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Lambrechts MJ, Siegel N, Karamian BA, Kanhere A, Tran K, Samuel AM, Viola Iii A, Tokarski A, Santisi A, Canseco JA, David Kaye I, Woods B, Kurd M, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD, Rihn J. Demographics and Medical Comorbidities as Risk Factors for Increased Episode of Care Costs Following Lumbar Fusion in Medicare Patients. Am J Med Qual 2022; 37:519-527. [PMID: 36314932 DOI: 10.1097/jmq.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective was to evaluate medical comorbidities and surgical variables as independent risk factors for increased health care costs in Medicare patients undergoing lumbar fusion. Care episodes limited to lumbar fusions were retrospectively reviewed on the Centers of Medicare and Medicaid Innovation (CMMI) Bundled Payment for Care Improvement (BPCI) reimbursement database at a single academic institution. Total episode of care cost was also collected. A multivariable linear regression model was developed to identify independent risk factors for increased total episode of care cost, and logistic models for surgical complications and readmission. A total of 500 Medicare patients were included. Risk factors associated with increased total episode of care cost included transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) (β = $5,399, P < 0.001) and ALIF+PLF (AP) fusions (β = $24,488, P < 0.001), levels fused (β = $3,989, P < 0.001), congestive heart failure (β = $6,161, P = 0.022), hypertension with end-organ damage (β = $10,138, P < 0.001), liver disease (β = $16,682, P < 0.001), inpatient complications (β = $4,548, P = 0.001), 90-day complications (β = $10,012, P = 0.001), and 90-day readmissions (β = $15,677, P < 0.001). The most common surgical complication was postoperative anemia, which was associated with significantly increased costs (β = $18,478, P < 0.001). Female sex (OR = 2.27, P = 0.001), AP fusion (OR = 2.59, P = 0.002), levels fused (OR = 1.45, P = 0.005), cerebrovascular disease (OR = 4.19, P = 0.003), cardiac arrhythmias (OR = 2.32, P = 0.002), and fluid electrolyte disorders (OR = 4.24, P = 0.002) were independent predictors of surgical complications. Body mass index (OR = 1.07, P = 0.029) and AP fusions (OR = 2.87, P = 0.049) were independent predictors of surgical readmission. Among medical comorbidities, congestive heart failure, hypertension with end-organ damage, and liver disease were independently associated with a significant increase in total episode of care cost. Interbody devices were associated with increased admission cost.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nicholas Siegel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Arun Kanhere
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Khoa Tran
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Andre M Samuel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Andrew Tokarski
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Anthony Santisi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - I David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jeffrey Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Yan X, Pang Y, Yan L, Ma Z, Jiang M, Wang W, Chen J, Han Y, Guo X, Hu H. Perioperative stroke in patients undergoing spinal surgery: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:652. [PMID: 35804343 PMCID: PMC9264537 DOI: 10.1186/s12891-022-05591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of perioperative stroke following spinal surgery, including ischemic and hemorrhagic stroke, has not been fully investigated in the Chinese population. Whether specific spinal or emergency/elective procedures are associated with perioperative stroke remains controversial. This study aimed to investigate the incidence of perioperative stroke, health economic burden, clinical outcomes, and associated risk factors. METHOD A retrospective cohort study using an electronic hospital information system database was conducted from Jan 1, 2015, to Jan 1, 2021, in a tertiary hospital in China. Patients aged ≥18 years who had undergone spinal surgery were included in the study. We recorded patient demographics, comorbidities, and health economics data. Clinical outcomes included perioperative stroke during hospitalization and associated risk factors. The patients' operative data, anesthetic data, and clinical manifestations were recorded. RESULT A total of 17,408 patients who had undergone spinal surgery were included in this study. Twelve patients had perioperative stroke, including seven ischemic stroke (58.3%) and five hemorrhagic stroke (41.7%). The incidence of perioperative stroke was 0.07% (12/17,408). In total, 12 stroke patients underwent spinal fusion. Patients with perioperative stroke were associated with longer hospital stay (38.33 days vs. 9.78 days, p < 0.001) and higher hospital expenses (RMB 175,642 vs. RMB 81,114, p < 0.001). On discharge, 50% of perioperative patients had severe outcomes. The average onset time of perioperative stroke was 1.3 days after surgery. Stroke history (OR 146.046, 95% CI: 28.102-759.006, p < 0.001) and hyperlipidemia (OR 4.490, 95% CI: 1.182-17.060, p = 0.027) were associated with perioperative stroke. CONCLUSION The incidence of perioperative stroke of spinal surgery in a tertiary hospital in China was 0.07%, with a high proportion of hemorrhagic stroke. Perioperative stroke patients experienced a heavy financial burden and severe outcomes. A previous stroke history and hyperlipidemia were associated with perioperative stroke.
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Affiliation(s)
- Xin Yan
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China.
| | - Ying Pang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Lirong Yan
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhigang Ma
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Ming Jiang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Weiwei Wang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Chen
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Yangtong Han
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaolei Guo
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Hongtao Hu
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
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Arena PJ, Mo J, Liu Q, Zhou X, Gong R, Wentworth C, Murugesan S, Huang K. The incidence of acute myocardial infarction after elective spinal fusions or joint replacement surgery in the United States: a large-scale retrospective observational cohort study in 322,585 patients : Post-surgical myocardial infarction data. Patient Saf Surg 2021; 15:30. [PMID: 34537067 PMCID: PMC8449870 DOI: 10.1186/s13037-021-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Acute myocardial infarction (AMI) is an uncommon but fatal complication among patients undergoing elective spinal fusion surgery (SF), total hip arthroplasty (THA), and total knee arthroplasty (TKA). Our objective was to estimate the incidence of AMI among adults undergoing elective SF, THA, and TKA in different post-operative risk windows and characterize high-risk sub-populations in the United States. Methods A retrospective cohort study was conducted using data from a longitudinal electronic healthcare record (EHR) database from January 1, 2007 to June 30, 2018. ICD codes were used to identify SF, THA, TKA, AMI, and selected clinical characteristics. Incidence proportions (IPs) and 95% confidence intervals were estimated in the following risk windows: index hospitalization, ≤ 30, ≤ 90, ≤ 180, and ≤ 365 days post-operation. Results A total of 67,533 SF patients, 87,572 THA patients, and 167,480 TKA patients were eligible for the study. The IP of AMI after SF, THA, and TKA ranged from 0.36, 0.28, and 0.25% during index hospitalization to 1.05, 0.93, and 0.85% ≤ 365 days post-operation, respectively. The IP of AMI was higher among patients who were older, male, with longer hospital stays, had a history of AMI, and had a history of diabetes. Conclusion The IP of post-operative AMI was generally highest among the SF cohort compared to the THA and TKA cohorts. Additionally, potential high-risk populations were identified. Future studies in this area are warranted to confirm these findings via improved confounder control and to identify effect measure modifiers. Supplementary Information The online version contains supplementary material available at 10.1186/s13037-021-00305-6.
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Affiliation(s)
- Patrick J Arena
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc., 235 E 42nd St, New York, NY, 10017, USA
| | - Jingping Mo
- Safety Surveillance Research, Pfizer Inc., New York, NY, USA
| | - Qing Liu
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc., Collegeville, PA, USA
| | - Xiaofeng Zhou
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc., 235 E 42nd St, New York, NY, 10017, USA
| | - Richard Gong
- Real World Evidence Center of Excellence, Pfizer Inc., New York, NY, USA
| | - Charles Wentworth
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc., 235 E 42nd St, New York, NY, 10017, USA
| | | | - Kui Huang
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc., 235 E 42nd St, New York, NY, 10017, USA.
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