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Vazquez S, Dominguez JF, Lu VM, Kumar V, Shah S, Brusko GD, Levi AD. Characteristics and Outcomes of Patients Treated with Cervical Spine Fusion at High Volume Hospitals. World Neurosurg 2024; 187:e494-e500. [PMID: 38677643 DOI: 10.1016/j.wneu.2024.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND High volume (HV) has been associated with improved outcomes in various neurosurgical procedures. The objective of this study was to explore the regional distribution of HV spine centers for cervical spine fusion and compare characteristics and outcomes for patients treated at HV centers versus lower volume centers. METHODS The National Inpatient Sample database 2016-2020 was queried for patients undergoing cervical spine fusion for degenerative pathology. HV was defined as case-loads greater than 2 standard deviations above the mean. Patient characteristics, procedures, and outcomes were compared. RESULTS Of 3895 hospitals performing cervical spine fusion for degenerative pathology, 28 (0.76%) were HV. The Mid-Atlantic and West South Central regions had the highest number of HV hospitals. HV hospitals were more likely to perform open anterior fusion surgeries (P < 0.01). Patients treated at HV hospitals were less likely to have severe symptomatology or comorbidities (P < 0.01 for all). When controlling for severity and demographics on multivariate analysis, HV centers had higher odds of length of stay ≤1 day, favorable discharge, and decreased total charges. CONCLUSIONS Patients who underwent cervical spine fusion surgery at HV hospitals were less complex and had increased odds of length of stay ≤1, favorable discharge, and total charges in the lower 25th percentile than patients treated at non-HV hospitals. Physician comfort, patient selection, institutional infrastructure, and geographic characteristics likely play a role.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, New York, USA.
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vignessh Kumar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sumedh Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Soleymani Majd H, Weeks E, Addley S, Cavallaro A, Collins SL. The Soleymani and Collins Obstetric morbidity score (SaCOMS): A quantitative tool for measuring maternal morbidity from complex obstetric surgery such as placenta accreta spectrum (PAS). Eur J Obstet Gynecol Reprod Biol 2024; 299:148-155. [PMID: 38870741 DOI: 10.1016/j.ejogrb.2024.06.005] [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: 03/05/2024] [Revised: 05/03/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
It is currently very difficult to compare different management strategies for complex obstetric surgery, such as hysterectomy for severe Placenta Accreta Spectrum (PAS), as there is no widely accepted consensus for the classification of maternal surgical morbidity. Many studies focus on the amount of blood products transfused or admission to intensive care units (ICU). However, these are dependent on local policies and available resources. It also gives an incomplete representation of the entire 'patient journey' after they leave the operating room. Subsequent repeat procedures for lower urinary track damage is arguably worse from the woman's perspective than a short stay on an intensive care unit (ICU) for observation. We suggest a version of the Clavien-Dindo morbidity classification specific to obstetrics. Then employ it to build a quantitative morbidity score which aims to reflect the whole 'patient experience' including the post-operative pathway. We then demonstrate the utility of this system in a cohort of women with Placenta Accreta Spectrum (PAS). The Clavien-Dindo classification was modified to reflect obstetric procedures and a quantitative morbidity measure, the Soleymani and Collins Obstetric Morbidity Score (SaCOMS), was developed based on this. Both were then validated using a survey-based consultation of a panel of experts in PAS and retrospectively applied to a cohort of 54 women who underwent caesarean hysterectomy for PAS. Clinicians with expertise in PAS believe that the Modified Obstetric Clavien-Dindo classification system and the novel SaCOMS tool can improve assessment of maternal morbidity, and better reflect the 'patient experience'. Application of the classification system to a single-centre PAS cohort suggested that surgery by gynecologic-oncology surgeons may be associated with decreased incidence and cumulative morbidity outcomes for women with PAS, especially those with the most severe presentation. This study presents a clinically useful obstetric-specific classification system for surgical morbidity. SaCOMS also provides a quantitative reflection of the full patient- journey experienced as a result of surgical complications enabling a more patient-centered representation of morbidity.
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Affiliation(s)
- Hooman Soleymani Majd
- Department of Gynaecological Oncology, Oxford University Hospitals, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, UK
| | - Esme Weeks
- The Medical Sciences Division, University of Oxford, Oxford, UK
| | - Susan Addley
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK
| | | | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK.
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Hines K, Philipp L, Thalheimer S, Montenegro TS, Gonzalez GA, Hughes LP, Leibold A, Mahtabfar A, Franco D, Heller JE, Jallo J, Prasad S, Sharan AD, Harrop JS. Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients. Clin Spine Surg 2023; 36:E86-E93. [PMID: 36006405 DOI: 10.1097/bsd.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN The present study design was that of a single center, retrospective cohort study to evaluate the influence of surgeon-specific factors on patient functional outcomes at 6 months following lumbar fusion. Retrospective review of a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis identified the present study population. OBJECTIVE This study seeks to evaluate surgeon-specific variable effects on patient-reported outcomes such as Oswestry Disability Index (ODI) and the effect of North American Spine Society (NASS) concordance on outcomes in the setting of variable surgeon characteristics. SUMMARY OF BACKGROUND DATA Lumbar fusion is one of the fastest growing procedures performed in the United States. Although the impact of surgeon-specific factors on patient-reported outcomes has been contested, studies examining these effects are limited. METHODS This is a single center, retrospective cohort study analyzing a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis by 1 of 5 neurosurgery fellowship trained spine surgeons. The primary outcome was improvement of ODI at 6 months postoperative follow-up compared with preoperative ODI. RESULTS A total of 307 patients were identified for analysis. Overall, 62% of the study population achieved minimum clinically important difference (MCID) in ODI score at 6 months. Years in practice and volume of lumbar fusions were statistically significant independent predictors of MCID ODI on multivariable logistic regression ( P =0.0340 and P =0.0343, respectively). Concordance with evidence-based criteria conferred a 3.16 (95% CI: 1.03, 9.65) times greater odds of achieving MCID. CONCLUSION This study demonstrates that traditional surgeon-specific variables predicting surgical morbidity such as experience and procedural volume are also predictors of achieving MCID 6 months postoperatively from lumbar fusion. Independent of surgeon factors, however, adhering to evidence-based guidelines can lead to improved outcomes.
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Affiliation(s)
- Kevin Hines
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA
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Effect of climate on surgical site infections and anticipated increases in the United States. Sci Rep 2022; 12:19698. [PMID: 36385136 PMCID: PMC9668825 DOI: 10.1038/s41598-022-24255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Surgical site infections (SSI) are one of the most common and costly hospital-acquired infections in the United States. Meteorological variables such as temperature, humidity, and precipitation may represent a neglected group of risk factors for SSI. Using a national private insurance database, we collected admission and follow-up records for National Healthcare Safety Network-monitored surgical procedures and associated climate conditions from 2007 to 2014. We found that every 10 cm increase of maximum daily precipitation resulted in a 1.09 odds increase in SSI after discharge, while every g/kg unit increase in specific humidity resulted in a 1.03 odds increase in SSI risk after discharge. We identified the Southeast region of the United States at highest risk of climate change-related SSI, with an estimated 3% increase in SSI by 2060 under high emission assumptions. Our results describe the effect of climate on SSI and the potential burden of climate-change related SSI in the United States.
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Chatterjee A, Rbil N, Yancey M, Geiselmann MT, Pesante B, Khormaee S. Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 11:100132. [PMID: 35783006 PMCID: PMC9243295 DOI: 10.1016/j.xnsj.2022.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Nada Rbil
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States
| | - Michael Yancey
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States
| | - Matthew T. Geiselmann
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Benjamin Pesante
- The University of Connecticut School of Medicine, Farmington, CT, United States
| | - Sariah Khormaee
- Weill Cornell Medical College, New York, NY, United States
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States
- Corresponding author: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States
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Morishita S, Yoshii T, Inose H, Hirai T, Matsukura Y, Ogawa T, Fushimi K, Katayanagi J, Jinno T, Okawa A. Perioperative Complications of Anterior Decompression with Fusion in Degenerative Cervical Myelopathy-A Comparative Study between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database. J Clin Med 2022; 11:jcm11123398. [PMID: 35743467 PMCID: PMC9225569 DOI: 10.3390/jcm11123398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/06/2023] Open
Abstract
For ossification of the posterior longitudinal ligament (OPLL) and cervical spondylotic myelopathy (CSM), anterior decompression with fusion (ADF) can accurately achieve spinal decompression. However, the difference in perioperative complications in ADF between OPLL and CSM is poorly described. This study aimed to investigate the perioperative complication rates of patients with degenerative cervical myelopathy undergoing ADF, represented by OPLL and CSM, using a large national inpatient database. In the OPLL and CSM groups, postoperative complication (systemic and local) rates, reoperation rates, medical costs during hospitalization, and mortality after propensity score matching were compared. After matching, 1197 matched pairs were made. The incidence of total systemic complications was similar between both groups (OPLL, 12.4%; CSM, 12.2%). In the OPLL group, more perioperative local complications (cerebrospinal fluid leakage: CSFL, [OPLL, 2.7%; CSM, 0.3%] and surgical site infection: SSI [OPLL, 2.1%; CSM, 0.9%]) were detected, and the hospitalization cost was approximately $3200 higher than that in the CSM group. Moreover, medical costs were significantly higher in patients who experienced complications in both OPLL and CSM. The frequency of perioperative complications of OPLL and CSM in ADF was detailed using large real-world data. Compared to CSM, OPLL had more perioperative complications such as CSFL and SSI, and higher medical costs. Regardless of the disease, medical costs were significantly increased when perioperative complications occurred.
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Affiliation(s)
- Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan; (J.K.); (T.J.)
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
- Correspondence: ; Tel.: +81-3-5803-5272; Fax: +81-3-5803-0110
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
| | - Junya Katayanagi
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan; (J.K.); (T.J.)
| | - Tetsuya Jinno
- Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan; (J.K.); (T.J.)
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (S.M.); (H.I.); (T.H.); (Y.M.); (T.O.); (A.O.)
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Mehta N, Lavoie-Gagne OZ, Cohn MR, Michalski J, Fitch A, Yanke AB, Cole BJ, Verma NN, Forsythe B. Travel Distance Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2022; 4:e511-e517. [PMID: 35494309 PMCID: PMC9042758 DOI: 10.1016/j.asmr.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/24/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nabil Mehta
- Address correspondence to Nabil Mehta, M.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL 60612, U.S.A.
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Rajan PV, Emara AK, Ng M, Grits D, Pelle DW, Savage JW. Longer operative time associated with prolonged length of stay, non-home discharge and transfusion requirement after anterior cervical discectomy and fusion: an analysis of 24,593 cases. Spine J 2021; 21:1718-1728. [PMID: 33971323 DOI: 10.1016/j.spinee.2021.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prolonged operative time of single-level ACDF has been associated with adverse postoperative outcomes. The current literature does not contain a comprehensive quantitative description of these associations PURPOSE: This study characterized the associations between single-level anterior cervical discectomy and fusion(ACDF) operative time and (1)30-day postoperative healthcare utilization, and (2)the incidence of local wound complications, need for transfusion and mechanical ventilation. DESIGN/SETTING Retrospective database analysis PATIENT SAMPLE: The American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database was queried for single-level ACDF cases(2012-2018) using current procedural terminology codes. A total of 24,593 cases were included. OUTCOME MEASURES Primary outcomes included healthcare utilization(lengths of stay[LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative time category. The secondary outcome was the incidence of wound complications, blood transfusion and need for ventilation per operative time category. METHODS Multivariate regression determined operative time categories associated with increased risk while adjusting for patient demographics and comorbidities. Predictive spline regression models visualized the associations. RESULTS Compared to the reference operative time of 81-100-minutes, the 101-120-minute category was associated with higher odds of LOS >2 days(OR:1.36,95%CI(1.18-1.568);p<.001) and non-home discharge(OR:1.341,95%CI(1.081-1.664);p=.008). Three-times greater odds of LOS >2 days(OR:3.367,95%CI(2.719-4.169); p<.001) and twice the odds of non-home discharge(OR:2.174,95%CI(1.563-3.022);p<.001) were detected at 181-200-minutes. The highest operative time category(≥221 minutes) was associated with the highest odds of LOS>2 days(OR:4.838,95%CI(4.032-5.804);p<.001), non-home discharge(OR:2.687,95%CI(2.045-3.531);p<.001) and reoperation(OR:1.794,95%CI(1.094-2.943);p=.021). Patients within the 201-220 and the ≥221-minute categories exhibited a significant association with greater odds of transfusion(OR:8.57,95%CI(2.321-31.639);p<.001, and OR:11.699, 95%CI(4.179-32.749);p=.001, respectively). Spline regression demonstrated that the odds of LOS >2 days, non-home discharge disposition, reoperation and bleeding requiring transfusion events began to rise, starting at 94, 91.6, 91.6, and 93.3 minutes of operative time, respectively. CONCLUSION This study demonstrated that prolonged operative time is associated with increased odds of healthcare utilization and transfusion after single-level ACDF. Operative times greater than 91 minutes may carry higher odds of postoperative complications.
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Affiliation(s)
- Prashant V Rajan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA; Center for Spine Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
| | - Mitchell Ng
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
| | - Dominic W Pelle
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA; Center for Spine Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
| | - Jason W Savage
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA; Center for Spine Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
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Risk factors for reoperation after lumbar total disc replacement at short-, mid-, and long-term follow-up. Spine J 2021; 21:1110-1117. [PMID: 33640583 DOI: 10.1016/j.spinee.2021.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The reoperation rate following TDR (Total Disc replacement) has been established at short- and mid-term time points through the Food and Drug Administration Investigational Device Exemption (FDA IDE) trials. However, these trials include highly selected centers and surgeons with strict governance of indications. The utilization of TDR throughout the community needs further analysis. PURPOSE To identify the risk factors for lumbar spine reoperation in patients undergoing lumbar total disc replacement (TDR) at short-, mid-, and long-term follow-up. STUDY DESIGN/SETTING This study is a multi-center retrospective cohort study utilizing the New York Statewide Planning and Research Cooperative System database. PATIENT SAMPLE We identified 1,368 patients who underwent an elective primary lumbar TDR in New York State between January 1, 2005 and September 30, 2013. OUTCOME MEASURES The primary functional outcome of interest was lumbar reoperation, specifically the evaluation of independent risk factors for lumbar reoperation at a minimum of 2 years, with sub-analyses performed at 5 and ten years. METHODS International Classification of Diseases, Ninth revision codes were utilized to identify patients undergoing a primary lumbar TDR. We excluded patients with primary/revision lumbar fusion procedures and revision disc replacement procedures. Hospital academic status was determined by the Accreditation Council for Graduate Medical Education. Unique encrypted patient identifiers allowed for longitudinal follow-up for reoperation. Logistic regression models compared reoperation and no-reoperation cohorts, and were performed on sub-analyses for significant univariate predictors of reoperation. RESULTS Between January 2005 and September 2013, 1368 patients underwent a primary lumbar TDR. Reoperation occurred in 8.8% by 2 years, 15.8% by 5 years, and 19.5% by ten years. Diabetics were more likely to have reoperations (7.5% vs 3.8%, p=.013). Teaching hospitals experienced a decreased reoperation rate compared to nonteaching hospitals at 2-year (5.0% vs 10.5%, p=.002), 5-year (10.7% vs 17.9%, p=.002) and 10-year (11.7% vs 21.9%, p=.045) follow-up. Lumbar fusion was the most common reoperation (14.2%). CONCLUSION We identified an 8.8% reoperation rate after inpatient lumbar TDR at 2-years, 15.8% at 5-years, and 19.5% at 10-years. When stratifying by teaching status, reoperation rates at teaching centers align with those reported in FDA IDE studies. Diabetes was the only patient factor influencing reoperation rate. There is a growing consensus that lumbar TDR is a durable and appropriate surgical option for lumbar degenerative disc disease. Proper indications are crucial to obtaining good outcomes with lumbar TDR.
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Takenaka S, Kashii M, Iwasaki M, Makino T, Sakai Y, Kaito T. Risk factor analysis of surgery-related complications in primary cervical spine surgery for degenerative diseases using a surgeon-maintained database. Bone Joint J 2021; 103-B:157-163. [PMID: 33380205 DOI: 10.1302/0301-620x.103b1.bjj-2020-1226.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases. METHODS We studied 5,015 patients with degenerative cervical diseases who underwent primary cervical spine surgery from 2012 to 2018. We investigated the effects of diseases, surgical procedures, and patient demographics on surgery-related complications. As subcategories, the presence of cervical kyphosis ≥ 10°, the presence of ossification of the posterior longitudinal ligament (OPLL) with a canal-occupying ratio ≥ 50%, and foraminotomy were selected. The surgery-related complications examined were postoperative upper limb palsy (ULP) with a manual muscle test (MMT) grade of 0 to 2 or a reduction of two grade or more in the MMT, neurological deficit except ULP, dural tear, dural leakage, surgical-site infection (SSI), and postoperative haematoma. Multivariate logistic regression analysis was performed. RESULTS The significant risk factors (p < 0.050) for ULP were OPLL (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.29 to 2.75), foraminotomy (OR 5.38, 95% CI 3.28 to 8.82), old age (per ten years, OR 1.18, 95% CI 1.03 to 1.36), anterior spinal fusion (OR 2.85, 95% CI 1.53 to 5.34), and the number of operated levels (OR 1.25, 95% CI 1.11 to 1.40). OPLL was also a risk factor for neurological deficit except ULP (OR 5.84, 95% CI 2.80 to 12.8), dural tear (OR 1.94, 95% CI 1.11 to 3.39), and dural leakage (OR 3.15, 95% CI 1.48 to 6.68). Among OPLL patients, dural tear and dural leakage were frequently observed in those with a canal-occupying ratio ≥ 50%. Cervical rheumatoid arthritis (RA) was a risk factor for SSI (OR 10.1, 95% CI 2.66 to 38.4). CONCLUSION The high risk of ULP, neurological deficit except ULP, dural tear, and dural leak should be acknowledged by clinicians and OPLL patients, especially in those patients with a canal-occupying ratio ≥ 50%. Foraminotomy and RA were dominant risk factors for ULP and SSI, respectively. An awareness of these risks may help surgeons to avoid surgery-related complications in these conditions. Cite this article: Bone Joint J 2021;103-B(1):157-163.
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Affiliation(s)
- Shota Takenaka
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masafumi Kashii
- Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Motoki Iwasaki
- Orthopaedic Surgery, Osaka-Rosai Hospital, Sakai, Osaka, Japan
| | - Takahiro Makino
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Sakai
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kaito
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Lopez CD, Boddapati V, Lombardi JM, Sardar ZM, Dyrszka MD, Lehman RA, Riew KD. Recent trends in medicare utilization and reimbursement for anterior cervical discectomy and fusion. Spine J 2020; 20:1737-1743. [PMID: 32562771 DOI: 10.1016/j.spinee.2020.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) has been considered the gold standard for treating various cervical spine pathologies stemming from cervical degenerative disorders. While cervical artificial disc replacement has emerged as an alternative in select cases, ACDF still remains a commonly performed procedure. PURPOSE This study seeks to define the costs of ACDF and identify trends and variations in ACDF volume, utilization, and surgeon and hospital reimbursement rates. STUDY DESIGN/SETTING Retrospective analysis of patients undergoing ACDF PATIENT SAMPLE: Medicare patients undergoing ACDF between 2012 and 2017 OUTCOME MEASURES: ACDF volume, utilization rates, and surgeon/hospital reimbursement rates METHODS: This study tracked annual Medicare claims and payments to ACDF surgeons using publicly-available databases and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates (per 10,000 Medicare beneficiaries), and reimbursement rates, and to examine associations between county-specific variables (ie, urban or rural, average household income, poverty rate, percent Medicare population, race/ethnicity demographics), and ACDF utilization and reimbursement rates. RESULTS A total of 264,673 ACDF surgeries were performed in the Medicare population from 2012 to 2017, with a 24.2% increase in annual procedure volume. Utilization also increased by 6.5% from 8.0 surgeries per 10,000 Medicare beneficiaries in 2012 to 8.5 in 2017. Hospital reimbursements for cervical spine fusion surgeries without complications or co-morbidities experienced nominal and inflation-adjusted increases of 9.5% and 0.7%, respectively, from $12,030.11 in 2012 to $13,167.64 in 2017. Surgeon reimbursements for single-level and multilevel ACDF each nominally decreased from $958.11 and $1,173.01, respectively, in 2012 to $950.34 and $1,138.41 in 2017 (a 0.8% and 2.9% decrease, respectively), but after adjusting for inflation, reimbursements per case fell by an average of 8.7% and 10.7%, respectively. In contrast, mean reimbursements per case for hospitals rose by 7.1% (1.5% inflation-adjusted decrease). A significant upward yearly trend in ambulatory surgical centers volume, resulted in a net increase of 184.5% between 2015 and 2017 (p<.001). CONCLUSIONS While ACDF volume and utilization has continued to increase since 2012, Medicare payments to hospitals and surgeons have struggled to keep up with inflation. Our study confirms that Medicare reimbursement per case continues to decrease at a disproportionate rate for surgeons, compared to hospitals. The increasing trend in procedures performed at ambulatory surgical centers shows promise for a future model of cost-efficient and value-based care.
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Affiliation(s)
- Cesar D Lopez
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Venkat Boddapati
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
| | - Joseph M Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Zeeshan M Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Marc D Dyrszka
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - K Daniel Riew
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
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Kurucan E, Sulovari A, Thirukumaran C, Greenstein A, Molinari R, Mesfin A. Volume-outcome relationship in halo vest utilization for C2 fractures. Spine J 2020; 20:1676-1684. [PMID: 32474222 DOI: 10.1016/j.spinee.2020.05.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The prevalence of C2 fractures has increased in recent years. The treatment of these fractures include halo-vest immobilization (HVI), rigid cervical collar, or spinal fusion. There is controversy regarding the management of these fractures with different institutions having their own protocols based on individualized experience. The volume-outcome relationship of HVI use for C2 fractures has not been studied. Evaluation of such relationships are important as they suggest that patients may benefit from referral to and treatment at high-volume institutions. PURPOSE To evaluate the volume-outcome relationship in HVI use for C2 fractures in New York State. STUDY DESIGN Retrospective analysis of a statewide database. PATIENT SAMPLE We queried the New York Statewide Planning and Research Cooperative System database for the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 805.02 (closed fracture of second cervical vertebra) and procedure code 029.4 (insertion or replacement of skull tongs or halo traction device) to identify all patients who received HVI for a fracture of the second cervical vertebra between the years 2001 and 2014. Those who had isolated C2 fractures were selected. OUTCOME MEASURES Outcomes of interest included resource utilization characteristics (hospitalization charges and length of stay), perioperative complications, comorbidities, 30-day mortality, any readmission, and any future cervical fusion surgery. METHODS The 2001 to 2014 Statewide Planning and Research Cooperative System database was used to identify patients with C2 fractures who received HVI. Our key independent variable was institution volume modeled as high- (>25 halos/year), medium-, (10-25 halos/year), or low-volume (<10 halos/year) based on the total number of HVI procedures reported by hospitals during the study period. We compared outcomes with respect to hospital volume. We also compared patients by age groups: <40, 40 to 60, 60 to 80, and >80. Multivariate logistic regressions were performed for the binary variables any complication and any readmission while controlling for covariates hospital volume, age, sex, race, insurance status, and Elixhauser comorbidity mean. Statistical significance was set at a value of p<.05 for all analyses. RESULTS In all, 625 patients with C2 fractures managed with HVI were included. Most patients were male (53%) and Caucasian (76%) with a mean age of 57. Patients at high-volume hospitals were younger (52 vs. 59 and 60 for medium- and low-volume, respectively; p<.01) and had fewer future readmissions (40% vs. 54% and 84% for medium- and low-volume, respectively; p<.01). On multivariable analysis, those with private insurance and worker's compensation had lower likelihood of future readmission compared to Medicaid patients. Patients >80 had higher rates of major in-hospital complications (52% vs. 40%, 18%, and 19% for groups 60-79, 40-59, and <40, respectively; p<.01), mortality (14% vs. 5%, 1%, and 1% for groups 60-79, 40-59, and <40, respectively; p<.01), and readmissions after the initial HVI (62% vs. 50%, 54%, and 37% for groups 60-79, 40-59, and <40, respectively; p<.01). The annual rate of HVI use for C2 fractures decreased significantly from 2001 to 2014 (0.32 to 0.06 HVI procedures per 100,000 people; p<.01) with the rate of decline being less pronounced in high-volume institutions (70% decrease vs. 85% and 90% for medium- and low-volume, respectively). CONCLUSIONS Halo vest utilization for C2 fractures in New York State has been declining over the past decade, with the decline being less pronounced in high-volume hospitals. Our hospital volume analysis suggests that HVI use in high-volume institutions is associated with a lower rate of future readmissions. This finding suggests that patients with C2 fractures may benefit from treatment at high-volume institutions. Further research to help improve referral of appropriate patients and increase access to such institutions is warranted.
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Affiliation(s)
- Etka Kurucan
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Aron Sulovari
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA; Department of Public Health Science, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Alexander Greenstein
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Robert Molinari
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Addisu Mesfin
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA; Department of Public Health Science, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
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Lopez CD, Boddapati V, Lombardi JM, Lee NJ, Saifi C, Dyrszka MD, Sardar ZM, Lenke LG, Lehman RA. Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures. Spine J 2020; 20:1586-1594. [PMID: 32534133 DOI: 10.1016/j.spinee.2020.05.558] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Understanding the scope of the volume and costs of lumbar fusions and discectomy procedures, as well as identifying significant trends within the Medicare system, may be beneficial in enhancing cost-efficiency and care delivery. However, there is a paucity of studies which analyze recent trends in lumbar fusion volume, utilization, and reimbursements. PURPOSE This study seeks to define the costs of lumbar fusions and discectomy procedures and identify trends and variations in volume, utilization, and surgeon and hospital reimbursement rates in the Medicare system between 2012 and 2017. STUDY DESIGN Retrospective database study. PATIENT SAMPLE Medicare Part A and Part B claims submitted for lumbar spine procedures from 2012 to 2017, as documented in the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use Files. OUTCOME MEASURES Procedure numbers and payments per episode. METHODS This cross-sectional study tracked annual Medicare claims and payments to spine surgeons using publicly-available databases and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates (per 10,000 Medicare beneficiaries), and reimbursement rates, and to examine associations between county-specific and lumbar spine procedure utilization and reimbursements. RESULTS A total of 772,532 lumbar spine procedures were performed in the Medicare population from 2012 to 2017, including 634,335 lumbar fusion surgeries and 138,197 primary lumbar discectomy and microdiscectomy single-level surgeries. There was a 26.0% increase in annual lumbar fusion procedure volume during the study period, with a compound annual growth rate (CAGR) of 4.7%. Lumbar discectomy/microdiscectomy experienced a 23.5% decrease in annual procedure volume (CAGR, -5.2%). Mean Medicare surgeon reimbursements for lumbar fusions nominally decreased by 3.7% from $767 in 2012 to $738 in 2017, equivalent to an inflation-adjusted decrease of 11.4% (CAGR, -0.7%). Mean Medicare payments for lumbar discectomy and microdiscectomy procedures nominally increased by 16.3% from $517 in 2012 to $601 in 2017, equivalent to an inflation-adjusted increase of 6.9% (CAGR, 3.1%). CONCLUSIONS This present study found the volume and utilization of lumbar fusions have increased since 2012, while lumbar discectomy and microdiscectomy volume and utilization have fallen. Medicare payments to hospitals and surgeons for lumbar fusions have either declined or not kept pace with inflation, and reimbursements for lumbar discectomy and microdiscectomy to hospitals have risen at a disproportionate rate compared to surgeon payments. These trends in Medicare payments, especially seen in decreasing allocation of reimbursements for surgeons, may be the effect of value-based cost reduction measures, especially for high-cost orthopedic and spine surgeries.
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Affiliation(s)
- Cesar D Lopez
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Venkat Boddapati
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA.
| | - Joseph M Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Nathan J Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Comron Saifi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Marc D Dyrszka
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Zeeshan M Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY 10032, USA
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Ishiguro H, Takenaka S, Kashii M, Ukon Y, Nagamoto Y, Furuya M, Makino T, Sakai Y, Kaito T. Direct Involvement of Concomitant Foraminotomy for Radiculomyelopathy in Postoperative Upper Limb Palsy in Cervical Laminoplasty. World Neurosurg 2020; 146:e14-e21. [PMID: 32992066 DOI: 10.1016/j.wneu.2020.09.105] [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: 08/19/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although concomitant foraminotomy has been reported to increase the risk of postoperative upper limb palsy (ULP) in cervical laminoplasty, the specific effects of concomitant foraminotomy on ULP remain uncertain. This study aimed to clarify the effect of concomitant foraminotomy on ULP in cervical laminoplasty. METHODS We identified 19 patients who developed ULP after laminoplasty with concomitant foraminotomy for radiculomyelopathy with nerve root impingement (laminoplasty with concomitant foraminotomy group [F-group]) from 4080 patients who underwent primary cervical laminoplasty at 27 affiliated institutions between 2012 and 2018. An age- and sex-matched control group comprised patients who developed ULP after laminoplasty without concomitant foraminotomy (n = 76, 4:1 ratio with F-group). Collected data included the time of onset and distribution of ULP (side and level). The site of foraminotomy was recorded in the F-group. RESULTS The F-group showed a significantly higher incidence of ULP than the candidates for the control group (15.1% vs. 3.1%, P < 0.001). The site of foraminotomy was consistent with the distribution of ULP in 79% (15 of 19 patients) of the F-group. The F-group showed a significantly higher proportion of preoperative upper-limb muscle weakness (74% vs. 37%, P = 0.005) and early-onset ULP occurring by postoperative day 1 (63% vs. 33%, P = 0.02) compared with the control group. CONCLUSIONS Our results indicate that the foraminotomy procedure in the stenotic foramen is directly involved in ULP. Combined with a previous report suggesting that early-onset ULP is associated with thermal nerve damage, our results indicate that thermal nerve damage partly explains the increased incidence of ULP in the F-group.
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Affiliation(s)
- Hiroyuki Ishiguro
- Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Shota Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masafumi Kashii
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Yuichiro Ukon
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masayuki Furuya
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takahiro Makino
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Lee R, Lee D, Iweala U, Ramamurti P, Weinreb JH, O’Brien JR. Outcomes following outpatient anterior cervical discectomy and fusion for the treatment of myelopathy. J Clin Orthop Trauma 2020; 15:161-167. [PMID: 33717932 PMCID: PMC7920123 DOI: 10.1016/j.jcot.2020.07.030] [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] [Received: 04/25/2020] [Revised: 06/14/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of degenerative cervical disease. With continued increase in U.S. healthcare expenditure, surgeons have begun to more closely examine the benefits of performing ACDF in an outpatient setting to increase efficiency, reduce the overall financial burden on patients/providers, and provide streamlined care for these patients. The purpose of this study was to analyze outcomes following outpatient ACDF for the treatment of myelopathy. METHODS 14,490 patients who had undergone ACDF for myelopathy from 2010 to 2018 were included in this retrospective study, of which 2956 (20.40%) patients were considered to have undergone outpatient surgery. Pearson chi-squared tests and Fischer's Exact Tests were used to analyze differences in categorical variables of demographics, preoperative comorbidities, and postoperative complications, while Mann-Whitney-U-Tests were used to compare mean values of continuous variables. Coarsened-exact-matching (CEM) was implemented to control for baseline differences in demographics and comorbidities, and post-matching diagnostics included multivariate and univariate imbalance measure assessment. Outcomes were compared between the CEM-matched inpatient and outpatients ACDF cohorts. RESULTS Upon CEM-matching (L1-statistic <0.001), the outpatient cohort (n = 2610, 25.13%) demonstrated significantly lower rates of any complication (p < 0.001), minor complications (p = 0.001), urinary tract infections (p = 0.029), blood transfusions (p < 0.001), major complications (p < 0.001), deep incisional surgical site infections (p = 0.017), ventilator dependence (p = 0.027), cardiac arrest (p = 0.028), unplanned reoperations (p = 0.001), and mortality (p = 0.006) in the 30-day postoperative period when compared to inpatient controls (n = 7774, 74.87%). CONCLUSION ACDF has been a target amongst spinal procedures as a prime candidate for outpatient surgery. However, no previous reports have described complication rates and perioperative parameters in the sub-population of outpatient ACDF patients with myelopathy. In addition to shorter times from admission to operating room, operative time, and LOS, our study also demonstrated lower rates of major and overall complications in outpatient ACDF's for myelopathy in comparison to their inpatient counterparts. Performing ACDF's for myelopathy in an outpatient setting may help to curb costs, improve outcomes, and serve as a valuable learning resource for graduate medical education with rapid turnovers and shorter operative times.
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Affiliation(s)
- Ryan Lee
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA,Corresponding author. The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, 20037, USA.
| | - Danny Lee
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA
| | - Uchechi Iweala
- Division of Spine Surgery, New York University Langone Orthopaedic Hospital in New York, NY, USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA
| | - Jeffrey H. Weinreb
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA
| | - Joseph R. O’Brien
- Washington Spine and Scoliosis Clinic, OrthoBethesda in Bethesda, MD, USA
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Perfetti D, Atlas AM, Galina J, Satin A, Hasan S, Amaral T, Sarwahi V. Surgeon volume affects short- and long-term surgical outcomes in idiopathic scoliosis. Spine Deform 2020; 8:455-461. [PMID: 32096129 DOI: 10.1007/s43390-020-00058-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/26/2019] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective review of New York Statewide Planning and Research Cooperative System (SPARCS) Inpatient Database. OBJECTIVE To identify the differences in short- and long-term complications, following long-segment pediatric spinal fusion in idiopathic scoliosis surgery, between surgeons with low versus high annual surgical volume. Spinal deformity surgery is complex and requires significant training and repetition to master. Surgeon and hospital volume have been shown to correlate with outcomes following cervical and lumbar spine surgery. However, there is limited literature regarding the impact of surgeon volume on long-term outcomes following pediatric idiopathic spinal deformity correction. METHODS This is a retrospective review of the SPARCS inpatient database from 2004 to 2013 of pediatric patients who underwent idiopathic scoliosis surgery. Surgeons were stratified into high (> 15 cases/year)- and low (≤ 15 cases/year)-volume cohorts by aggregating all cases completed over the study period until 50% of the total cases were captured above and below an average case per-year threshold. This threshold occurred at 15 cases/year. Short-term and long-term readmission and medical/surgical complications were collected. Multivariate logistic regression models assessed the risk of short- and long-term complications between cohorts. RESULTS 3910 pediatric patients underwent a primary arthrodesis from a total of 223 surgeons. More high-volume surgeons operated at academic teaching hospitals (p < 0.001), used a combined AP surgical approach (p < 0.001), and fewer utilized rhBMP (p < 0.001). High-volume surgeons had shorter lengths of stay (p < 0.001). Low-volume surgeons had increased odds of inpatient surgical complications (OR 1.55, 95% CI 1.00-2.45). Low-volume surgeons had increased odds of revision at 5 and 10 years (5 years. OR 1.56, 95% CI 1.05-2.31; 10 years. OR 1.59, 95% CI 1.09-2.31). Low-volume surgeons had increased odds of implant malfunction at 10 years (OR 1.81, 95% CI 1.15-2.86). CONCLUSIONS High-volume surgeons had decreased odds of short- and long-term complications compared to low volume when performing primary spinal arthrodesis in idiopathic scoliosis. Low-volume surgeons experienced significantly greater odds of inpatient surgical complications, as well as increased risk of revision during long-term follow-up with a significantly increased risk of implant malfunction at 10 years post-operatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dean Perfetti
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA.
| | - Aaron M Atlas
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Jesse Galina
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Alexander Satin
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Sayyida Hasan
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Terry Amaral
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Vishal Sarwahi
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
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Chung WF, Liu SW, Huang LC, Chang HK, Wu JC, Chen LF, Chen YC, Huang WC, Cheng H, Lo SS. Serious dysphagia following anterior cervical discectomy and fusion: long-term incidence in a national cohort. J Neurosurg Sci 2020; 64:231-237. [DOI: 10.23736/s0390-5616.17.03970-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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The impact of anesthesia and surgical provider characteristics on outcomes after spine 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; 28:2112-2121. [PMID: 31267212 DOI: 10.1007/s00586-019-06055-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Information regarding the impact of provider characteristics on perioperative outcomes in the spine surgery setting is limited. Existing studies primarily consider the impact of surgical provider volume. This analysis sought to identify the impact of anesthesiologist and surgeon volume and experience as well as anesthesia care team composition on adverse outcomes following anterior cervical discectomy and fusions (ACDF) and posterior lumbar fusions (PLF). METHODS We identified 5900 patients who underwent ACDF or PLF procedures at a high-volume orthopedic institution from 2005 to 2014. Provider characteristics of interest were anesthesiologist and surgeon volume and experience along with anesthesia care team composition. Multivariable logistic regression models were used to evaluate the outcomes of any complication, cardiopulmonary complication, and prolonged length of stay (> 7 days). Intraclass correlation coefficients were calculated to determine how much variation in outcomes could be explained by provider characteristics. RESULTS There were no significant relationships between provider characteristics and perioperative outcomes among ACDF patients. Within the PLF cohort, surgeon annual case volume > 25 was associated with decreased odds of prolonged length of stay, while anesthesia resident involvement was associated with increased odds of prolonged length of stay. Surgeon characteristics explained the greatest proportion of variation in outcomes while anesthesiologist characteristics explained the least. CONCLUSIONS Anesthesia provider volume and experience did not significantly impact the odds of adverse outcome for ACDF and PLF patients. Higher surgeon volume was exclusively associated with decreased odds of prolonged length of stay following PLF. Further study is necessary to determine if these relationships persist in a less-specialized setting. These slides can be retrieved under Electronic Supplementary Material.
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Arrighi-Allisan AE, Neifert SN, Gal JS, Deutsch BC, Caridi JM. Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion. World Neurosurg 2019; 122:e139-e146. [DOI: 10.1016/j.wneu.2018.09.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/17/2023]
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Li HZ, Lin Z, Li ZZ, Yang ZY, Zheng Y, Li Y, Lu HD. Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:441. [PMID: 30596071 DOI: 10.21037/atm.2018.10.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The relationship between surgeon volume and outcomes in spine surgery is unclear and published studies report inconsistent results. Therefore, a dose-response meta-analysis was conducted to clarify the influence of surgeon volume on outcomes in spine surgery. Methods PubMed, Embase, and The Cochrane Library were systematically searched without language limitation for observational studies which investigated the relationship between surgeon volume and outcomes in spine surgery. The primary outcome was postoperative morbidity and the secondary outcomes consisted of mortality, length of hospital stay, readmission, and hospital costs. For binary variable and continuous variable, odds ratios (ORs) with 95% CIs and weighted mean differences (WMDs) with 95% CIs were pooled respectively. Additionally, a dose-response meta-analysis was performed for the primary outcome. Results Eleven studies with 1,986,545 patients were included in the current meta-analysis. Pooled estimate indicated that a higher surgeon volume was associated with lower postoperative morbidity (OR, 0.62; 95% CI: 0.52-0.75; I2=93.9%), lower mortality (OR, 0.76; 95% CI: 0.66-0.87; I2=0), shorter length of hospital stay (WMD, -7.07; 95% CI: -7.08 to -7.06; I2=100%), less readmission (OR, 0.78; 95% CI: 0.72-0.85; I2=93.1%), and lower hospital costs (WMD, -25,497.47; 95% CI: -25,528.43 to -25,466.51; I2=100%). Dose-response analysis suggested a nonlinear relationship between surgeon volume and postoperative morbidity (P for nonlinearity less than 0.00001). Conclusions The current evidence indicate that higher surgeon volume is associated with lower morbidity and mortality, shorter length of hospital stay, less readmission, and lower hospital costs in spine surgery.
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Affiliation(s)
- Hui-Zi Li
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Zhong Lin
- Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.,Center for Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Zong-Ze Li
- Department of Orthopaedics, The People's Hospital of Ruijin City, Ruijin 342500, China
| | - Zeng-Yan Yang
- Department of Orthopaedics, The People's Hospital of Ruijin City, Ruijin 342500, China
| | - Yang Zheng
- Department of General Surgery, the Fourth Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yong Li
- Department of Orthopaedics, The People's Hospital of Ruijin City, Ruijin 342500, China
| | - Hua-Ding Lu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
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Takeuchi K, Yokoyama T, Numasawa T, Wada KI, Itabashi T, Yamasaki Y, Kudo H, Ota S. Fixed Neck Position in Multilevel Cervical Posterior Decompression and Fusion to Reduce Postoperative Disturbances of Cervical Spine Function. Spine Surg Relat Res 2018; 2:253-262. [PMID: 31435531 PMCID: PMC6690097 DOI: 10.22603/ssrr.2017-0090] [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: 11/30/2017] [Accepted: 03/15/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical posterior spine surgery. The range of motion of the cervical spine decreases markedly after multilevel cervical posterior decompression and fusion (PDF). However, details regarding the limitations of cervical spine function due to postoperative reduced neck mobility after multilevel PDF are as yet unclarified. The present study aimed to clarify the quality of life and its related factors after PDF, and the optimal fixed neck position in multilevel PDF that minimizes the limitations of ADL accompanying markedly reduced postoperative neck mobility. Methods Limitations of ADL involving neck extension, rotation, and flexion were investigated in 32 consecutive patients who underwent C2-T1 PDF using the responses to the cervical spine function domain of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The EuroQol 5 Dimension, Japanese Orthopedic Association score, and five domains of the JOACMEQ were also investigated. We investigated the risk factors regarding the fixed neck position in PDF for the impossibility to perform ADL involving each of three movements using cut-off values obtained from receiver-operating characteristic curves. Results Postoperative comprehensive quality of life was significantly related to neurological improvements and to poor outcomes of cervical spine function after PDF. The significant risk factors for impossibility to perform ADL involving neck rotation were a C2-C7 lordotic angle ≥ 6° (P = 0.0057) or a proportion coefficient of C2-T1 tilt angle/C2-C7 lordotic angle ≤ 1.8 (P = 0.0024). There were no significant risk factors for impossibility to perform ADL involving neck extension or flexion. Conclusions The optimal fixed neck position in C2-T1 PDF to reduce postoperative limitations of ADL involving neck mobility is a C2-C7 lordotic angle of less than 6°, or a C2-T1 tilt angle (°) of greater than 1.8 × the C2-C7 lordotic angle (°).
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Takuya Numasawa
- Department of Orthopedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Kan-Ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Taito Itabashi
- Department of Orthopedic Surgery, Towada City Hospital, Towada, Japan
| | | | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
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Cho PG, Ji GY, Park SH, Shin DA. Biomechanical Analysis of Biodegradable Cervical Plates Developed for Anterior Cervical Discectomy and Fusion. Asian Spine J 2018; 12:1092-1099. [PMID: 30322246 PMCID: PMC6284132 DOI: 10.31616/asj.2018.12.6.1092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design In-vitro biomechanical investigation. Purpose To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels. Overview of Literature Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear. Methods A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4–C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5–C6 segment) and adjacent (C4–C5 segment) levels. Results The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models. Conclusions The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.
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Affiliation(s)
- Pyung Goo Cho
- Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyuk Park
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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Dy CJ, Kazmers NH, Baty J, Bommarito K, Osei DA. An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion Surgery in the USA. HSS J 2018; 14:245-250. [PMID: 30258328 PMCID: PMC6148584 DOI: 10.1007/s11420-018-9619-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scaphoid fractures treated non-operatively and operatively may be complicated by nonunion. QUESTIONS/PURPOSES We sought to test the primary hypothesis that the incidence density of scaphoid fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether the frequency of surgical treatment increased over time. METHODS The MarketScan® database was queried for all records of treatment (casting and surgery) for closed scaphoid fractures over a 6-year period. We examined subsequent claims to determine frequency of additional procedures for nonunion treatment (revision fixation or vascularized grafting occurring 28 days or more after initial treatment). Trend analyses were used to determine whether changes in frequency of surgical treatment or revision procedure occurred. RESULTS The estimated incidence density of scaphoid fracture is 10.6 per 100,000 person-years in a commercially insured population of less than 65 years of age. Of 8923 closed scaphoid fractures, 29 and 71% were treated with surgery and casting, respectively. The frequency of surgical treatment rose significantly, from 22.1% in 2006 to 34.1% in 2012. The frequency of nonunion treatment was 10.8% after surgery and 3% after casting; neither changed over time. Younger age, male sex, and surgical treatment are associated with a higher risk of nonunion treatment. CONCLUSIONS Our estimated incidence of scaphoid fracture is higher than previously reported. The increased enthusiasm in the USA to surgically treat scaphoid fractures is reflected by our trend analysis. The frequency of surgical treatment for presumed nonunion after initial surgical management for closed scaphoid fractures exceeded 10%. Given the increased utilization of surgery, surgeons and patients should be aware of the frequency of nonunion treatment to inform treatment decisions.
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Affiliation(s)
- Christopher J. Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO USA
| | | | - Jack Baty
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO USA
| | - Kerry Bommarito
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO USA
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Postoperative Emergency Department Utilization and Hospital Readmission After Cervical Spine Arthrodesis: Rates, Trends, Causes, and Risk Factors. Spine (Phila Pa 1976) 2018; 43:1031-1037. [PMID: 29215499 DOI: 10.1097/brs.0000000000002518] [Citation(s) in RCA: 9] [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 Retrospective state database analysis. OBJECTIVE To quantify the 30- and 90-day emergency department (ED) utilization and inpatient readmission rates after primary cervical arthrodesis, to stratify these findings by surgical approach, and to describe risk factors and conditions precipitating these events. SUMMARY OF BACKGROUND DATA Limited data exist on ED utilization and hospital readmission rates after cervical spine arthrodesis. METHODS The New York State all-payer health-care database was queried to identify all 87,045 patients who underwent primary subaxial cervical arthrodesis from 1997 through 2012. Demographic data and clinical information were extracted. Readmission data were available for the entire study period, whereas ED utilization data collection began later and was therefore analyzed starting in 2005. Incidences of these events within 30 and 90 days of discharge as well as trends over time were tabulated. The conditions prompting these encounters were also collected. Data were analyzed with respect to surgical approach. RESULTS The hospital readmission rate was 4.2% at 30 days and 6.2% at 90 days postoperatively. Approximately 6.2% of patients were managed in the ED without inpatient admission within 30 days and 11.3% within 90 days of surgery. The most common conditions prompting such events were dysphagia or dysphonia, respiratory complications, and infection. ED utilization and readmission rates were lowest after anterior surgeries. A preoperative Charlson Comorbidity Index of 1 or greater and traumatic pathologies were associated with increased risk of subsequent ED utilization or hospital readmission. Thirty-day hospital readmission rates declined after 2010, whereas 30-day ED utilization continued to increase. CONCLUSION Patient comorbidities, traumatic pathologies, and surgical approach are associated with increased postoperative complications. Anterior procedures carry the lowest risk, followed by posterior and then circumferential. Awareness of these findings should help to encourage development of strategies to minimize the rate of postoperative ED utilization and hospital readmission. LEVEL OF EVIDENCE 3.
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25
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Bartlett RS, Thibeault SL. Insights Into Oropharyngeal Dysphagia From Administrative Data and Clinical Registries: A Literature Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:868-883. [PMID: 29710238 PMCID: PMC6105122 DOI: 10.1044/2018_ajslp-17-0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/25/2017] [Accepted: 12/27/2017] [Indexed: 06/08/2023]
Abstract
Purpose The call for data-driven health care has been bolstered by the digitization of medical records, quality initiatives, and payment reform. Administrative databases and clinical registries are increasingly being used to study oropharyngeal dysphagia and to facilitate data-driven decision making. The objective of this work was to summarize key findings, etiologies studied, data sources used, study objectives, and quality of evidence of all original research articles that have investigated oropharyngeal dysphagia or aspiration pneumonia using administrative or clinical registry data to date. Method A literature search was completed in MEDLINE, Scopus, and Google Scholar (January 1, 1990, to February 1, 2017). Each study that met inclusion criteria was rated for quality of evidence on a 5-point scale. Results Eighty-four research articles were included in the final analysis (n = 221-1,649,871). Over the past 20 years, the number of new publications in this area has quintupled. Most of the administrative database and clinical registry studies of dysphagia have been retrospective cohort studies and cross-sectional studies and limited to quality of evidence levels of 3-4. In these studies, much has been learned about risk factors for dysphagia and pneumonia in defined populations and health care costs and usage. Little has been gleaned from these studies regarding swallowing physiology or dysphagia management. Conclusions Investigators are just beginning to develop the methods to study oropharyngeal dysphagia using administrative data and clinical registries. Future research is needed in all areas, from the fundamental issue of how to identify individuals with dysphagia with high sensitivity in these data sets to evaluating treatment effectiveness. Supplemental Material https://doi.org/10.23641/asha.6066515.
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Affiliation(s)
- Rebecca S. Bartlett
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
| | - Susan L. Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
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Adogwa O, Elsamadicy AA, Vuong VD, Mehta AI, Vasquez RA, Cheng J, Bagley CA, Karikari IO. Immediate Postoperative Pain Scores Predict Neck Pain Profile up to 1 Year Following Anterior Cervical Discectomy and Fusion. Global Spine J 2018; 8:231-236. [PMID: 29796370 PMCID: PMC5958477 DOI: 10.1177/2192568217706700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN Retrospective cohort review. OBJECTIVE To assess whether immediate postoperative neck pain scores accurately predict 12-month visual analog scale-neck pain (VAS-NP) outcomes following Anterior Cervical Discectomy and Fusion surgery (ACDF). METHODS This was a retrospective study of 82 patients undergoing elective ACDF surgery at a major academic medical center. Patient reported outcomes measures VAS-NP scores were recorded on the first postoperative day, then at 6-weeks, 3, 6, and 12-months after surgery. Multivariate correlation and logistic regression methods were utilized to determine whether immediate postoperative VAS-NP score accurately predicted 1-year patient reported VAS-NP Scores. RESULTS Overall, 46.3% male, 25.6% were smokers, and the mean age and body mass index (BMI) were 53.7 years and 28.28 kg/m2, respectively. There were significant correlations between immediate postoperative pain scores and neck pain scores at 6 weeks VAS-NP (P = .0015), 6 months VAS-NP (P = .0333), and 12 months VAS-NP (P = .0247) after surgery. Furthermore, immediate postoperative pain score is an independent predictor of 6 weeks, 6 months, and 1 year VAS-NP scores. CONCLUSION Our study suggests that immediate postoperative patient reported neck pain scores accurately predicts and correlates with 12-month VAS-NP scores after an ACDF procedure. Patients with high neck pain scores after surgery are more likely to report persistent neck pain 12 months after index surgery.
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Affiliation(s)
- Owoicho Adogwa
- Rush University Medical Center, Chicago, IL, USA,Owoicho Adogwa, Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL 60612, USA.
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The impact of surgeon volume on patient outcome in spine surgery: a systematic review. 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; 27:530-542. [DOI: 10.1007/s00586-017-5447-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/23/2017] [Indexed: 02/04/2023]
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Trend of Spine Surgeries in the Outpatient Hospital Setting Versus Ambulatory Surgical Center. Spine (Phila Pa 1976) 2017; 42:E1429-E1436. [PMID: 28368986 DOI: 10.1097/brs.0000000000002180] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE The aim of the present study was to examine how often spine surgery is being performed in an outpatient hospital setting versus a more "true" ambulatory setting, specifically ambulatory surgery centers (ASCs) in which admission and discharge are required on the same calendar day. SUMMARY OF BACKGROUND DATA Recent studies have assessed the safety, satisfactory clinical outcomes, and increasing utilization of both cervical and lumbar spinal surgeries performed in the outpatient setting. No studies have delineated between true ambulatory settings and outpatient hospitals when assessing the rates of these procedures. METHODS A retrospective review of the Truven Health Marketscan Research Databases was conducted for patients undergoing spine operations between 2003 and 2014. The frequency of each Common Procedural Terminology code was identified per year, and then categorized into each of "inpatient hospital," "outpatient hospital," or "ASC" in states that clearly define ASCs as facilities in which patients are discharged on the same calendar day of the operation, and do not stay overnight. RESULTS During the period between 2003 and 2014, the procedures that had the most dramatic increase as an outpatient hospital procedure included lumbar decompression laminotomy first level (18.7%-68.5%) and posterior cervical decompression laminectomy without facetectomy discectomy first level (0%-46.7%). ASC procedures had more modest increases during this time period with the most significant increases in lumbar decompression laminotomy first level (0.7%-10.6%) and posterior cervical decompression laminotomy first level (0%-23.4%). CONCLUSION "True" ambulatory surgeries are not increasing at the same rate as outpatient procedures with 23-hour observation capacity. Although prior studies have demonstrated the safety of outpatient spine surgery, one possible reason for this trend may be that surgeons feel that this safety may not be comparable to that of other outpatient procedures. LEVEL OF EVIDENCE 3.
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De la Garza Ramos R, Nakhla J, Nasser R, Jada A, Bhashyam N, Kinon MD, Yassari R. Volume-Outcome Relationship After 1 and 2 Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2017; 105:543-548. [DOI: 10.1016/j.wneu.2017.05.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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Reinard KA, Cook DM, Zakaria HM, Basheer AM, Chang VW, Abdulhak MM. A cohort study of the morbidity of combined anterior-posterior cervical spinal fusions: incidence and predictors of postoperative dysphagia. 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 2016; 25:2068-77. [PMID: 26972082 DOI: 10.1007/s00586-016-4429-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery. METHODS A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia. RESULTS The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554). CONCLUSION Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.
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Affiliation(s)
- Kevin A Reinard
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Diana M Cook
- Division of Speech and Language Pathology, Henry Ford Hospital, Detroit, MI, USA
| | - Hesham M Zakaria
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Azam M Basheer
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Victor W Chang
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Muwaffak M Abdulhak
- Department of Neurosurgery, K-11, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
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Cervical cages placed bilaterally in the facet joints from a posterior approach significantly increase foraminal area. 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 2016; 25:2279-85. [PMID: 26869077 DOI: 10.1007/s00586-016-4430-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/09/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Foraminal stenosis is a common cause of cervical radiculopathy. Posterior cervical cages can indirectly increase foraminal area and decompress the nerve root. The aim of this study was to assess the influence of bilateral posterior cervical cages on the surface area and shape of the neural foramen. METHODS Radiographic analysis was performed on 43 subjects enrolled in a prospective, multi-center study. CT scans were obtained at baseline and 6- and 12-months after cervical fusion using bilateral posterior cervical cages. The following measurements were performed on CT scan: foraminal area (A), theoretical area (TA), height (H), superior diagonal (DSI), inferior diagonal (DIS), and inferior diagonal without implant (DISI). Comparisons were performed using R-ANOVA with a significance of α < 0.05. RESULTS Foraminal area, height, TA and DISI were significantly greater following placement of the implant. The mean (SD) A increased from 4.01 (1.09) mm(2) before surgery to 4.24 (1.00) mm(2) at 6 months, and 4.18 (1.05) mm(2) at 12 months after surgery (p < 0.0001). Foraminal height (H) increased from mean (SD) 9.20 (1.08) mm at baseline to 9.65 (1.06) mm and 9.55 (1.14) mm at 6- and 12-months post-operatively, respectively (p < 0.0001). The mean DIS did not change significantly. There was a significant decrease in DSI: 6.18 (1.59) mm pre-operatively, 5.95 (1.47) mm and 5.73 (1.46) mm at 6- and 12-months (p < 0.0001). CONCLUSIONS Implantation of bilateral posterior cervical cages can increase foraminal area and may indirectly decompress the nerve roots. Correlation between increase in foraminal area and clinical outcomes needs further investigation.
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