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Morishita S, Yoshii T, Inose H, Hirai T, Yamada K, Matsukura Y, Egawa S, Hashimoto J, Takahashi T, Ogawa T, Fushimi K. Perioperative complications and cost of posterior decompression with fusion in thoracic spine for ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum -a comparative study using a national inpatient database. BMC Musculoskelet Disord 2024; 25:513. [PMID: 38961370 PMCID: PMC11221184 DOI: 10.1186/s12891-024-07617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 06/21/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Although posterior decompression with fusion (PDF) are effective for treating thoracic myelopathy, surgical treatment has a high risk of various complications. There is currently no information available on the perioperative complications in thoracic ossification of the longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF). We evaluate the perioperative complication rate and cost between T-OPLL and T-OLF for patients underwent PDF. METHODS Patients undergoing PDF for T-OPLL and T-OLF from 2012 to 2018 were detected in Japanese nationwide inpatient database. One-to-one propensity score matching between T-OPLL and T-OLF was performed based on patient characteristics and preoperative comorbidities. We examined systemic and local complication rate, reoperation rate, length of hospital stays, costs, discharge destination, and mortality after matching. RESULTS In a total of 2,660 patients, 828 pairs of T-OPLL and T-OLF patients were included after matching. The incidence of systemic complications did not differ significantly between the T-OPLL and OLF groups. However, local complications were more frequently occurred in T-OPLL than in T-OLF groups (11.4% vs. 7.7% P = 0.012). Transfusion rates was also significantly higher in the T-OPLL group (14.1% vs. 9.4%, P = 0.003). T-OPLL group had longer hospital stay (42.2 days vs. 36.2 days, P = 0.004) and higher medical costs (USD 32,805 vs. USD 25,134, P < 0.001). In both T-OPLL and T-OLF, the occurrence of perioperative complications led to longer hospital stay and higher medical costs. While fewer patients in T-OPLL were discharged home (51.6% vs. 65.1%, P < 0.001), patients were transferred to other hospitals more frequently (47.5% vs. 33.5%, P = 0.001). CONCLUSION This research identified the perioperative complications of T-OPLL and T-OLF in PDF using a large national database, which revealed that the incidence of local complications was higher in the T-OPLL patients. Perioperative complications resulted in longer hospital stays and higher medical costs.
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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
| | - 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.
| | - 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
| | - 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
| | - Kentaro Yamada
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - 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
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takuya Takahashi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - 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
| | - 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
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Ohata M, Nawa N, Minami K, Uchida T, Fujiwara T. Impact of preoperative intervention for smoking cessation on postoperative length of stay and cost for spine surgery patients: Propensity score matching analysis. Anaesth Crit Care Pain Med 2023; 42:101270. [PMID: 37379968 DOI: 10.1016/j.accpm.2023.101270] [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: 12/27/2022] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Preoperative intervention for smoking cessation reduces the prevalence of postoperative complications in spine surgery. To date, however, the impact of these interventions on the length of stay (LOS) and cost for patients is unclear. PATIENTS/METHODS This retrospective cohort study analyzed data from 317 patients who were current smokers and underwent spine surgery between January 2014 and December 2019 at a single facility in Tokyo, Japan. Most patients (262) received preoperative intervention for smoking cessation within 60 days before spine surgery; the remaining 55 patients did not receive the intervention. The postoperative LOS was compared using propensity score matching. Patients were matched for age, gender, body mass index, surgical plan (cervical surgery, anterior approach surgery, minimally invasive surgery), preoperative comorbidities (diabetes mellitus, hypertension, ischemic cardiac disease, chronic lung disease), and recent history of steroid therapy, which yielded 48 pairs of patients. RESULTS The length of postoperative hospital stay was significantly shorter in the intervention group (-10.60 days, [95% CI, -15.79 to -5.42]). The cost for service was significantly lower in the intervention group (coefficient, Japanese yen [JPY] -1,515,529; [95% CI, -2,130,631 to -900,426]; 110 JPY equivalent to 1 United States dollar). CONCLUSIONS Preoperative interventions for smoking cessation may decrease postoperative hospital stay and hospitalization costs.
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Affiliation(s)
- Megumi Ohata
- Department of Anesthesiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Anesthesiology, Musashino Red Cross Hospital, 1-26-1 Kyounan-chou, Musashino-shi, Tokyo 180-8610, Japan.
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Kotaro Minami
- Department of Anesthesiology, Musashino Red Cross Hospital, 1-26-1 Kyounan-chou, Musashino-shi, Tokyo 180-8610, Japan.
| | - Tokujiro Uchida
- Department of Anesthesiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
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Takasawa E, Iizuka Y, Mieda T, Inoue H, Kimura A, Takeshita K, Sonoda H, Takakura K, Sorimachi Y, Ara T, Arai A, Shida K, Nakajima T, Tsutsumi S, Arai H, Moridaira H, Taneichi H, Funayama T, Noguchi H, Miura K, Kobayashi R, Iizuka H, Chazono M, Chikuda H. Trends in cervical laminoplasty and 30-day postoperative complications: 10-year results from a retrospective, multi-institutional study of 1095 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3575-3582. [PMID: 37624437 DOI: 10.1007/s00586-023-07902-2] [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: 02/07/2023] [Revised: 06/05/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to investigate the recent 10-year trends in cervical laminoplasty and 30-day postoperative complications. METHODS This retrospective multi-institutional cohort study enrolled patients who underwent laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament. The primary outcome was the occurrence of all-cause 30-day complications. Trends were investigated and compared in the early (2008-2012) and late (2013-2017) periods. RESULTS Among 1095 patients (mean age, 66 years; 762 [70%] male), 542 and 553 patients were treated in the early and late periods, respectively. In the late period, patients were older at surgery (65 years vs. 68 years), there were more males (66% vs. 73%), and open-door laminoplasty (50% vs. 69%) was the preferred procedure, while %CSM (77% vs. 78%) and the perioperative JOA scores were similar to the early period. During the study period, the rate of preservation of the posterior muscle-ligament complex attached to the C2/C7-spinous process (C2, 89% vs. 93%; C7, 62% vs. 85%) increased and the number of laminoplasty levels (3.7 vs. 3.1) decreased. While the 30-day complication rate remained stable (3.9% vs. 3.4%), C5 palsy tended to decrease (2.4% vs. 0.9%, P = 0.059); superficial SSI increased significantly (0% vs. 1.3%, P = 0.015), while the decreased incidence of deep SSI did not reach statistical significance (0.6% vs. 0.2%). CONCLUSIONS From 2008 to 2017, there were trends toward increasing age at surgery and surgeons' preference for refined open-door laminoplasty. The 30-day complication rate remained stable, but the C5 palsy rate halved.
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Affiliation(s)
- Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan
| | - Hiroyuki Sonoda
- Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kenta Takakura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yasunori Sorimachi
- Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Tsuyoshi Ara
- Department of Orthopaedic Surgery, NHO Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Atsushi Arai
- Department of Orthopaedic Surgery, NHO Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Kosuke Shida
- Department of Orthopaedic Surgery, NHO Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Takashi Nakajima
- Department of Orthopaedic Surgery, JCHO Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Satoshi Tsutsumi
- Department of Orthopaedic Surgery, JCHO Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Hidekazu Arai
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryoichi Kobayashi
- Department of Orthopaedic Surgery, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Masaaki Chazono
- Department of Orthopaedic Surgery, NHO Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Sarraj M, Hache P, Foroutan F, Oitment C, Marion TE, Guha D, Pahuta M. Long-Term Survivorship of Cervical Spine Procedures; A Survivorship Meta-Analysis and Meta-Regression. Global Spine J 2023; 13:840-854. [PMID: 36069054 DOI: 10.1177/21925682221125766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To conduct a meta-analysis on the survivorship of commonly performed cervical spine procedures to develop survival function curves for (i) second surgery at any cervical level, and (ii) adjacent level surgery. METHODS A systematic review of was conducted following PRISMA guidelines. Articles with cohorts of greater than 20 patients followed for a minimum of 36 months and with available survival data were included. Procedures included were anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (ADR), laminoplasty (LAMP), and posterior laminectomy and fusion (PDIF). Reconstructed individual patient data were pooled across studies using parametric Bayesian survival meta-regression. RESULTS Of 1829 initial titles, 16 citations were included for analysis. 73 811 patients were included in the second surgery analysis and 2858 patients in the adjacent level surgery analysis. We fit a Log normal accelerated failure time model to the second surgery data and a Gompertz proportional hazards model to the adjacent level surgery data. Relative to ACDF, the risk of second surgery was higher with ADR and PDIF with acceleration factors 1.73 (95% CrI: 1.04, 2.80) and 1.35 (95% CrI: 1.25, 1.46) respectively. Relative to ACDF, the risk of second surgery was lower with LAMP with deceleration factor .06 (95% CrI: .05, .07). ADR decreased the risk of adjacent level surgery with hazard ratio .43 (95% CrI: .33, .55). CONCLUSIONS In cases of clinical equipoise between fusion procedures, our analysis suggests superior survivorship with anterior procedures. For all procedures, laminoplasty demonstrated superior survivorship.
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Affiliation(s)
- Mohamed Sarraj
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Philip Hache
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, 7989University Health Network, Toronto, ON, Canada
- Department of Health Research, Methods, Impact, 3710McMaster University, Hamilton, ON, Canada
| | - Colby Oitment
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Travis E Marion
- Department of Orthopaedic Surgery, 26627Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
| | - Markian Pahuta
- Division of Orthopedic Surgery, Hamilton General Hospital, 3710McMaster University, Hamilton, ON, Canada
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Sakaki K, Sakai K, Arai Y, Torigoe I, Tomori M, Hirai T, Onuma H, Kobayashi Y, Okawa A, Yoshii T. Prospective Comparative Study of Dysphagia after Subaxial Cervical Spine Surgery: Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament Ossification. J Clin Med 2023; 12:jcm12051774. [PMID: 36902561 PMCID: PMC10003155 DOI: 10.3390/jcm12051774] [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: 01/30/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases.
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Affiliation(s)
- Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
| | - Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi 332-8558, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo 108-0075, Japan
- Correspondence: ; Tel.: +81-3-5803-5678
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