temperature and humidity of each month with infection and type of bacteria. However, there was a significant relation between warmer season periods and infection. The rate of infection among patients was 3.25% ranged from 2.5% to 4% in colder and warmer seasons accordingly. It was determined that air pollution had a significant relationship with the infection and the type of bacteria. (p value < 0.05, R-Squared = 0.249). CONCLUSIONS Our study revealed a 60% increase in spine SSI during warmer seasons. There was a significant correlation between air pollution and the rate of infection. These may suggest the necessity to reduce the number of elective spine surgeries during warmer seasons and when the level of air pollutant is high.
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Affiliation(s)
- Mohammadreza Chehrassan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shakeri
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Behnamnia
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri Mahabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Victorio, Shen R, Nasution MN, Mahadewa TGB. Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:247-253. [PMID: 38957755 PMCID: PMC11216654 DOI: 10.4103/jcvjs.jcvjs_48_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Laminectomy has long been a "gold standard" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT). Materials and Methods A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman's correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted. Results The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient. Conclusions FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.
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Affiliation(s)
- Victorio
- Department of Neurosurgery, Lamina Pain and Spine Center, South Jakarta, Indonesia
- Department of Neurosurgery, TK. II Moh. Ridwan Meuraksa Military Hospital, East Jakarta, Indonesia
| | - Robert Shen
- Atma Jaya Neuroscience and Cognitive Center, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, Jakarta, Indonesia
- Department of Emergency, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
| | - Mahdian Nur Nasution
- Department of Neurosurgery, Lamina Pain and Spine Center, South Jakarta, Indonesia
- Department of Neurosurgery, Mayapada Hospital Kuningan, South Jakarta, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Tavanaei R, Ashghani MN, Ahmadi P, Alizadeh S, Yazdani KO, Zali A, Oraee-Yazdani S. Effects of Preoperative Use of Povidone-Iodine-Impregnated Dressing on Postoperative Rate of Surgical Site Infection in Patients Undergoing Posterolateral Lumbar Spinal Fusion Surgery: A Randomized, Nonblinded, Active-Controlled Trial. Neurosurgery 2023:00006123-990000000-00962. [PMID: 37971223 DOI: 10.1227/neu.0000000000002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES No study has evaluated the efficacy of using preoperative antiseptic dressings in reducing the rate of surgical site infection (SSI) in spine surgery thus far. To investigate the efficacy of the use of preoperative povidone-iodine-impregnated antiseptic dressings in patients undergoing instrumented posterolateral lumbar spinal fusion. METHODS This was a randomized, nonblinded, active-controlled, parallel-group clinical trial. Patients were randomly assigned to the 2 study groups, including treatment and control. Patients in the treatment group received povidone-iodine-impregnated antiseptic dressing applied to the anticipated incision site 12 hours before the operation. The control group merely received the standard perioperative care with no additional intervention or placebo. Patients were followed up for 90 days, and SSIs were recorded. RESULTS A total of 200 patients were included in this study (100 in each arm). Three cases of SSI were observed in the treatment group compared with 12 in the control one. A significant reduction in the postoperative rate of SSI was observed in the treatment group compared with the control one (P = .029). In addition to study intervention (P = .029), body mass index (P = .005), smoking status (P = .005), duration of the procedure (P = .003), American Society of Anesthesiologists class (P = .002), and diabetes mellitus (P < .001) were significantly associated with the postoperative rate of SSI. CONCLUSION To the best of our knowledge, this study for the first time showed that preoperative use of antiseptic dressings is significantly effective in reducing the rate of SSI in instrumented posterior lumbar spinal fusion surgery. Future studies are warranted to evaluate the efficacy of different preparations or the effectiveness of the present one in patients undergoing spine procedures with other surgical characteristics.
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Affiliation(s)
- Roozbeh Tavanaei
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasirzadeh Ashghani
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooria Ahmadi
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Alizadeh
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hassan FM, Lenke LG, Berven SH, Kelly MP, Smith JS, Shaffrey CI, Dahl BT, de Kleuver M, Spruit M, Pellise F, Cheung KMC, Alanay A, Polly DW, Sembrano J, Matsuyama Y, Qiu Y, Lewis SJ. Independent Prognostic Factors Associated With Improved Patient-Reported Outcomes in the Prospective Evaluation of Elderly Deformity Surgery (PEEDS) Study. Global Spine J 2023:21925682231174182. [PMID: 37154697 DOI: 10.1177/21925682231174182] [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: 05/10/2023] Open
Abstract
STUDY DESIGN Prospective, multicenter, international, observational study. OBJECTIVE Identify independent prognostic factors associated with achieving the minimal clinically important difference (MCID) in patient reported outcome measures (PROMs) among adult spinal deformity (ASD) patients ≥60 years of age undergoing primary reconstructive surgery. METHODS Patients ≥60 years undergoing primary spinal deformity surgery having ≥5 levels fused were recruited for this study. Three approaches were used to assess MCID: (1) absolute change:0.5 point increase in the SRS-22r sub-total score/0.18 point increase in the EQ-5D index; (2) relative change: 15% increase in the SRS-22r sub-total/EQ-5D index; (3) relative change with a cut-off in the outcome at baseline: similar to the relative change with an imposed baseline score of ≤3.2/0.7 for the SRS-22r/EQ-5D, respectively. RESULTS 171 patients completed the SRS-22r and 170 patients completed the EQ-5D at baseline and at 2 years postoperative. Patients who reached MCID in the SRS-22r self-reported more pain and worse health at baseline in both approaches (1) and (2). Lower baseline PROMs ((1) - OR: .01 [.00-.12]; (2)- OR: .00 [.00-.07]) and number of severe adverse events (AEs) ((1) - OR: .48 [.28-.82]; (2)- OR: .39 [.23-.69]) were the only identified risk factors. Patients who reached MCID in the EQ-5D demonstrated similar characteristics regarding pain and health at baseline as the SRS-22r using approaches (1) and (2). Higher baseline ODI ((1) - OR: 1.05 [1.02-1.07]) and number of severe AEs (OR: .58 [.38-.89]) were identified as predictive variables. Patients who reached MCID in the SRS22r experienced worse health at baseline using approach (3). The number of AEs (OR: .44 [.25-.77]) and baseline PROMs (OR: .01 [.00-.22] were the only identified predictive factors. Patients who reached MCID in the EQ-5D experienced less AEs and a lower number of actions taken due to the occurrence of AEs using approach (3). The number of actions taken due to AEs (OR: .50 [.35-.73]) was found to be the only predictive variable factor. No surgical, clinical, or radiographic variables were identified as risk factors using either of the aforementioned approaches. CONCLUSION In this large multicenter prospective cohort of elderly patients undergoing primary reconstructive surgery for ASD, baseline health status, AEs, and severity of AEs were predictive of reaching MCID. No clinical, radiological, or surgical parameters were identified as factors that can be prognostic for reaching MCID.
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Affiliation(s)
- Fthimnir M Hassan
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | | | - Benny T Dahl
- Department of Orthopaedic Surgery, Texas Children's Hospital, Bellaire, TX, USA
| | - Marinus de Kleuver
- Department of Orthopedics, Radboud University Medical Center, The Netherlands
| | - Maarten Spruit
- Department of Orthopedics, Sint Maartenskliniek, The Netherlands
| | - Ferran Pellise
- Department of Orthopaedic Surgery, Vall D'Hebron University Hospital, Spain
| | - Kenneth M C Cheung
- Department of Orthopaedic Surgery, Hong Kong University Schenzhen Hospital, Hong Kong, China
| | - Ahmet Alanay
- Department of Orthopedics, Acıbadem Mehmet ali Aydınlar University School of Medicine, Turkey
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan Sembrano
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamatsu University School of Medicine, Hamatsu, Japan
| | - Yong Qiu
- Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, China
| | - Stephen J Lewis
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Canada
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Arora A, Lituiev D, Jain D, Hadley D, Butte AJ, Berven S, Peterson TA. Predictive Models for Length of Stay and Discharge Disposition in Elective Spine Surgery: Development, Validation, and Comparison to the ACS NSQIP Risk Calculator. Spine (Phila Pa 1976) 2023; 48:E1-E13. [PMID: 36398784 PMCID: PMC9772082 DOI: 10.1097/brs.0000000000004490] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN A retrospective study at a single academic institution. OBJECTIVE The purpose of this study is to utilize machine learning to predict hospital length of stay (LOS) and discharge disposition following adult elective spine surgery, and to compare performance metrics of machine learning models to the American College of Surgeon's National Surgical Quality Improvement Program's (ACS NSQIP) prediction calculator. SUMMARY OF BACKGROUND DATA A total of 3678 adult patients undergoing elective spine surgery between 2014 and 2019, acquired from the electronic health record. METHODS Patients were divided into three stratified cohorts: cervical degenerative, lumbar degenerative, and adult spinal deformity groups. Predictive variables included demographics, body mass index, surgical region, surgical invasiveness, surgical approach, and comorbidities. Regression, classification trees, and least absolute shrinkage and selection operator (LASSO) were used to build predictive models. Validation of the models was conducted on 16% of patients (N=587), using area under the receiver operator curve (AUROC), sensitivity, specificity, and correlation. Patient data were manually entered into the ACS NSQIP online risk calculator to compare performance. Outcome variables were discharge disposition (home vs. rehabilitation) and LOS (days). RESULTS Of 3678 patients analyzed, 51.4% were male (n=1890) and 48.6% were female (n=1788). The average LOS was 3.66 days. In all, 78% were discharged home and 22% discharged to rehabilitation. Compared with NSQIP (Pearson R2 =0.16), the predictions of poisson regression ( R2 =0.29) and LASSO ( R2 =0.29) models were significantly more correlated with observed LOS ( P =0.025 and 0.004, respectively). Of the models generated to predict discharge location, logistic regression yielded an AUROC of 0.79, which was statistically equivalent to the AUROC of 0.75 for NSQIP ( P =0.135). CONCLUSION The predictive models developed in this study can enable accurate preoperative estimation of LOS and risk of rehabilitation discharge for adult patients undergoing elective spine surgery. The demonstrated models exhibited better performance than NSQIP for prediction of LOS and equivalent performance to NSQIP for prediction of discharge location.
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Affiliation(s)
- Ayush Arora
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Dmytro Lituiev
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Deeptee Jain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Dexter Hadley
- Department of Pathology, University of Central Florida, FL, USA
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, USA
| | - Sigurd Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas A. Peterson
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
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Bartosiak K, Janik MR, Walędziak M, Paśnik K, Kwiatkowski A. Effect of Significant Postoperative Complications on Decision Regret After Laparoscopic Sleeve Gastrectomy: a Case-Control Study. Obes Surg 2022; 32:2591-2597. [PMID: 35619046 PMCID: PMC9273554 DOI: 10.1007/s11695-022-06113-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
Background Thus far, no data are available on decision regret about sleeve gastrectomy (SG), particularly in patients who experienced perioperative complications. This study aimed to assess whether patients with postoperative complications regret their decision to undergo laparoscopic SG more than patients with an uneventful postoperative course. Methods The study group comprised patients with complications after laparoscopic SG (cases). The control group comprised patients who did not experience any postoperative complications (controls). A telephone survey was conducted on all patients. Patients’ satisfaction regarding their decision to undergo surgery was assessed using the Decision Regret Scale. Results In total, 21 patients who experienced postoperative complications and 69 controls were included. The patients in the study and control groups achieved similar percentages of total weight loss (32.9 ± 11.9 vs. 33.8 ± 15.0, p = 0.717) and excessive body mass index loss (74.9 ± 30.7 vs. 73.1 ± 36.7, p = 0.398) at 1 year postoperatively. The difference in weight change at 12 months postoperatively was not significant in both groups. The mean regret scores in the study and control groups were 13.2 ± 1.2 (range, 28–63) and 13.3 ± 1.1 (range, 12–66) (p = 0.818), respectively. Moreover, no significant difference was found among patients who expressed regret between the study and control groups (regret score > 50; 4.76% vs. 4.35%) (p = 1.000). Conclusion This study suggests that patients with postoperative complications do not regret their decision to undergo SG more than patients with an uneventful postoperative course. Graphical abstract ![]()
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Affiliation(s)
- Katarzyna Bartosiak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141 Warsaw, Poland
| | - Michał R. Janik
- Department of General Surgery, Military Institute of Aviation Medicine, 54/56 Krasińskiego St, 01-755 Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141 Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, 53-59 St. Joseph St, 87-100, Toruń, Poland
| | - Andrzej Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141 Warsaw, Poland
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Wang H, Fan T, Yang B, Lin Q, Li W, Yang M. Development and Internal Validation of Supervised Machine Learning Algorithms for Predicting the Risk of Surgical Site Infection Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. Front Med (Lausanne) 2022; 8:771608. [PMID: 34988091 PMCID: PMC8720930 DOI: 10.3389/fmed.2021.771608] [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] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: Machine Learning (ML) is rapidly growing in capability and is increasingly applied to model outcomes and complications in medicine. Surgical site infections (SSI) are a common post-operative complication in spinal surgery. This study aimed to develop and validate supervised ML algorithms for predicting the risk of SSI following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods: This single-central retrospective study included a total of 705 cases between May 2012 and October 2019. Data of patients who underwent MIS-TLIF was extracted by the electronic medical record system. The patient's clinical characteristics, surgery-related parameters, and routine laboratory tests were collected. Stepwise logistic regression analyses were used to screen and identify potential predictors for SSI. Then, these factors were imported into six ML algorithms, including k-Nearest Neighbor (KNN), Decision Tree (DT), Support Vector Machine (SVM), Random Forest (RF), Multi-Layer Perceptron (MLP), and Naïve Bayes (NB), to develop a prediction model for predicting the risk of SSI following MIS-TLIF under Quadrant channel. During the training process, 10-fold cross-validation was used for validation. Indices like the area under the receiver operating characteristic (AUC), sensitivity, specificity, and accuracy (ACC) were reported to test the performance of ML models. Results: Among the 705 patients, SSI occurred in 33 patients (4.68%). The stepwise logistic regression analyses showed that pre-operative glycated hemoglobin A1c (HbA1c), estimated blood loss (EBL), pre-operative albumin, body mass index (BMI), and age were potential predictors of SSI. In predicting SSI, six ML models posted an average AUC of 0.60–0.80 and an ACC of 0.80–0.95, with the NB model standing out, registering an average AUC and an ACC of 0.78 and 0.90. Then, the feature importance of the NB model was reported. Conclusions: ML algorithms are impressive tools in clinical decision-making, which can achieve satisfactory prediction of SSI with the NB model performing the best. The NB model may help access the risk of SSI following MIS-TLIF and facilitate clinical decision-making. However, future external validation is needed.
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Affiliation(s)
- Haosheng Wang
- Department of Orthopedics, Taizhou Central Hospital (Affiliated Hospital to Taizhou College), Taizhou, China.,Department of Orthopedics, Baoji City Hospital of Traditional Chinese Medicine, Baoji, China
| | - Tingting Fan
- Department of Endocrinology, Baoji City Hospital of Traditional Chinese Medicine, Baoji, China
| | - Bo Yang
- Department of Orthopedics, Baoji City Hospital of Traditional Chinese Medicine, Baoji, China
| | - Qiang Lin
- Department of Orthopedics, Baoji City Hospital of Traditional Chinese Medicine, Baoji, China
| | - Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Mingyu Yang
- Department of Orthopedics, Taizhou Central Hospital (Affiliated Hospital to Taizhou College), Taizhou, China
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Ramey WL, Jack AS, Chapman JR. The lexicon of multirod constructs in adult spinal deformity: a concise description of when, why, and how. J Neurosurg Spine 2021:1-7. [PMID: 34972079 DOI: 10.3171/2021.10.spine21745] [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: 05/30/2021] [Accepted: 10/12/2021] [Indexed: 11/06/2022]
Abstract
The use of multirod constructs in the setting of adult spinal deformity (ASD) began to prevent rod fracture and pseudarthrosis near the site of pedicle subtraction osteotomies (PSOs) and 3-column osteotomies (3COs). However, there has been unclear and inconsistent nomenclature, both clinically and in the literature, for the various techniques of supplemental rod implantation. In this review the authors aim to provide the first succinct lexicon of multirod constructs available for the treatment of ASD, providing a universal nomenclature and definition for each type of supplementary rod. The primary rod of ASD constructs is the longest rod that typically spans from the bottom of the construct to the upper instrumented vertebrae. The secondary rod is shorter than the primary rod, but is connected directly to pedicle screws, albeit fewer of them, and connects to the primary rod via lateral connectors or cross-linkers. Satellite rods are a 4-rod technique in which 2 rods span only the site of a 3CO via pedicle screws at the levels above and below, and are not connected to the primary rod (hence the term "satellite"). Accessory rods are connected to the primary rods via side connectors and buttress the primary rod in areas of high rod strain, such as at a 3CO or the lumbosacral junction. Delta rods span the site of a 3CO, typically a PSO, and are not contoured to the newly restored lordosis of the spine, thus buttressing the primary rod above and below a 3CO. The kickstand rod itself functions as an additional means of restoring coronal balance and is secured to a newly placed iliac screw on the side of truncal shift and connected to the primary rod; distracting against the kickstand then helps to correct the concavity of a coronal curve. The use of multirod constructs has dramatically increased over the last several years in parallel with the increasing prevalence of ASD correction surgery. However, ambiguity persists both clinically and in the literature regarding the nomenclature of each supplemental rod. This nomenclature of supplemental rods should help unify the lexicon of multirod constructs and generalize their usage in a variety of scientific and clinical scenarios.
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Affiliation(s)
- Wyatt L Ramey
- 1Department of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona.,2Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Andrew S Jack
- 3Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; and
| | - Jens R Chapman
- 4Division of Complex Spine, Swedish Neuroscience Institute, Seattle, Washington
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Mizera M, Wysocki M, Walędziak M, Bartosiak K, Kowalewski P, Proczko-Stepaniak M, Szymański M, Kalinowski P, Orłowski M, Franczak P, Hady HR, Myśliwiec P, Szeliga J, Major P, Pędziwiatr M. The impact of severe postoperative complications on outcomes of bariatric surgery-multicenter case-matched study. Surg Obes Relat Dis 2021; 18:53-60. [PMID: 34736868 DOI: 10.1016/j.soard.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/18/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery has relatively low complication rates, especially severe postoperative complications (defined by Clavien-Dindo classification as types 3 and 4), but these rates cannot be ignored. In other than bariatric surgical disciplines, complications affect not only short-term but also long-term results. In the field of bariatric surgery, this topic has not been extensively studied. OBJECTIVES The aim of the study was to assess the outcomes of bariatric treatment in patients with obesity and severe postoperative complications in comparison to patients with a noneventful perioperative course. SETTING Six surgical units at Polish public hospitals. METHODS We performed a multicenter propensity score matched analysis of 206 patients from 6 Polish surgical units and assessed the outcomes of bariatric procedures. A total of 103 patients with severe postoperative complications (70 laparoscopic sleeve gastrectomy [SG] and 33 with laparoscopic Roux en Y gastric bypass [RYGB]) were compared to 103 patients with no severe complications in terms of peri- and postoperative outcomes. RESULTS The outcomes of bariatric treatment did not differ between compared groups. Median percentage of total weight loss 12 months after the surgery was 28.8% in the group with complications and 27.9% in patients with no severe complications (P = 0.993). Remission rates of both type 2 diabetes mellitus and arterial hypertension showed no significant difference between SG and RYGB (36% versus 42%, P = 0.927, and 41% versus 46%, P = 0.575. respectively). CONCLUSIONS The study suggests that severe postoperative complications had no significant influence either on weight loss effects or obesity-related diseases remission.
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Affiliation(s)
- Magdalena Mizera
- Second Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Bartosiak
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Ceynowa Hospital, Wejherowo, Poland
| | - Paula Franczak
- Department of General and Oncological Surgery, Ceynowa Hospital, Wejherowo, Poland
| | - Hady Razak Hady
- First Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Myśliwiec
- First Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery CM, Nicolaus Copernicus University, Toruń, Poland
| | - Piotr Major
- Second Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Pędziwiatr
- Second Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland.
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Watanabe K, Yamaguchi T, Suzuki S, Suzuki T, Nakayama K, Demura S, Taniguchi Y, Yamamoto T, Sugawara R, Sato T, Fujiwara K, Murakami H, Akazawa T, Kakutani K, Hirano T, Yanagida H, Watanabe K, Matsumoto M, Uno K, Kotani T, Takeshita K, Ohara T, Kawakami N. Surgical Site Infection Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study of Rates, Risk Factors, and Pathogens. Spine (Phila Pa 1976) 2021; 46:1097-1104. [PMID: 33496537 DOI: 10.1097/brs.0000000000003960] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter study. OBJECTIVE To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity. SUMMARY OF BACKGROUND DATA There have been no extensive investigations of the risk factors for SSI in Japan. METHODS Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline. RESULTS The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225-116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109-125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201-193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718). CONCLUSION The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.Level of Evidence: 3.
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Affiliation(s)
- Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Toru Yamaguchi
- Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Higashi-ku, Fukuoka City, Fukuoka, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Suma-ku, Kobe City, Hyogo, Japan
| | - Keita Nakayama
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura City, Chiba, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa City, Ishikawa, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Red Cross Kagoshima Hospital, Kagoshima City, Kagoshima, Japan
| | - Ryo Sugawara
- Department of Orthopaedic Surgery, Jichi Medical University School of Medicine, Shimotsuke City, Tochigi, Japan
| | - Tatsuya Sato
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenta Fujiwara
- Department of Orthopaedic Surgery, Osaka Medical College School of Medicine, Takatsuki City, Osaka, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Iwate Medical University School of Medicine, Morioka City, Iwate, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St Marianna University School of Medicine, Miyamae-ku, Kawasaki City, Kanagawa, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University School of Medicine, chuou-ku, Kobe City, Hyogo, Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Haruhisa Yanagida
- Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Higashi-ku, Fukuoka City, Fukuoka, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Suma-ku, Kobe City, Hyogo, Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura City, Chiba, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University School of Medicine, Shimotsuke City, Tochigi, Japan
| | - Tetsuya Ohara
- Department of Orthopaedic Surgery, Meijo Hospital, Naka-ku, Nagoya City, Aichi, Japan
| | - Noriaki Kawakami
- Department of Orthopaedic Surgery, Meijo Hospital, Naka-ku, Nagoya City, Aichi, Japan
- Department of Orthopaedic Surgery, Ichinomiyanishi Hospital, Ichinomiya City, Aichi, Japan
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11
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Tindal EW, Heffernan DS, Kheirbek T, Stephen A, Lueckel SN. Adding Infectious Insult to Traumatic Injury: The Impact of Infectious Complications in End-of-Life Decision Making. Surg Infect (Larchmt) 2021; 22:884-888. [PMID: 34227896 DOI: 10.1089/sur.2021.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Trauma increases the risk for infection, but it is unknown how infection affects goals-of-care (GOC) decision making. We sought to determine how infections impact transition to comfort measures only (CMO), hypothesizing that infectious complications would expedite withdrawal of life-sustaining treatment (WOLST). Patients and Methods: We performed a retrospective review at a level-one trauma center over two years for adult patients without pre-existing advance directives who were made CMO with length of stay longer than one day. Demographics, injuries, and hospital course including infections and the GOC timeline were collected. Patients were divided on the basis of infection development, defined as an infectious complication requiring antibiotics or more invasive intervention, with subgroup analysis comparing those with single versus multiple infections. The primary end point was time to death or discharge. Results: Two hundred thirty-two patients met inclusion criteria and 72 developed an infection. Pneumonia was the most common infection (53.8%). Although those in the infection group had no substantial difference in demographics or comorbidities, they had higher emergency department Glasgow Coma Scale (GCS; 14 vs. 13), lower rate of head injury (28.6 vs. 49%), and higher time to death or discharge (12 vs. 2 days). Goals-of-care discussions were initiated later based on time to first family meeting (7 vs. 1 days), most occurring after the first infection. Subsequent analysis showed that versus those with a single infection (n = 38), those with multiple infections (n = 34) had a higher time to death or discharge (16.5 vs. 10.5 days) despite no difference in demographics, comorbidities, or trauma severity. Time to first family meeting was longer (8.5 vs. 4.5 days) with most occurring after the first infection. Conclusions: We did not find that development of an infection shortens time to WOLST. The increased time to death or discharge in the setting of multiple infections and similar patient populations may be a marker of provider approach to GOC plus family beliefs. Infectious complications play an uncertain role in end-of-life discussions after trauma.
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Affiliation(s)
- Elizabeth W Tindal
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Daithi S Heffernan
- Division of Trauma and Critical Care, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Department of Surgery, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Tareq Kheirbek
- Division of Trauma and Critical Care, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew Stephen
- Division of Trauma and Critical Care, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Stephanie N Lueckel
- Division of Trauma and Critical Care, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
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12
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Núñez-Pereira S, Pellisé F, Vila-Casademunt A, Alanay A, Acaraglou E, Obeid I, Sánchez Pérez-Grueso FJ, Kleinstück F. Impact of resolved early major complications on 2-year follow-up outcome following adult spinal deformity surgery. 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 2019; 28:2208-2215. [DOI: 10.1007/s00586-019-06041-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/27/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022]
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13
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Lim HJ, Kim BY. Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease. Open Nurs J 2019. [DOI: 10.2174/1874434601913010028] [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
Background:Many patients facing spinal surgery experience fear and anxiety about surgery, anesthesia, risk of postoperative pain or complications, or even death. Spinal surgery patients often experience mobility disorders due to lasting postoperative pain and require aids such as spinal braces, which can induce depression. Alleviating patients’ anxiety and depression during the perioperative period by utilizing consistent and standardized information is required for high-quality care.Objective:We developed and assessed a standardized care protocol for degenerative spinal surgery patients.Methods:The protocol was developed through focus group interviews with spinal surgery patients and the recommendations of an expert panel. Then, a quasi-experimental design was employed to comparatively study patients undergoing spinal surgery. Ninety-eight Patients were assigned to either a treatment group (n= 49) or a control group (n= 49). The treatment group received an intervention based on the newly developed standardized care protocol, while the control group received traditional care. After treatment, participants’ anxiety, depression, uncertainty, and care satisfaction were compared between groups.Results:Patients who had received the care protocol-based intervention showed lower anxiety, depression, and uncertainty, and higher satisfaction than did those who received traditional care.Conclusion:The developed care protocol may be useful for reducing anxiety and depression and for improving the healthcare provided to spinal surgery patients, as it involves the proactive dissemination of accurate information throughout the hospitalization process. The protocol also positively affected patients’ uncertainty and satisfaction with their medical care.
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14
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What are the risk factors for surgical site infection after spinal fusion? A meta-analysis. 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 2018; 27:2469-2480. [DOI: 10.1007/s00586-018-5733-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/19/2018] [Accepted: 08/13/2018] [Indexed: 01/05/2023]
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15
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Okuda S, Fujimori T, Oda T, Maeno T, Yamashita T, Matsumoto T, Iwasaki M. Factors associated with patient satisfaction for PLIF: Patient satisfaction analysis. Spine Surg Relat Res 2017; 1:20-26. [PMID: 31440608 PMCID: PMC6698533 DOI: 10.22603/ssrr.1.2016-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/03/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction: Posterior lumbar interbody fusion (PLIF) has produced satisfactory clinical outcomes; however, all previous reports have only included evaluations by surgeon-based methods. The purpose of this study was to investigate patient-based surgical outcomes and the factors associated with patient satisfaction for PLIF. Methods: Patients who underwent PLIF for lumbar spondylolisthesis were reviewed (n=443). The average follow-up period was 8 years. Surgical outcomes were assessed using an original questionnaire, a numerical rating scale (NRS), the 36-Item Short Form Health Survey (SF-36), the Japanese Orthopedic Association (JOA) score, and the recovery rate. The original questionnaire consisted of five categories, with patient-evaluated score out of 100 points for surgery, satisfaction, improvement, recommendation to others, and willingness to undergo repeat surgery on a 5-point scale. According to the questionnaire responses, patient-based outcomes were divided into three groups: positive, intermediate, and negative and were compared with the NRS, SF-36, and JOA scores. Furthermore, factors associated with patient satisfaction were examined. Results: A total of 273 patients responded. Response rate was 62%. The average patient-evaluated score for surgery was 82 points. In terms of satisfaction section, positive, intermediate, and negative response rates were 82%, 7%, and 11%, respectively. With respect to other sections, positive, intermediate, and negative response rates were 87%, 7%, and 6% in improvement section; 66%, 23%, and 11% in recommending section; and 72%, 18%, and 10% in repeat section, respectively. The average pre- and postoperative JOA scores were 12 and 24, respectively. Significant correlations were detected between patient-based surgical outcomes and the NRS scores, physical component scores of the SF-36, and the JOA score. Postoperative permanent motor loss and multiple revision surgery were the major factors related to a negative response. Conclusions: High satisfaction rate to PLIF and significant correlation between patient- and surgeon-based surgical outcomes were detected. Postoperative permanent motor loss and multiple revision surgery were the major factors related to a negative response.
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Affiliation(s)
- Shinya Okuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Japan
| | | | - Takenori Oda
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Japan
| | - Takafumi Maeno
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Japan
| | | | | | - Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Japan
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16
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Guan J, Cole CD, Schmidt MH, Dailey AT. Utility of intraoperative rotational thromboelastometry in thoracolumbar deformity surgery. J Neurosurg Spine 2017; 27:528-533. [PMID: 28862571 DOI: 10.3171/2017.5.spine1788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Blood loss during surgery for thoracolumbar scoliosis often requires blood product transfusion. Rotational thromboelastometry (ROTEM) has enabled the more targeted treatment of coagulopathy, but its use in deformity surgery has received limited study. The authors investigated whether the use of ROTEM reduces transfusion requirements in this case-control study of thoracolumbar deformity surgery. METHODS Data were prospectively collected on all patients who received ROTEM-guided blood product management during long-segment (≥ 7 levels) posterior thoracolumbar fusion procedures at a single institution from April 2015 to February 2016. Patients were matched with a group of historical controls who did not receive ROTEM-guided therapy according to age, fusion segments, number of osteotomies, and number of interbody fusion levels. Demographic, intraoperative, and postoperative transfusion requirements were collected on all patients. Univariate analysis of ROTEM status and multiple linear regression analysis of the factors associated with total in-hospital transfusion volume were performed, with p < 0.05 considered to indicate statistical significance. RESULTS Fifteen patients who received ROTEM-guided therapy were identified and matched with 15 non-ROTEM controls. The mean number of fusion levels was 11 among all patients, with no significant differences between groups in terms of fusion levels, osteotomy levels, interbody fusion levels, or other demographic factors. Patients in the non-ROTEM group required significantly more total blood products during their hospitalization than patients in the ROTEM group (8.5 ± 4.2 units vs 3.71 ± 2.8 units; p = 0.001). Multiple linear regression analysis showed that the use of ROTEM (p = 0.016) and a lower number of fused levels (p = 0.022) were associated with lower in-hospital transfusion volumes. CONCLUSIONS ROTEM use during thoracolumbar deformity correction is associated with lower transfusion requirements. Further investigation will better define the role of ROTEM in transfusion during deformity surgery.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Chad D Cole
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and.,Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
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Passias PG, Diebo BG, Marascalchi BJ, Jalai CM, Horn SR, Zhou PL, Paltoo K, Bono OJ, Worley N, Poorman GW, Challier V, Dixit A, Paulino C, Lafage V. A novel index for quantifying the risk of early complications for patients undergoing cervical spine surgeries. J Neurosurg Spine 2017; 27:501-507. [PMID: 28841106 DOI: 10.3171/2017.3.spine16887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE It is becoming increasingly necessary for surgeons to provide evidence supporting cost-effectiveness of surgical treatment for cervical spine pathology. Anticipating surgical risk is critical in accurately evaluating the risk/benefit balance of such treatment. Determining the risk and cost-effectiveness of surgery, complications, revision procedures, and mortality rates are the most significant limitations. The purpose of this study was to determine independent risk factors for medical complications (MCs), surgical complications (SCs), revisions, and mortality rates following surgery for patients with cervical spine pathology. The most relevant risk factors were used to structure an index that will help quantify risk and anticipate failure for such procedures. METHODS The authors of this study performed a retrospective review of the National Inpatient Sample (NIS) database for patients treated surgically for cervical spine pathology between 2001 and 2010. Multivariate models were performed to calculate the odds ratio (OR) of the independent risk factors that led to MCs and repeated for SCs, revisions, and mortality. The models controlled for age (< and > 65 years old), sex, race, revision status (except for revision analysis), surgical approach, number of levels fused/re-fused (2-3, 4-8, ≥ 9), and osteotomy utilization. ORs were weighted based on their predictive category: 2 times for revision surgery predictors and 4 times for mortality predictors. Fifty points were distributed among the predictors based on their cumulative OR to establish a risk index. RESULTS Discharges for 362,989 patients with cervical spine pathology were identified. The mean age was 52.65 years, and 49.47% of patients were women. Independent risk factors included medical comorbidities, surgical parameters, and demographic factors. Medical comorbidities included the following: pulmonary circulation disorder, coagulopathy, metastatic cancer, renal failure, congestive heart failure, alcohol abuse, neurological disorder, nonmetastatic cancer, liver disease, rheumatoid arthritis/collagen vascular diseases, and chronic blood loss/anemia. Surgical parameters included posterior approach to fusion/re-fusion, ≥ 9 levels fused/re-fused, corpectomy, 4-8 levels fused/re-fused, and osteotomy; demographic variables included age ≥ 65 years. These factors increased the risk of at least 1 of MC, SC, revision, or mortality (risk of death). A total of 50 points were distributed among the factors based on the cumulative risk ratio of every factor in proportion to the total risk ratios. CONCLUSIONS This study proposed an index to quantify the potential risk of morbidity and mortality prior to surgical intervention for patients with cervical spine pathology. This index may be useful for surgeons in patient counseling efforts as well as for health insurance companies and future socioeconomics studies in assessing surgical risks and benefits for patients undergoing surgical treatment of the cervical spine.
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Affiliation(s)
- Peter G Passias
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn
| | - Bryan J Marascalchi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland; and
| | - Cyrus M Jalai
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Samantha R Horn
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Peter L Zhou
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Karen Paltoo
- Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn
| | - Olivia J Bono
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Nancy Worley
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Gregory W Poorman
- Division of Spine Surgery, Department of Neurological and Orthopaedic Surgery, NYU Langone Medical Center, New York
| | - Vincent Challier
- Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Anant Dixit
- Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn
| | - Carl Paulino
- Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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18
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Patient Satisfaction After Adult Spinal Deformity Surgery Does Not Strongly Correlate With Health-Related Quality of Life Scores, Radiographic Parameters, or Occurrence of Complications. Spine (Phila Pa 1976) 2017; 42:764-769. [PMID: 27748701 DOI: 10.1097/brs.0000000000001921] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a multicenter retrospective review of prospectively collected cases. OBJECTIVE Our objective was to evaluate the relationship between patient satisfaction, health-related quality of life (HRQoL) scores, complications, and radiographic measures at 2 years postoperative follow-up. SUMMARY OF BACKGROUND DATA For patients receiving operative management for adult spine deformity (ASD), the relationship between HRQoL measures, radiographic parameters, postoperative complications, and self-reported satisfaction remains unclear. METHODS Data from 248 patients across 11 centers within the United States who underwent thoracolumbar fusion for ASD and had a minimum of 2 years follow-up was collected. Pre- and postoperative scores were obtained from the Scoliosis Research Society 22-item (SRS-22r), the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and the Visual Analogue Scale. Sagittal vertical axis, coronal C7 plumbline, lumbar lordosis, pelvic tilt, T1 pelvic angle, and the difference between pelvic incidence and lumbar lordosis were assessed using postoperative radiographic films. Satisfaction (SAT) was assessed using the SRS-22r; patients were categorized as highly satisfied (HS) or less satisfied (LS). The correlation between SAT and HRQoL scores, radiographic parameters, and complications was determined. RESULTS When compared with LS (n = 60) patients, HS (n = 188) patients demonstrated greater improvement in final ODI, SF-36 component scores, SRS-Total, and Visual Analogue Scale back scores (P < 0.05). The correlations between SAT and the final follow-up and 2 year change from baseline values were moderate for Mental Component Summary, Physical Component Summary, and ODI or weak for HRQoL scores (P < 0.0001). The HS and LS groups were equal in pre- or final postoperative radiographic parameters. Occurrence of complications had no effect on satisfaction. CONCLUSION Among operatively treated ASD patients, satisfaction was moderately correlated with some HRQoL measures, and not with radiographic changes or postoperative complications. Other factors, such as patient expectations and relationship with the surgeon, may be stronger drivers of patient satisfaction. LEVEL OF EVIDENCE 3.
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Nute DW, Kusnezov N, Dunn JC, Waterman BR. Return to Function, Complication, and Reoperation Rates Following Primary Pectoralis Major Tendon Repair in Military Service Members. J Bone Joint Surg Am 2017; 99:25-32. [PMID: 28060230 DOI: 10.2106/jbjs.16.00124] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pectoralis major tendon ruptures have become increasingly common injuries among young, active individuals over the past 30 years; however, there is presently a paucity of reported outcome data. We investigated the ability to return to full preoperative level of function, complications, reoperation rates, and risk factors for failure following surgical repair of the pectoralis major tendon in a cohort of young, highly active individuals. METHODS All U.S. active-duty military patients undergoing pectoralis major tendon repair between 2008 and 2013 were identified from the Military Health System using the Management Analysis and Reporting Tool (M2). Demographic characteristics, injury characteristics, and trends in preoperative and postoperative self-reported pain scale (0 to 10) and strength were extracted. The ability to return to the full preoperative level of function and rates of rerupture and reoperation were the primary outcome measures. Univariate analysis followed by multivariate analysis identified significant variables. RESULTS A total of 257 patients with pectoralis major tendon repair were identified with a mean follow-up (and standard deviation) of 47.8 ± 17 months (range, 24 to 90 months). At the time of the latest follow-up, 242 patients (94%) were able to return to the full preoperative level of military function. Fifteen patients (5.8%) were unable to return to duty because of persistent upper-extremity disability. A total of 15 reruptures occurred in 14 patients (5.4%). Increasing body mass index and active psychiatric conditions were significant predictors of inability to return to function (odds ratio, 1.56 [p = 0.0001] for increasing body mass index; and odds ratio, 6.59 [p = 0.00165] for active psychiatric conditions) and total failure (odds ratio, 1.26 [p = 0.0012] for increasing body mass index; and odds ratio, 2.73 [p = 0.0486] for active psychiatric conditions). CONCLUSIONS We demonstrate that 94% of patients were able to return to the full preoperative level of function within active military duty following surgical repair of pectoralis major tendon rupture and 5.4% of patients experienced rerupture after primary repair. Increasing body mass index and active psychiatric diagnoses are significant risk factors for an inability to return to function and postoperative failures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Drew W Nute
- 1Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
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Fujimori T, Okuda S, Iwasaki M, Yamasaki R, Maeno T, Yamashita T, Matsumoto T, Wada E, Oda T. Validity of the Japanese Orthopaedic Association scoring system based on patient-reported improvement after posterior lumbar interbody fusion. Spine J 2016; 16:728-36. [PMID: 26826003 DOI: 10.1016/j.spinee.2016.01.181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/13/2015] [Accepted: 01/15/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Japanese Orthopaedic Association (JOA) scoring system is a physician-based outcome that has been used to evaluate treatment effectiveness after lumbar surgery. However, patient-centered evaluation becomes increasingly important. There is no study that has examined the relationship between the JOA scoring system and patients' self-reported improvement. PURPOSE The purpose of the present study was to validate the JOA scoring system for assessment of patient-reported improvement after lumbar surgery. STUDY DESIGN This is a retrospective review of prospectively collected data. PATIENT SAMPLE The patient sample included 273 mail-in responders of the 466 consecutive patients who underwent posterior lumbar interbody fusion for spondylolisthesis between 1996 and 2008 in a single hospital. OUTCOME MEASURES The outcome measures were the JOA scoring system and patients' self-reported improvement. METHODS Two hundred seventy three patients were divided into five anchoring groups based on self-reported improvement from "Much better" to "Much worse." Outcomes (ie, recovery rate, amount of change from preoperative condition, and postoperative score) based on the JOA scoring system were compared among groups. Using the patient's self-reported improvement scale as an anchor, the association among each of the outcomes was examined. The cutoff point and the area under the curve (AUC) that differentiated "Improved" from "Neither improved nor worse" was calculated using receiver operating characteristic (ROC) curve analysis. RESULTS The recovery rate and postoperative score were significantly different in 9 of 10 pairs of anchoring groups. The amount of change was significantly different in six pairs. Spearman correlation coefficient for the 5-point scale anchors of patients' self-reported improvement was 0.20 (p=.001) for the baseline score, 0.31 (p<.001) for the amount of change, 0.55 (p<.001) for the recovery rate, and 0.56 (p<.001) for the postoperative score. According to ROC analysis, the best cutoff points and AUCs were 13 points and 0.69, respectively, for the amount of change, 67% and 0.73, respectively, for recovery rate, and 23 points and 0.72, respectively, for postoperative score. CONCLUSIONS The JOA scoring system is a valid method for assessment of patients' self-reported improvement. Patients' self-reported improvement is more likely to be associated with the final condition, such as postoperative score or recovery rate, rather than the change from the preoperative condition.
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Affiliation(s)
- Takahito Fujimori
- Department of Orthopaedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka 530-0005, Japan.
| | - Shinya Okuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Ryoji Yamasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Takafumi Maeno
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Tomiya Matsumoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Kitaku Nagasonetyou, Sakai, Osaka, Japan
| | - Eiji Wada
- Department of Orthopaedic Surgery, Ehime Prefectural Central Hospital, 83 Kasugatyou, Matsuyama, Ehime, Japan
| | - Takenori Oda
- Department of Orthopaedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka 530-0005, Japan
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Abstract
Adult spinal deformity (ASD) is a very diverse condition that affects the quality of life of the involved individuals deeply. There is an ongoing discussion as to whether treatment should be surgical (which is potentially dangerous) or non-surgical.In addition to a systematic review of literature on the surgical treatment of ASD with special emphasis on complications, a decision-analysis was performed using the patient information within a European multi-centric database of ASD.The probabilities of improvement and complications as well as associated disease burden (utility) were calculated at the baseline and at first-year follow-up.Decision-analysis suggests that the chances of clinical improvement are significantly higher with surgical treatment. Though surgical treatment is significantly more prone to complications, the likelihood of improvement remains higher than that offered by non-surgical treatment.Surgical treatment of ASD appears to be associated with a higher likelihood of clinical improvement. Future work needs to focus on refining the criteria for appropriate patient selection and decreasing the incidence of complications. Cite this article: Acaroglu E, European Spine Study Group. Decision-making in the treatment of adult spinal deformity. EFORT Open Rev 2016;1:167-176. DOI: 10.1302/2058-5241.1.000013.
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Affiliation(s)
- Emre Acaroglu
- Ankara ARTES Spine and Spinal Cord Center, Ankara, Turkey
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Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM, Errico TJ, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Soroceanu A, Kelly MP, Line B, Gupta M, Deviren V, Hart R, Burton DC, Bess S, Ames CP. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 2016; 25:1-14. [PMID: 26918574 DOI: 10.3171/2015.11.spine151036] [Citation(s) in RCA: 236] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.
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Affiliation(s)
- Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and
| | - Renaud Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Gregory M Mundis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas J Errico
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Justin K Scheer
- University of California San Diego School of Medicine, San Diego, California
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Breton Line
- Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Munish Gupta
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | | | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Shay Bess
- Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
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Patient-Based Surgical Outcomes of Posterior Lumbar Interbody Fusion: Patient Satisfaction Analysis. Spine (Phila Pa 1976) 2016; 41:E148-54. [PMID: 26866741 DOI: 10.1097/brs.0000000000001188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The purpose of this study was to investigate: (1) patient-based surgical outcomes of posterior lumbar interbody fusion (PLIF); (2) correlations between patient-based surgical outcomes and surgeon-based surgical outcomes; (3) factors associated with patient satisfaction. SUMMARY OF BACKGROUND DATA There have been no reports of patient-based surgical outcomes of PLIF for lumbar spondylolisthesis. METHODS Patients who underwent PLIF for L4 degenerative spondylolisthesis between 2006 and 2009 were reviewed (n = 121). Surgical outcomes were assessed 5 years after primary surgery using a questionnaire, a numerical rating scale (NRS) of pain, the 36-Item Short Form Health Survey (SF-36), the Japanese Orthopedic Association score (JOA score), and the recovery rate. The original questionnaire consisted of 5 categories, with scoring out of 100 points for surgery, satisfaction, improvement, recommendation to others, and willingness to undergo repeat surgery. Patient-based outcomes were divided into 3 groups according to the questionnaire responses as positive, intermediate, and negative and were compared with the JOA scores. RESULTS A total of 103 patients responded, for a response rate of 85%. The average patient-evaluated score for surgery was 82 points. The positive response rate in each category was 78% for satisfaction, 88% for improvement, 74% for recommendation, and 71% for repeat. The average pre- and postoperative JOA scores were 11.2 and 23.2, respectively. The average recovery rate was 68.5%. There were significant correlations between patient-based surgical outcomes and the JOA score. Furthermore, there were significant correlations between patient-based surgical outcomes and the NRS and physical component scores of the SF-36. Postoperative permanent motor loss was a major factor related to a negative response. CONCLUSION The patient-evaluated score for surgery was 82 points. More than 70% of patients gave positive responses in all sections of the questionnaire. There were significant correlations between patient-based and surgeon-based surgical outcomes. LEVEL OF EVIDENCE 2.
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Primary Versus Revision Surgery in the Setting of Adult Spinal Deformity: A Nationwide Study on 10,912 Patients. Spine (Phila Pa 1976) 2015; 40:1674-80. [PMID: 26267823 DOI: 10.1097/brs.0000000000001114] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected database. OBJECTIVE This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery SUMMARY OF BACKGROUND DATA.: Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. METHODS Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95% CI]). RESULTS Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P = 0.580), as was in-hospital mortality (P = 0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 % vs. 71.97%, P = 0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P < 0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29-1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). CONCLUSION Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.
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Radcliff KE, Neusner AD, Millhouse PW, Harrop JD, Kepler CK, Rasouli MR, Albert TJ, Vaccaro AR. What is new in the diagnosis and prevention of spine surgical site infections. Spine J 2015; 15:336-47. [PMID: 25264181 DOI: 10.1016/j.spinee.2014.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 05/06/2014] [Accepted: 09/15/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical site infection (SSI) after spinal surgery can result in several serious secondary complications, such as pseudoarthrosis, neurological injury, paralysis, sepsis, and death. There is an increasing body of literature on risk factors, diagnosis, and specific intraoperative interventions, including attention to sterility of instrumentation, application of minimally invasive fusion techniques, intraoperative irrigation, and application of topical antibiotics, that hold the most promise for reduction of SSI. PURPOSE The purpose of this review is to identify and summarize the recent literature on the incidence, risk factors, diagnosis, prevention, and treatment of SSIs after adult spine surgery. STUDY DESIGN The study design included systematic review and literature synthesis. METHODS For the systematic reviews, a search was performed in Medline and Scopus using keywords derived from a preliminary review of the literature and Medline MeSH terms. These studies were then manually filtered to meet the study criteria outlined in each section. Studies were excluded via predetermined criteria, and the majority of articles reviewed were excluded. RESULTS There are a number of patient- and procedure-specific risk factors for SSI. Surgical site infection appears to have significant implications from the patients' perspective on outcome of care. Diagnosis of SSI appears to rely primarily on clinical factors, while laboratory values such as C-reactive protein are not universally sensitive. Similarly, novel methods of perioperative infection prophylaxis such as local antibiotic administration appear to be modestly effective. CONCLUSIONS Surgical site infections are a common multifactorial problem after spine surgery. There is compelling evidence that improved risk stratification, detection, and prevention will reduce SSIs.
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Affiliation(s)
- Kris E Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
| | - Alexander D Neusner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA; Department of Surgery, Temple University Hospital, 3401 N. Broad St, Suite 400, Philadelphia, PA 19140, USA
| | - Paul W Millhouse
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - James D Harrop
- Department of Neurosurgery, Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Mohammad R Rasouli
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Todd J Albert
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
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Reis RC, de Oliveira MF, Rotta JM, Botelho RV. Risk of complications in spine surgery: a prospective study. Open Orthop J 2015; 9:20-5. [PMID: 25674185 PMCID: PMC4321205 DOI: 10.2174/1874325001509010020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/04/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs 52.8%, p = 0.87). The risk of complications was higher among patients submitted to spine instrumentation than those submitted to non-instrumented surgery (33% vs 22%), p=0.8. Conclusion : Just over one-quarter of patients in the sample developed complications. In this study, age, BMI, comorbidities were not associated with increased risk of complications after spine surgery. The use of instrumentation increased the absolute risk of complications.
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Affiliation(s)
- Rodolfo Casimiro Reis
- Spine Surgery Section, Hospital do Servidor Puúblico Estadual de São Paulo, São Paulo-SP, Brazil
| | | | - José Marcus Rotta
- Spine Surgery Section, Hospital do Servidor Puúblico Estadual de São Paulo, São Paulo-SP, Brazil
| | - Ricardo Vieira Botelho
- Spine Surgery Section, Hospital do Servidor Puúblico Estadual de São Paulo, São Paulo-SP, Brazil
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