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Nagata K, Chang C, Nishizawa M, Yamada K. Estimated number of spine surgeries and related deaths in Japan from 2014 to 2020. J Orthop Sci 2024:S0949-2658(23)00371-8. [PMID: 38168611 DOI: 10.1016/j.jos.2023.12.006] [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: 10/11/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The total number of spine surgeries per year and their related deaths in Japan has not been adequately estimated in the literature. METHODS We retrospectively reviewed the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) between April 2014 to March 2021, which covers 99.9 % of health insurance claim receipts by general practitioners. The annual number of surgeries was counted using K codes, a procedure classification unique to Japan, and classified into the following six categories; percutaneous vertebroplasty, endoscopic surgery, open discectomy, laminoplasty/laminectomy, instrumentation surgery, and others. The data distribution was also summarized by sex and age. Additionally, by reviewing DPC database-related papers for evaluation of the mortality rate after spine surgery in Japan, the number of spine surgery-related deaths was calculated. RESULTS The NDB showed that the number of spine surgeries analyzed in this study increased from 170,081 in 2014 to 193,903 in 2019, with a slight decrease in 2020. The ratio of instrumentation surgery increased from 33.0 % in 2014 to 37.9 % in 2020. The rate of patients aged 75 or older increased 31.6 % to 39.6 %. Combining these findings with DPC data showing a mortality rate of 0.1 % to 0.4 % revealed that the estimated number of deaths related to spine surgery in Japan ranged from 200 to 800 per year. CONCLUSIONS Approximately 200,000 spine surgeries and 200 to 800 spine surgery-related inpatient deaths were estimated to have occurred in Japan around 2020.
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Affiliation(s)
- Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Chang Chang
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Mitsuhiro Nishizawa
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, 94143, United States
| | - Koji Yamada
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan; Nakanoshima Orthopaedics, F&F Haimu, 6-26-2, Nakanoshima, Tama-ku, Kawasaki City 214-0012, Japan
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Fregna G, Rossi Raccagni S, Negrini A, Zaina F, Negrini S. Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis. SENSORS (BASEL, SWITZERLAND) 2023; 24:116. [PMID: 38202978 PMCID: PMC10780905 DOI: 10.3390/s24010116] [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: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine and trunk deformity. Bracing is an effective treatment for medium-degree curves. Thermal sensors help monitor patients' adherence (compliance), a critical issue in bracing treatment. Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts. We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We performed a cross-sectional study of patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year. To ensure high adherence, for years, we have provided specific support to brace treatment through a series of cognitive-behavioural interventions for patients and parents. We used iButton thermal sensor systematic data collection to precisely analyse the real brace-wearing time. We included 514 adolescents, age 13.8 ± 1.6, with the worst scoliosis curve of 34.5 ± 10.3° Cobb. We found a 95% (95CI 60-101%) adherence to the brace prescription of 21.9 ± 1.7 h per day. Determinants included gender (91% vs. 84%; females vs. males) and age < 14 years (92% vs. 88%). Brace hours prescription, BMI, and all clinical variables (worst curve Cobb degrees, angle of trunk rotation, and TRACE index for aesthetics) did not influence adherence.
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Affiliation(s)
- Giulia Fregna
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Sara Rossi Raccagni
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Alessandra Negrini
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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Rogers NG, Carrillo-Marquez M, Carlisle A, Sanders CD, Burge L. Friends Not Foes: Optimizing Collaboration with Subspecialists. Orthop Clin North Am 2023; 54:277-285. [PMID: 37271556 DOI: 10.1016/j.ocl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pediatric orthopedic patients can be complex to manage. As orthopedists plan for possible surgical interventions, consultation with pediatric subspecialists will be necessary. This article discusses the considerations an orthopedist should make when deciding on the timing and the appropriateness of consultation-both preoperatively and perioperatively. Consultation before surgical intervention will especially be useful if the subspecialist will be collaborating in the management of the condition postoperatively (whether inpatient or outpatient). Clear and early consultation in both written and verbal format will facilitate quality and expedite the patient's care.
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Affiliation(s)
- Nathaniel G Rogers
- Division of Pediatric Hospital Medicine, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA.
| | - Maria Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Annette Carlisle
- Division of Allergy & Immunology, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Catherine D Sanders
- Division of Pulmonology, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Lauren Burge
- Division of Child Abuse, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
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Jackson JE, Rajasekar G, Vukcevich O, Coakley BA, Nuño M, Saadai P. Association Between Race, Gender, and Pediatric Postoperative Outcomes: An Updated Retrospective Review. J Surg Res 2023; 281:112-121. [PMID: 36155268 DOI: 10.1016/j.jss.2022.08.027] [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: 11/18/2021] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There has not been a recent evaluation of the association between racial and gender and surgical outcomes in children. We aimed to evaluate improvements in race- and gender-related pediatric postoperative outcomes since a report utilizing the Kids' Inpatient Database data from 2003 to 2006. METHODS Using Kids' Inpatient Database (2009, 2012, 2016), we identified 245,976 pediatric patients who underwent appendectomy for acute appendicitis (93.6%), pyloromyotomy for pyloric stenosis (2.7%), empyema decortication (1.6%), congenital diaphragmatic hernia repair (0.7%), small bowel resection for intussusception (0.5%), or colonic resection for Hirschsprung disease (0.2%). The primary outcome was the development of postoperative complications. Multivariable logistic regression was used to evaluate risk-adjusted associations among race, gender, income, and postoperative complications. RESULTS Most patients were male (61.5%) and 45.7% were White. Postoperative complications were significantly associated with male gender (P < 0.0001) and race (P < 0.0001). After adjustment, Black patients were more likely to experience any complication than White patients (adjusted odds ratio 1.3, confidence interval 1.2-1.4), and males were more likely than females (adjusted odds ratio 1.3, confidence interval 1.2-1.4). CONCLUSIONS No clear progress has been made in eliminating race- or gender-based disparities in pediatric postoperative outcomes. New strategies are needed to better understand and address these disparities.
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Affiliation(s)
- Jordan E Jackson
- Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Ganesh Rajasekar
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California
| | - Olivia Vukcevich
- Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Brian A Coakley
- Division of Pediatric Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Miriam Nuño
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California
| | - Payam Saadai
- Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California.
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Sugawara R, Takeshita K, Takahashi J, Arai Y, Watanabe K, Yamato Y, Oba H, Matsumoto M. The complication trends of pediatric spinal deformity surgery in Japan - The Japanese Scoliosis Society Morbidity and Mortality survey from 2012 to 2017. J Orthop Sci 2021; 26:744-749. [PMID: 32800635 DOI: 10.1016/j.jos.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/26/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Japanese Scoliosis Society Morbidity & Mortality Committee performed a longitudinal nationwide complication survey of spinal deformity surgery from 2012 to 2017. The present study aimed to analyze the survey results and report the complication trends of pediatric spinal deformity surgery in Japan. METHODS All Japanese Scoliosis Society members were invited to participate in the survey. Diagnoses were grouped into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, other types of scoliosis, and pediatric kyphosis. Complications were grouped into death, blindness, neurological deficits (motor/sensory), infection, massive bleeding, hematoma, pneumonia, cardiac failure, deep vein thrombosis/pulmonary embolism, gastrointestinal perforation, and instrumentation failure. RESULTS The surveys were performed in 2012, 2014, and 2017. The overall complication rate decreased from 10.7% in 2012 to 8.1% in 2017. In particular, the complication rate in patients with idiopathic scoliosis decreased from 8.8% in 2012 to 4.0% in 2017. The complication rate of patients with neuromuscular scoliosis and kyphosis remained high. The rate of neurological deficits, especially in motor deficits, significantly decreased from 2.0% in 2012 to 0.7% in 2017, and tended to be highest in patients with kyphosis. The rate of massive bleeding was significantly decreased from 3.3% in 2012 to 0.8% in 2017, especially in patients with neuromuscular scoliosis (12.2-4.4%). However, patients with neuromuscular scoliosis had a high rate of postoperative pneumonia (3.7%, 2.6%, and 5.1%, respectively). The rate of instrumentation failure was also high (2.1%, 1.5%, and 2.2%, respectively), especially in patients with early onset idiopathic, congenital and other types of scoliosis. CONCLUSIONS The overall surgical complication rates in pediatric patients decreased due to decreased rates of neurological deficits and massive bleeding, especially in patients with idiopathic scoliosis. However, the complication rates remain high in patients with neuromuscular scoliosis and kyphosis.
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Affiliation(s)
- Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan; Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan.
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan; Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan
| | - Jun Takahashi
- Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan
| | - Yasuhisa Arai
- Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan
| | - Kei Watanabe
- Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan
| | - Yu Yamato
- Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan
| | - Hiroki Oba
- Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Japan
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Taniguchi Y, Ohara T, Suzuki S, Watanabe K, Suzuki T, Uno K, Yamaguchi T, Yanagida H, Nakayama K, Kotani T, Watanabe K, Hirano T, Yamamoto T, Kawamura I, Sugawara R, Takeshita K, Demura S, Oku N, Sato T, Fujiwara K, Akazawa T, Murakami H, Kakutani K, Matsubayashi Y, Kawakami N. Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study with Minimum 2-year Follow-Up. Spine (Phila Pa 1976) 2021; 46:E498-E504. [PMID: 33186273 DOI: 10.1097/brs.0000000000003822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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 cohort study. OBJECTIVE The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity. SUMMARY OF BACKGROUND DATA Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology. METHODS We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR. RESULTS We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR. CONCLUSION The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.
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Affiliation(s)
- Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Yamaguchi
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Haruhisa Yanagida
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Keita Nakayama
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Norihiro Oku
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Sato
- Department of Orthopedic Surgery, School of Medicine, Juntendo University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenta Fujiwara
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, Morioka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Noriaki Kawakami
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Devision of Spine Surgery, Department of Orthopedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
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Eklund JE, Shah SH, Rubin DS, Mehta AI, Minev EM, Lee HH, Roth S. Incidence of and factors associated with acute kidney injury after scoliosis surgery in pediatric patients. Spine Deform 2020; 8:991-999. [PMID: 32378041 DOI: 10.1007/s43390-020-00126-0] [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: 01/03/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We sought to identify the national incidence of acute kidney injury (AKI) associated with pediatric posterior spinal fusion (PSF) surgery for scoliosis, and to determine factors that increase risk. METHODS The 1998-2014 National Inpatient Sample (NIS), a large United States hospital discharge database, was queried for discharges aged 0-17 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for scoliosis undergoing PSF for the outcome of AKI. Discharges were divided into those with AKI and unaffected. We fit adjusted logistic regression models to yield point estimates, odds ratios, 95% confidence intervals, and p values for the weighted, national population sample with postulated risk factors. The fit of the multivariable regression model was tested using the Hosmer-Lemeshow test, and collinearity using the variance inflation factor. RESULTS The NIS contained 103,270 weighted discharges meeting inclusion criteria. AKI incidence was 0.1%. Multivariable logistic regression model showed significantly increased odds ratios with thrombocytopenia, rhabdomyolysis, chronic kidney disease, abnormal coagulation, and male sex. AKI increased both hospital stay and cost by threefold compared to unaffected children. CONCLUSION This study suggests that AKI after pediatric PSF is rare. It is associated with abnormal coagulation, chronic kidney disease, and rhabdomyolysis, but not with the number of vertebral levels fused. Female sex appears to be protective. The retrospective nature of study and reliance on ICD-9-CM codes may under-represent the incidence of AKI in pediatric PSF patients.
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Affiliation(s)
- Jamey E Eklund
- Department of Anesthesiology, University of Illinois Hospital and Health Sciences, 1740 West Taylor Street, Suite 3200 W, M/C 515, Chicago, IL, 60612, USA. .,Department of Anesthesiology, Shriners Hospital for Children, Chicago, Chicago, IL, USA.
| | - Shikhar H Shah
- Department of Anesthesiology, Walter Read National Military Medical Center, Bethesda, MD, USA
| | - Daniel S Rubin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois Hospital and Health Sciences, Chicago, IL, USA
| | - Evgueni M Minev
- Nephrology Associates of Northern Illinois and Indiana, Mount Prospect, IL, USA
| | - Helen H Lee
- Department of Anesthesiology, University of Illinois Hospital and Health Sciences, 1740 West Taylor Street, Suite 3200 W, M/C 515, Chicago, IL, 60612, USA.,Department of Anesthesiology, Shriners Hospital for Children, Chicago, Chicago, IL, USA
| | - Steven Roth
- Department of Anesthesiology, University of Illinois Hospital and Health Sciences, 1740 West Taylor Street, Suite 3200 W, M/C 515, Chicago, IL, 60612, USA
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Kashyap S, Podkovik S, Tashjian V. Disseminated intravascular coagulation in spine surgery: illustrative case review and the paradigms of management. J Neurosurg Spine 2019; 32:139-143. [PMID: 31604327 DOI: 10.3171/2019.7.spine19756] [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: 06/27/2019] [Accepted: 07/12/2019] [Indexed: 11/06/2022]
Abstract
Disseminated intravascular coagulation (DIC) is rarely encountered by spine surgeons outside of deformity or severe trauma cases. The authors report an extraordinarily unique case of refractory DIC after elective resection of multiple en plaque thoracic meningiomas in a patient with neurofibromatosis type 1. A 49-year-old man underwent T1-3 laminoplasty and expansile duraplasty for resection of multiple en plaque meningiomas for thoracic myelopathy. Intraoperatively, the patient was found to be in a state of DIC that did not resolve postoperatively despite massive transfusions of blood products. He required subsequent returns to the operating room due to recurrent epidural hematomas with resulting paraplegia. Ultimately, the wound was left open, and a wound vacuum-assisted closure (VAC) was placed to prevent further returns to the operating room. DIC persisted until the administration of recombinant factor VIIa. In this report, the authors review the mechanisms, subtypes, and approaches to treatment of DIC with a focus on the bleeding subtype. If this subtype is refractory to blood product administration (> 24 hours), recombinant factor VIIa is a safe and effective option. A wound VAC can be safely utilized with exposed dura if deemed necessary by the surgeon; however, the volume and characteristics of the output should be closely monitored. The use of unconventional surgical solutions may provide options to mitigate the morbidity associated with refractory DIC in spine surgery.
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Affiliation(s)
- Samir Kashyap
- 1Department of Neurosurgery, Riverside University Health System, Riverside; and
- 2Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California
| | - Stacey Podkovik
- 1Department of Neurosurgery, Riverside University Health System, Riverside; and
- 2Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California
| | - Vartan Tashjian
- 2Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California
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Malik AT, Kim J, Yu E, Khan SN. Timing of Complications After Posterior Spinal Fusions in Pediatric Spine Deformity. Spine Deform 2019; 7:709-719. [PMID: 31495470 DOI: 10.1016/j.jspd.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/17/2018] [Accepted: 01/06/2019] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional survey. OBJECTIVE To investigate the timing of complications after posterior spinal fusion for idiopathic and neuromuscular pediatric spine deformity. SUMMARY OF BACKGROUND DATA Evidence is limited with regard to when complications occur after posterior spinal fusions in pediatric spine deformities. METHODS The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database files were queried using Current Procedural Terminology codes (22800, 22802, and 22804) for patients undergoing posterior spinal fusion for idiopathic or neuromuscular deformity. Median day-of-diagnosis and interquartile ranges were calculated for database-recorded complications. RESULTS A total of 10,579 patients were included in the study. The frequency and median day of diagnosis of each complication are as follows: superficial surgical site infection (SSI) (idiopathic = 0.6%, Day 18.5; neuromuscular = 1.6%, Day 19.5), deep SSI (idiopathic = 0.5%, Day 16.0; neuromuscular = 2.3%, Day 18), organ/space SSI (idiopathic = 0.1%, Day 17; neuromuscular = 0.4%, Day 16), wound disruption (idiopathic = 0.4%, Day 15; neuromuscular = 1.2%, Day 15), pneumonia (idiopathic = 0.6%, Day 5; neuromuscular = 4.0%, Day 3), unplanned intubation (idiopathic = 0.4%, Day 2; neuromuscular = 3.5%, Day 1), urinary tract infection (idiopathic = 0.4%, Day 6; neuromuscular = 2.8%, Day 4.5), nerve injury causing neurologic deficit (idiopathic = 0.4%, Day 1; neuromuscular = 0.3%, Day 5), bleeding requiring transfusions (idiopathic = 64.6%, Day 0; neuromuscular = 74.1%, Day 0), sepsis (idiopathic = 0.3%, Day 11; neuromuscular = 2.4%, Day 12.5), and mortality (idiopathic = ∼0%, Day 5; neuromuscular = 0.4%, Day 9). CONCLUSION Understanding the timing of complications is important for patients and providers, as it reflects the need of heightened awareness and low thresholds of testing during periods of highest risks to catch complications, launch appropriate optimization protocols, and minimize the cost burden associated with readmissions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Jeffery Kim
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Elizabeth Yu
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Safdar N Khan
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA.
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Wang Y, Hai Y, Liu Y, Guan L, Liu T. Risk factors for postoperative pulmonary complications in the treatment of non-degenerative scoliosis by posterior instrumentation and fusion. 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; 28:1356-1362. [PMID: 30963290 DOI: 10.1007/s00586-019-05968-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/19/2019] [Accepted: 03/30/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prevalence and risk factors for postoperative pulmonary complications (PPC) after posterior instrumentation and fusion (PIF) in patients with non-degenerative scoliosis. METHODS We retrospectively evaluated 703 patients (224 males, 479 females) diagnosed with non-degenerative scoliosis who underwent PIF in our center from January 2010 to January 2018. Preoperative, perioperative, demographic data, surgical methods and radiographic parameters were extracted and analyzed to identify risk factors for PPC. RESULTS The mean age of the patients was 20.8 ± 9.0 years with the following diagnoses: congenital scoliosis (287/703, 40.8%), idiopathic scoliosis (281/703, 40.0%), neuromuscular scoliosis (103/703, 14.7%) and syndromic scoliosis (32/703, 4.5%). PPC manifested in 82 patients (11.7%) including pleural effusion (39/82, 47.6%), pneumonia (33/82, 40.2%), pneumothorax (3/82, 3.7%), respiratory failure (3/82, 3.7%), hemothorax (2/82, 2.4%), pulmonary edema (1/82, 1.2%) and pulmonary embolism (1/82, 1.2%). Multifactorial regression analysis confirmed that revision surgery [odds ratio (OR) = 2.320, P = 0.030], preoperative respiratory disease (OR = 14.286, P < 0.001), preoperative Cobb angle of main curve > 75° (OR = 1.701, P = 0.046) and thoracoplasty (OR = 4.098 P < 0.001) were risk factors for PPC after PIF in patients with non-degenerative scoliosis. CONCLUSIONS A prevalence of 11.7% PPC was observed after PIF. Risk factors were preoperative Cobb angle of main curve > 75°, preoperative respiratory disease, revision surgery and thoracoplasty. Surgeons should recognize and pay attention to these risk factors and take appropriate preventive measures to prevent severe pulmonary complications. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Yunsheng Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Tie Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
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Segreto FA, Vasquez-Montes D, Bortz CA, Horn SR, Diebo BG, Vira S, Kelly JJ, Stekas N, Ge DH, Ihejirika YU, Lafage R, Lafage V, Karamitopoulos M, Delsole EM, Hockley A, Petrizzo AM, Buckland AJ, Errico TJ, Gerling MC, Passias PG. Impact of presenting patient characteristics on surgical complications and morbidity in early onset scoliosis. J Clin Neurosci 2019; 62:105-111. [PMID: 30635164 DOI: 10.1016/j.jocn.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
This study sought to assess comorbidity profiles unique to early-onset-scoliosis (EOS) patients by employing cluster analytics and to determine the influence of isolated comorbidity clusters on perioperative complications, morbidity and mortality using a high powered administrative database. The KID database was queried for ICD-9 codes pertaining to congenital and idiopathic scoliosis from 2003, 2006, 2009, 2012. Patients <10 y/o (EOS group) were included. Demographics, incidence and comorbidity profiles were assessed. Comorbidity profiles were stratified by body systems (neurological, musculoskeletal, pulmonary, cardiovascular, renal). K-means cluster and descriptive analyses elucidated incidence and comorbidity relationships between frequently co-occurring comorbidities. Binary logistic regression models determined predictors of perioperative complication development, mortality, and extended length-of-stay (≥75th percentile). 25,747 patients were included (Age: 4.34, Female: 52.1%, CCI: 0.64). Incidence was 8.9 per 100,000 annual discharges. 55.2% presented with pulmonary comorbidities, 48.7% musculoskeletal, 43.8% neurological, 18.6% cardiovascular, and 11.9% renal; 38% had concurrent neurological and pulmonary. Top inter-bodysystem clusters: Pulmonary disease (17.2%) with epilepsy (17.8%), pulmonary failure (12.2%), restrictive lung disease (10.5%), or microcephaly and quadriplegia (2.1%). Musculoskeletal comorbidities (48.7%) with renal and cardiovascular comorbidities (8.2%, OR: 7.9 [6.6-9.4], p < 0.001). Top intra-bodysystem clusters: Epilepsy (11.7%) with quadriplegia (25.8%) or microcephaly (20.5%). Regression analysis determined neurological and pulmonary clusters to have a higher odds of perioperative complication development (OR: 1.28 [1.19-1.37], p < 0.001) and mortality (OR: 2.05 [1.65-2.54], p < 0.001). Musculoskeletal with cardiovascular and renal anomalies had higher odds of mortality (OR: 1.72 [1.28-2.29], p < 0.001) and extLOS (OR: 2.83 [2.48-3.22], p < 0.001). EOS patients with musculoskeletal conditions were 7.9x more likely to have concurrent cardiovascular and renal anomalies. Clustered neurologic and pulmonary anomalies increased mortality risk by as much as 105%. These relationships may benefit pre-operative risk assessment for concurrent anomalies and adverse outcomes. Level of Evidence: III - Retrospective Prognostic Study.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Shaleen Vira
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - John J Kelly
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Nicholas Stekas
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - David H Ge
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Mara Karamitopoulos
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Edward M Delsole
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Aaron Hockley
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Anthony M Petrizzo
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Aaron J Buckland
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Thomas J Errico
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Michael C Gerling
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
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12
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Araki S, Tomioka S, Otani M, Suga S, Ichikawa S, Matsuda S, Fushimi K, Kusuhara K, Shirahata A. Incidence and In-Hospital Mortality of Neonatal Disseminated Intravascular Coagulation in Japan: An Observational Study of a Nationwide Hospital Claims Database. J UOEH 2019; 41:295-302. [PMID: 31548484 DOI: 10.7888/juoeh.41.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aimed to estimate the incidence and prognosis of neonatal disseminated intravascular coagulation (DIC) in Japan by analyzing data retrieved from a national administrative database. Clinically, the prognosis of DIC in neonates is poor, but there is little epidemiological data in Japan. This retrospective observational study identified patients diagnosed with neonatal DIC and who were registered in the Japanese diagnosis procedure combination (DPC) database between April 1, 2014 and March 31, 2016. The patients, who were diagnosed with neonatal DIC, included those with ICD-10 code D65 or P60 in primary and secondary diagnosis, with comorbid conditions existing at admission, and with complications occurring after admission. Of 78,073 neonates admitted to 1,474 neonatal intensive care units, 1,864 (2.4%) were diagnosed with DIC. There was no difference between sexes in incidence of DIC; the incidence of DIC was higher in extremely low birth weight infants (9.8%), and significantly higher than that in normal birth weight infants. The overall mean length of hospital stay was longer in neonates with DIC (69.5 days) than in those without DIC (32.6 days, P < 0.001). The number of deaths was 1,156 (1.5%). In-hospital mortality was significantly higher in neonates with DIC (14.1%) than in those without DIC (1.2%, P < 0.001), especially in premature babies. This nationwide study was the first report to investigate the incidence and in-hospital mortality of neonatal DIC in Japan. Neonatal DIC has a significant impact on prognosis, and its influence is greater in premature than in term infants.
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Affiliation(s)
- Shunsuke Araki
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shinichi Tomioka
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Makoto Otani
- Occupational Health Data Science Center, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shutaro Suga
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shun Ichikawa
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan
- Occupational Health Data Science Center, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan
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