1
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Lim S, Schultz L, Zakko P, Macki M, Hamilton T, Pawloski J, Fadel H, Mansour T, Yeh HH, Preston G, Nerenz D, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Perez-Cruet M, Park D, Chang V. The Potential Negative Effects of Smoking on Cervical and Lumbar Surgery Beyond Pseudarthrosis: A Michigan Spine Surgery Improvement Collaborative Study. World Neurosurg 2023; 173:e241-e249. [PMID: 36791883 DOI: 10.1016/j.wneu.2023.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To review the Michigan Spine Surgery Improvement Collaborative registry to investigate the long-term associations between current smoking status and outcomes after elective cervical and lumbar spine surgery. METHODS Using the Michigan Spine Surgery Improvement Collaborative, we captured all cases from January 1, 2017, to November 21, 2020, with outcomes data available; 19,251 lumbar cases and 7936 cervical cases were included. Multivariate regression analyses were performed to assess the relationship of smoking with the clinical outcomes. RESULTS Current smoking status was associated with lower urinary retention and satisfaction for patients after lumbar surgery and was associated with less likelihood of achieving minimal clinically important difference in primary outcome measures including Patient-Reported Outcomes Measurement Information System, back pain, leg pain, and EuroQol-5D at 90 days and 1 year after surgery. Current smokers were also less likely to return to work at 90 days and 1 year after surgery. Among patients who underwent cervical surgery, current smokers were less likely to have urinary retention and dysphagia postoperatively. They were less likely to be satisfied with the surgery outcome at 1 year. Current smoking was associated with lower likelihood of achieving minimal clinically important difference in Patient-Reported Outcomes Measurement Information System, neck pain, arm pain, and EuroQol-5D at various time points. There was no difference in return-to-work status. CONCLUSIONS Our analysis suggests that smoking is negatively associated with functional improvement, patient satisfaction, and return-to-work after elective spine surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA; Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Philip Zakko
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Mohamed Macki
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacob Pawloski
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hassan Fadel
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tarek Mansour
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gordon Preston
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - David Nerenz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA; Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Daniel Park
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Victor Chang
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
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Squires M, Schultz L, Schwalb J, Park P, Chang V, Nerenz D, Perez-Cruet M, Abdulhak M, Khalil J, Aleem I. Correlation of mJOA, PROMIS physical function, and patient satisfaction in patients with cervical myelopathy: an analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. Spine J 2023; 23:550-557. [PMID: 36567055 DOI: 10.1016/j.spinee.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND CONTEXT Patient-reported outcomes (PROs) are increasingly utilized to evaluate the efficacy and value of spinal procedures. Among patients with cervical myelopathy, the modified Japanese Orthopaedic Association (mJOA) remains the standard instrument, with Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and patient satisfaction also frequently assessed. These outcomes have not all been directly compared using a large spine registry at 2 years follow-up for cervical myelopathic patients undergoing surgery. PURPOSE To determine the correlation and association of PROMIS PF, mJOA, and patient satisfaction outcomes in patients undergoing surgery for cervical myelopathy. STUDY DESIGN/SETTING Retrospective review of a multicenter spine registry database. PATIENT SAMPLE Adult patients with cervical myelopathy who underwent cervical spine surgery between 2/26/2018 and 4/17/2021. OUTCOME MEASURES PROMIS PF, mJOA, and North American Spine Society (NASS) patient satisfaction index. METHODS The MSSIC database was accessed to gather pre- and postoperative outcome data on patients with cervical myelopathy. Spearman's correlation coefficients relating mJOA and PROMIS PF were quantified up to 2 years postoperatively. The correlations between patient satisfaction with mJOA and PROMIS were determined. Kappa statistics were used to evaluate for agreement between those reaching the minimum clinically important difference (MCID) for mJOA and PROMIS PF. Odds ratios were calculated to determine the association between patient satisfaction and those reaching MCID for mJOA and PROMIS PF. Support for MSSIC is provided by BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program. RESULTS Data from 2,023 patients were included. Moderate to strong correlations were found between mJOA and PROMIS PF at all time points (p<.001). These outcomes had fair agreement at all postoperative time points when comparing those who reached MCID. Satisfaction was strongly related to changes from baseline for both mJOA and PROMIS PF at all time points (p<.001). Odds ratios associating satisfaction with PROMIS PF MCID were higher at all time points compared with mJOA, although the differences were not significant. CONCLUSIONS PROMIS PF has a strong positive correlation with mJOA up to 2 years postoperatively in patients undergoing surgery for cervical myelopathy, with similar odds of achieving MCID with both instruments. Patient satisfaction is predicted similarly by these outcome measures by 2 years postoperatively. These results affirm the validity of PROMIS PF in the cervical myelopathic population. Given its generalizability and ease of use, PROMIS PF may be a more practical outcome measure for clinical use compared with mJOA.
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Affiliation(s)
- Mathieu Squires
- Department of Orthopedic Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Lonni Schultz
- Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | - Jason Schwalb
- Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Victor Chang
- Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | - David Nerenz
- Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | | | | | - Jad Khalil
- Beaumont Health System, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA
| | - Ilyas Aleem
- Department of Orthopedic Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
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Lim S, Yeh HH, Macki M, Haider S, Hamilton T, Mansour TR, Telemi E, Schultz L, Nerenz DR, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil JG, Perez-Cruet M, Chang V. Postoperative opioid prescription and patient-reported outcomes after elective spine surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2023; 38:242-248. [PMID: 36208431 DOI: 10.3171/2022.8.spine22571] [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: 05/26/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study was designed to assess how postoperative opioid prescription dosage could affect patient-reported outcomes after elective spine surgery. METHODS Patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) from January 2020 to September 2021 were included in this study. Opioid prescriptions at discharge were converted to total morphine milligram equivalents (MME). A reference value of 225 MME per week was used as a cutoff. Patients were divided into two cohorts based on prescribed total MME: ≤ 225 MME and > 225 MME. Primary outcomes included patient satisfaction, return to work status after surgery, and whether improvement of the minimal clinically important difference (MCID) of the Patient-Reported Outcomes Measurement Information System 4-question short form for physical function (PROMIS PF) and EQ-5D was met. Generalized estimated equations were used for multivariate analysis. RESULTS Regression analysis revealed that patients who had postoperative opioids prescribed with > 225 MME were less likely to be satisfied with surgery (adjusted OR [aOR] 0.81) and achieve PROMIS PF MCID (aOR 0.88). They were also more likely to be opioid dependent at 90 days after elective spine surgery (aOR 1.56). CONCLUSIONS The opioid epidemic is a serious threat to national public health, and spine surgeons must practice conscientious postoperative opioid prescribing to achieve adequate pain control. The authors' analysis illustrates that a postoperative opioid prescription of 225 MME or less is associated with improved patient satisfaction, greater improvement in physical function, and decreased opioid dependence compared with those who had > 225 MME prescribed.
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Affiliation(s)
| | | | | | | | | | | | | | - Lonni Schultz
- Departments of1Neurological Surgery
- 2Public Health Services, and
| | - David R Nerenz
- Departments of1Neurological Surgery
- 3Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Ilyas Aleem
- 5Orthopedics, University of Michigan, Ann Arbor, Michigan
| | - Richard Easton
- 6Department of Orthopedics, William Beaumont Hospital, Troy, Michigan; and
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Lawless MH, Tong D, Claus CF, Hanson C, Li C, Park P, Chang VW, Abdulhak MM, Houseman CM, Bono PL, Carr DA, Richards BF, Kelkar PS, Soo TM. The Effect of Preoperative Symptom Duration on Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion in Nonmyelopathic Patients: Analyses From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery 2022; 92:955-962. [PMID: 36524819 DOI: 10.1227/neu.0000000000002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The effect of preoperative symptom duration (PSD) on patient-reported outcomes (PROs) in anterior cervical discectomy and fusion (ACDF) for radiculopathy is unclear. OBJECTIVE To determine whether PSD is a predictor for PRO after ACDF for radiculopathy. METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried between March, 2014, and July, 2019, for patients who underwent ACDF without myelopathy and PROs (baseline, 90 days, 1 year, 2 years). PROs were measured by numerical rating scales for neck/arm pain, Patient-Reported Outcomes Measurement Information System Short Form-Physical Function (PROMIS-PF), EuroQol-5D (EQ5D), and North American Spine Society satisfaction. Univariate analyses were used to evaluate the proportion of patients reaching minimal clinically important differences (MCID). PSD was <3 months, 3 month-1 year, or >1 years. Multiple logistic regression models were used to estimate the association between PSD and PRO reaching MCID. The discriminative ability of the model was evaluated by receiver operating characteristic curve. RESULTS We included 2233 patients who underwent ACDF with PSD <3 months (278, 12.4%), 3 month-1 year (669, 30%), and >1 years (1286, 57.6%). Univariate analyses demonstrated a greater proportion of patients achieving MCID in <3-month cohort for arm numerical rating scales, PROMIS-PF, EQ5D, and North American Spine Society Satisfaction. Multivariable analyses demonstrated using <3 months PSD as a reference, PSD >1 years was associated with decreased odds of achieving MCID for EQ5D (odds ratio 0.5, CI 0.32-0.80, P = .004). Private insurance and increased baseline PRO were associated with significantly higher odds for achieving PROMIS-PF MCID and EQ5D-MCID. CONCLUSION Preoperative symptom duration greater than 1 year in patients who underwent ACDF for radiculopathy was associated with worse odds of achieving MCID for multiple PROs.
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Affiliation(s)
- Michael H Lawless
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Doris Tong
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Chad F Claus
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Connor Hanson
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Clifford M Houseman
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Peter L Bono
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Daniel A Carr
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Boyd F Richards
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Prashant S Kelkar
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Teck M Soo
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
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5
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Macki M, Hamilton T, Massie L, Bazydlo M, Schultz L, Seyfried D, Park P, Aleem I, Abdulhak M, Chang VW, Schwalb JM. Characteristics and outcomes of patients undergoing lumbar spine surgery for axial back pain in the Michigan Spine Surgery Improvement Collaborative. Spine J 2022; 22:1651-1659. [PMID: 35803577 DOI: 10.1016/j.spinee.2022.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The indications for surgical intervention of axial back pain without leg pain for degenerative lumbar disorders have been limited in the literature, as most study designs allow some degree of leg symptoms in the inclusion criteria. PURPOSE To determine the outcome of surgery (decompression only vs. fusion) for pure axial back pain without leg pain. STUDY DESIGN/SETTING Prospectively collected data in the Michigan Spine Surgery Improvement Collaborative (MSSIC). PATIENT SAMPLE Patients with pure axial back pain without leg pain underwent lumbar spine surgery for primary diagnoses of lumbar disc herniation, lumbar stenosis, and isthmic or degenerative spondylolisthesis ≤ grade II. OUTCOME MEASURES Minimally clinically important difference (MCID) for back pain, Numeric Rating Scale of back pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), MCID of PROMIS-PF, and patient satisfaction on the North American Spine Surgery Patient Satisfaction Index were collected at 90 days, 1 year, and 2 years after surgery. METHODS Log-Poisson generalized estimating equation models were constructed with patient-reported outcomes as the independent variable, reporting adjusted risk ratios (RRadj). RESULTS Of the 388 patients at 90 days, multi-level versus single level lumbar surgery decreased the likelihood of obtaining a MCID in back pain by 15% (RRadj=0.85, p=.038). For every one-unit increase in preoperative back pain, the likelihood for a favorable outcome increased by 8% (RRadj=1.08, p<.001). Of the 326 patients at 1 year, symptom duration > 1 year decreased the likelihood of a MCID in back pain by 16% (RRadj=0.84, p=.041). The probability of obtaining a MCID in back pain increased by 9% (RRadj=1.09, p<.001) for every 1-unit increase in baseline back pain score and by 14% for fusions versus decompression alone (RRadj=1.14, p=.0362). Of the 283 patients at 2 years, the likelihood of obtaining MCID in back pain decreased by 30% for patients with depression (RRadj=0.70, p<.001) and increased by 8% with every one-unit increase in baseline back pain score (RRadj=1.08, p<.001). CONCLUSIONS Only the severity of preoperative back pain was associated with improvement in MCID in back pain at all time points, suggesting that surgery should be considered for selected patients with severe axial pain without leg pain. Fusion surgery versus decompression alone was associated with improved patient-reported outcomes at 1 year only, but not at the other time points.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Lara Massie
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Donald Seyfried
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive #5201, Ann Arbor, MI 48109 USA
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, Floor 2 Reception B, Ann Arbor, MI 48109 USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA.
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6
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Lim S, Bazydlo M, Macki M, Haider S, Hamilton T, Hunt R, Chaker A, Kantak P, Schultz L, Nerenz D, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil JG, Perez-Cruet MJ, Chang V. Validation of the Benefits of Ambulation Within 8 Hours of Elective Cervical and Lumbar Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery 2022; 91:505-512. [PMID: 35550477 DOI: 10.1227/neu.0000000000002032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early ambulation is considered a key element to Enhanced Recovery After Surgery protocol after spine surgery. OBJECTIVE To investigate whether ambulation less than 8 hours after elective spine surgery is associated with improved outcome. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to track all elective cervical and lumbar spine surgery between July 2018 and April 2021. In total, 7647 cervical and 17 616 lumbar cases were divided into 3 cohorts based on time to ambulate after surgery: (1) <8 hours, (2) 8 to 24 hours, and (3) >24 hours. RESULTS For cervical cases, patients who ambulated 8 to 24 hours (adjusted odds ratio [aOR] 1.38; 95% CI 1.11-1.70; P = .003) and >24 hours (aOR 2.20; 95% CI 1.20-4.03; P = .011) after surgery had higher complication rate than those who ambulated within 8 hours of surgery. Similar findings were noted for lumbar cases with patients who ambulated 8 to 24 hours (aOR 1.31; 95% CI 1.12-1.54; P < .001) and >24 hours (aOR 1.96; 95% CI 1.50-2.56; P < .001) after surgery having significantly higher complication rate than those ambulated <8 hours after surgery. Analysis of secondary outcomes for cervical cases demonstrated that <8-hour ambulation was associated with home discharge, shorter hospital stay, lower 90-day readmission, and lower urinary retention rate. For lumbar cases, <8-hour ambulation was associated with shorter hospital stay, satisfaction with surgery, lower 30-day readmission, home discharge, and lower urinary retention rate. CONCLUSION Ambulation within 8 hours after surgery is associated with significant improved outcome after elective cervical and lumbar spine surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rachel Hunt
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anisse Chaker
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pranish Kantak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad G Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Abstract
STUDY DESIGN Delphi expert panel consensus. OBJECTIVE To obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery. SUMMARY OF BACKGROUND DATA Several studies have shown high patient satisfaction associated with telemedicine during the COVID-19 peak pandemic period as well as after easing of restrictions. As this technology will most likely continue to be employed, there is a need to define appropriate utilization. METHODS An expert panel consisting of 27 spine surgeons from various countries was assembled in February 2021. A two-round consensus-based Delphi method was used to generate consensus statements on various aspects of telemedicine (separated as video visits or audio visits) including themes, such as patient location and impact of patient diagnosis, on assessment of new patients. Topics with ≥75% agreement were categorized as having achieved a consensus. RESULTS The expert panel reviewed a total of 59 statements. Of these, 32 achieved consensus. The panel had consensus that video visits could be utilized regardless of patient location and that video visits are appropriate for evaluating as well as indicating for surgery multiple common spine pathologies, such as lumbar stenosis, lumbar radiculopathy, and cervical radiculopathy. Finally, the panel had consensus that video visits could be appropriate for a variety of visit types including early, midterm, longer term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e., physical therapy, injection). CONCLUSION Although telemedicine was initially introduced out of necessity, this technology most likely will remain due to evidence of high patient satisfaction and significant cost savings. This study was able to provide a framework for appropriate telemedicine utilization in spine surgery from a panel of experts. However, several questions remain for future research, such as whether or not an in-person consultation is necessary prior to surgery and which physical exam maneuvers are appropriate for telemedicine.Level of Evidence: 4.
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Lawless MH, Tong D, Claus CF, Hanson C, Li C, Houseman CM, Bono P, Richards BF, Kelkar PS, Abdulhak MM, Chang V, Carr DA, Park P, Soo TM. Age as a Risk Factor for Complications Following Anterior Cervical Discectomy and Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Spine (Phila Pa 1976) 2022; 47:343-351. [PMID: 34392275 DOI: 10.1097/brs.0000000000004200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected registry data using multivariable analyses of imputed data. OBJECTIVE We sought to demonstrate that age would not be associated with complications in patients undergoing anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Elderly patients (≥70 yrs) undergoing ACDF are considered a higher risk for complications. However, conclusive evidence is lacking. The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a quality improvement collaborative with 30 hospitals across Michigan. METHODS The study included all patients who had 1 to 4 level ACDF (September 2015-August 2019) for 90-day complications. Major and minor complications were defined using a validated classification. Multiple imputations were used to generate complete covariate datasets. Generalized estimating equation model was used to identify associations with complications using the whole cohort and elderly subgroup analyses. Bonferroni correction was used. RESULTS Nine thousand one hundred thirty five patients (11.1% ≥ 70 yrs and 88.9% <70 yrs) with 2266 complications were analyzed. Comparing elderly versus non-elderly, the elderly had a significantly higher rate of any complications (31.5% vs. 24.0%, P < 0.001) and major complications (14.1% vs. 7.0%, P < 0.001). On multivariable analysis, age was not independently associated with any complication. POD#0 ambulation and preop independent ambulation were independently associated with significantly decreased odds of any complication. In the elderly, independent preoperative ambulation was protective for any complication (odds ratio [OR] 0.53, 0.39-0.73 95% confidence interval [CI]), especially major complications (OR 0.41, 0.27-0.61 95% CI). CONCLUSION Age was not an independent risk factor for complications in patients that underwent ACDF. In the elderly, independent preoperative ambulation was especially protective for major complications.Level of Evidence: 3.
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Affiliation(s)
- Michael H Lawless
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Doris Tong
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Chad F Claus
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Connor Hanson
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| | | | - Peter Bono
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Boyd F Richards
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Prashant S Kelkar
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | | | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI
| | - Daniel A Carr
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Teck M Soo
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI
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9
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Jagsi R, Schipper M, Mietzel M, Pandya R, Moran JM, Matuszak M, Vicini F, Jolly S, Paximadis P, Mancini B, Griffith K, Hayman J, Pierce L, On Behalf Of The Michigan Radiation Oncology Quality Consortium Mroqc. The Michigan Radiation Oncology Quality Consortium: A Novel Initiative to Improve the Quality of Radiation Oncology Care. Int J Radiat Oncol Biol Phys 2022; 113:257-265. [PMID: 35124133 DOI: 10.1016/j.ijrobp.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Numerous quality measures have been proposed in radiation oncology, and initiatives to improve access to high-complexity care, quality, and equity are needed. We describe the design and evaluate impact of a voluntary statewide collaboration for quality improvement in radiation oncology initiated a decade ago. METHODS AND MATERIALS We evaluate compliance before and since implementation of annual metrics for quality improvement, using an observational dataset with information from over 20,000 patients treated in the 28 participating radiation oncology practices. At thrice-yearly meetings, experts have spoken regarding trends within the field and inspired discussions regarding potential targets for quality improvement. Blinded data on practices at various sites have been provided. Following Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines, we describe the approach and measures the program has implemented. To evaluate impact, we compare compliance at baseline and now with active measures using mixed effects regression models with site-level random effects. RESULTS Compliance has increased, including use of guideline-concordant hypofractionated radiotherapy, doses to targets/normal tissues, motion management, and consistency in delineating and naming contoured structures (a precondition for quality evaluation). For example, use of guideline-concordant hypofractionation for breast cancer increased from 47% to 97%, adherence to target coverage goals and heart dose limits for dose increased from 46% to 86%, motion assessment in patients with lung cancer increased from 52% to 94%, and use of standard nomenclature increased from 53% to 82% for lung patients and from 80% to 94% for breast patients (all p<0.001). CONCLUSIONS Although observational analysis cannot fully exclude secular trends, contextual data revealing slow uptake of best practices elsewhere in the US and qualitative feedback from participants suggests that this initiative has improved the consistency, efficiency, and quality of radiation oncology care in its member practices and may be a model for oncology quality improvement more generally.
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Lim S, Bazydlo M, Macki M, Haider S, Schultz L, Nerenz D, Fadel H, Pawloski J, Yeh HH, Park P, Aleem I, Khalil J, Easton R, Schwalb JM, Abdulhak M, Chang V. A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. Spine (Phila Pa 1976) 2022; 47:220-226. [PMID: 34516058 DOI: 10.1097/brs.0000000000004169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective, cohort analysis of multi-institutional database. OBJECTIVE This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries. SUMMARY OF BACKGROUND DATA After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation. RESULTS We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13-1.34; P < 0.001). There were no significant differences in other outcomes measured. CONCLUSION Our analysis demonstrated that drain use is associated with significant longer hospital stay.Level of Evidence: 3.
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Affiliation(s)
- Seokchun Lim
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Michael Bazydlo
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - Mohamed Macki
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Sameah Haider
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Lonni Schultz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - David Nerenz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Hassan Fadel
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Jacob Pawloski
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Hsueh-Han Yeh
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Ilyas Aleem
- Department of Orthopaedics, University of Michigan, Ann Arbor, MI
| | - Jad Khalil
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Richard Easton
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Jason M Schwalb
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Muwaffak Abdulhak
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Victor Chang
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
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Macki M, Hamilton T, Lim S, Mansour TR, Telemi E, Bazydlo M, Schultz L, Nerenz DR, Park P, Chang V, Schwalb J, Abdulhak MM. The role of postoperative antibiotic duration on surgical site infection after lumbar surgery. J Neurosurg Spine 2022; 36:254-260. [PMID: 34534952 DOI: 10.3171/2021.4.spine201839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite a general consensus regarding the administration of preoperative antibiotics, poorly defined comparison groups and underpowered studies prevent clear guidelines for postoperative antibiotics. Utilizing a data set tailored specifically to spine surgery outcomes, in this clinical study the authors aimed to determine whether there is a role for postoperative antibiotics in the prevention of surgical site infection (SSI). METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar operations performed for degenerative spinal pathologies over a 5-year period from 2014 to 2019. Preoperative prophylactic antibiotics were administered for all surgical procedures. The study population was divided into three cohorts: no postoperative antibiotics, postoperative antibiotics ≤ 24 hours, and postoperative antibiotics > 24 hours. This categorization was intended to determine 1) whether postoperative antibiotics are helpful and 2) the appropriate duration of postoperative antibiotics. First, multivariable analysis with generalized estimating equations (GEEs) was used to determine the association between antibiotic duration and all-type SSI with adjusted odds ratios; second, a three-tiered outcome-no SSI, superficial SSI, and deep SSI-was calculated with multivariable multinomial logistical GEE analysis. RESULTS Among 37,161 patients, the postoperative antibiotics > 24 hours cohort had more men with older average age, greater body mass index, and greater comorbidity burden. The postoperative antibiotics > 24 hours cohort had a 3% rate of SSI, which was significantly higher than the 2% rate of SSI of the other two cohorts (p = 0.004). On multivariable GEE analysis, neither postoperative antibiotics > 24 hours nor postoperative antibiotics ≤ 24 hours, as compared with no postoperative antibiotics, was associated with a lower rate of all-type postoperative SSIs. On multivariable multinomial logistical GEE analysis, neither postoperative antibiotics ≤ 24 hours nor postoperative antibiotics > 24 hours was associated with rate of superficial SSI, as compared with no antibiotic use at all. The odds of deep SSI decreased by 45% with postoperative antibiotics ≤ 24 hours (p = 0.002) and by 40% with postoperative antibiotics > 24 hours (p = 0.008). CONCLUSIONS Although the incidence of all-type SSI was highest in the antibiotics > 24 hours cohort, which also had the highest proportions of risk factors, duration of antibiotics failed to predict all-type SSI. On multinomial subanalysis, administration of postoperative antibiotics for both ≤ 24 hours and > 24 hours was associated with decreased risk of only deep SSI but not superficial SSI. Spine surgeons can safely consider antibiotics for 24 hours, which is equally as effective as long-term administration for prophylaxis against deep SSI.
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Affiliation(s)
| | | | | | | | | | | | | | - David R Nerenz
- 3Center for Health Policy and Health Services Research, Henry Ford Hospital, Detroit, Michigan; and
| | - Paul Park
- 4University of Michigan, Ann Arbor, Michigan
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12
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Hamilton T, Macki M, Oh SY, Bazydlo M, Schultz L, Zakaria HM, Khalil JG, Perez-Cruet M, Aleem I, Park P, Easton R, Nerenz DR, Schwalb J, Abdulhak M, Chang V. The association of patient education level with outcomes after elective lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2021:1-9. [PMID: 34891131 DOI: 10.3171/2021.9.spine21421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Socioeconomic factors have been shown to impact a host of healthcare-related outcomes. Level of education is a marker of socioeconomic status. This study aimed to investigate the relationship between patient education level and outcomes after elective lumbar surgery and to characterize any education-related disparities. METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations. Primary outcomes included patient satisfaction determined by the North American Spine Society patient satisfaction index, and reaching the minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score and return to work up to 2 years after surgery. Multivariate Poisson generalized estimating equation models reported adjusted risk ratios. RESULTS A total of 26,229 lumbar spine patients had data available for inclusion in this study. On multivariate generalized estimating equation analysis all comparisons were done versus the high school (HS)/general equivalency development (GED)-level cohort. For North American Spine Society satisfaction scores after surgery the authors observed the following: at 90 days the likelihood of satisfaction significantly decreased by 11% (p < 0.001) among < HS, but increased by 1% (p = 0.52) among college-educated and 3% (p = 0.011) among postcollege-educated cohorts compared to the HS/GED cohort; at 1 year there was a decrease of 9% (p = 0.02) among < HS and increases of 3% (p = 0.02) among college-educated and 9% (p < 0.001) among postcollege-educated patients; and at 2 years, there was an increase of 5% (p = 0.001) among postcollege-educated patients compared to the < HS group. The likelihood of reaching a minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score at 90 days increased by 5% (p = 0.005) among college-educated and 9% (p < 0.001) among postcollege-educated cohorts; at 1 year, all comparison cohorts demonstrated significance, with a decrease of 12% (p = 0.007) among < HS, but an increase by 6% (p < 0.001) among college-educated patients and 14% (p < 0.001) among postcollege-educated compared to the HS/GED cohort; at 2 years, there was a significant decrease by 19% (p = 0.003) among the < HS cohort, an increase by 8% (p = 0.001) among the college-educated group, and an increase by 16% (p < 0.001) among the postcollege-educated group. For return to work, a significant increase was demonstrated at 90 days and 1 year when comparing the HS or less group with college or postcollege cohorts. CONCLUSIONS This study demonstrated negative associations on all primary outcomes with lower levels of education. This finding suggests a potential disparity linked to education in elective spine surgery.
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Affiliation(s)
| | | | - Seok Yoon Oh
- 2Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | | | - Lonni Schultz
- Departments of1Neurosurgery and.,3Public Health Sciences, and
| | | | | | | | | | - Paul Park
- 7Neurosurgery, University of Michigan Hospital, Ann Arbor
| | - Richard Easton
- 8Department of Orthopedic Surgery, William Beaumont Hospital-Troy, Michigan; and
| | - David R Nerenz
- 9Center for Health Services Research, Henry Ford Hospital, Detroit
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Lim S, Yeh HH, Macki M, Mansour T, Schultz L, Telemi E, Haider S, Nerenz DR, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Perez-Cruet M, Chang V. Preoperative HbA1c > 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery 2021; 89:819-826. [PMID: 34352887 DOI: 10.1093/neuros/nyab294] [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: 12/08/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preoperative hemoglobin A1c (HbA1c) is a useful screening tool since a significant portion of diabetic patients in the United States are undiagnosed and the prevalence of diabetes continues to increase. However, there is a paucity of literature analyzing comprehensive association between HbA1c and postoperative outcome in lumbar spine surgery. OBJECTIVE To assess the prognostic value of preoperative HbA1c > 8% in patients undergoing elective lumbar spine surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried to track all elective lumbar spine surgeries between January 2018 and December 2019. Cases were divided into 2 cohorts based on preoperative HbA1c level (≤8% and >8%). Measured outcomes include any complication, surgical site infection (SSI), readmission (RA) within 30 d (30RA) and 90 d (90RA) of index operation, patient satisfaction, and the percentage of patients who achieved minimum clinically important difference (MCID) using Patient-Reported Outcomes Measurement Information System. RESULTS We captured 4778 patients in this study. Our multivariate analysis demonstrated that patients with HbA1c > 8% were more likely to experience postoperative complication (odds ratio [OR] 1.81, 95% CI 1.20-2.73; P = .005) and be readmitted within 90 d of index surgery (OR 1.66, 95% CI 1.08-2.54; P = .021). They also had longer hospital stay (OR 1.12, 95% CI 1.03-1.23; P = .009) and were less likely to achieve functional improvement after surgery (OR 0.64, 95% CI 0.44-0.92; P = .016). CONCLUSION HbA1c > 8% is a reliable predictor of poor outcome in elective lumbar spine surgery. Clinicians should consider specialty consultation to optimize patients' glycemic control prior to surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Department of Public Health Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tarek Mansour
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Public Health Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Edvin Telemi
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - David R Nerenz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Victor Chang
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Hamilton T, Lim S, Telemi E, Bazydlo M, Nerenz DR, Zakaria HM, Schultz L, Khalil JG, Perez-Cruet MJ, Aleem IS, Park P, Schwalb JM, Abdulhak MM, Chang V. Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2021; 35:91-99. [PMID: 33962387 DOI: 10.3171/2020.10.spine20914] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: the North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work. METHODS The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and "other." Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios. RESULTS The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression. CONCLUSIONS While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.
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Affiliation(s)
- Mohamed Macki
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | - Seokchun Lim
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | - Edvin Telemi
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | - David R Nerenz
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | - Lonni Schultz
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | | | | | - Paul Park
- 5Neurosurgery, University of Michigan Hospital, Ann Arbor, Michigan
| | | | | | - Victor Chang
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
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15
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Age as a Predictor for Complications and Patient-reported Outcomes in Multilevel Transforaminal Lumbar Interbody Fusions: Analyses From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Spine (Phila Pa 1976) 2021; 46:356-365. [PMID: 33620179 DOI: 10.1097/brs.0000000000003792] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a multi-institutional data registry. OBJECTIVE The authors sought to determine the association between age and complications & patient-reported outcomes (PRO) in patients undergoing multilevel transforaminal interbody lumbar fusion (MTLIF). SUMMARY OF BACKGROUND DATA Elderly patients undergoing MTLIF are considered high risk. However, data on complications and PRO are lacking. Additionally, safety of multilevel lumbar fusion in the elderly remains uncertain. METHODS Patients ≥50-year-old who underwent MTLIF for degenerative lumbar spine conditions were analyzed. Ninety-day complications and PROs (baseline, 90-d, 1-y, 2-y) were queried using the MSSIC database. PROs were measured by back & leg visual analog scale (VAS), Patient-reported Outcomes Measurement Information System (PROMIS), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Patient Satisfaction Index. Univariate analyses were used to compare among elderly and complication cohorts. Generalized estimating equation (GEE) was used to identify predictors of complications and PROs. RESULTS A total of 3120 patients analyzed with 961 (31%) ≥ 70-y-o and 2159 (69%) between 50-69. A higher proportion of elderly experienced postoperative complications (P = .003) including urinary retention (P = <.001) and urinary tract infection (P = .002). Multivariate analysis demonstrated that age was not independently associated with complications. Number of operative levels was associated with any (P = .001) and minor (P = .002) complication. Incurring a complication was independently associated with worse leg VAS and PROMIS scores (P = <.001). Preoperative independent ambulation was independently associated with improved PROMIS, and EQ5D (P = <.001). Within the elderly, preoperative independent ambulation and lower BMI were associated with improved PROMIS (P = <.001). Complications had no significant effect on PROs in the elderly. CONCLUSIONS Age was not associated with complications nor predictive of functional outcomes in patients who underwent MTLIF. Age alone, therefore, may not be an appropriate surrogate for risk. Furthermore, baseline preoperative independent ambulation was associated with better clinical outcomes and should be considered during preoperative surgical counseling.Level of Evidence: 3.
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Macki M, Fadel HA, Hamilton T, Lim S, Massie LW, Zakaria HM, Pawloski J, Chang V. The influence of sagittal spinopelvic alignment on patient discharge disposition following minimally invasive lumbar interbody fusion. JOURNAL OF SPINE SURGERY 2021; 7:8-18. [PMID: 33834123 DOI: 10.21037/jss-20-596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to investigate the changes to spinopelvic sagittal alignment following minimally invasive (MIS) lumbar interbody fusion, and the influence of such changes on postoperative discharge disposition. Methods The Michigan Spine Surgery Improvement Collaborative was queried for all patients who underwent transforaminal lumbar interbody fusion (TLIF)or lateral lumbar interbody fusion (LLIF) procedures for degenerative spine disease. Several spinopelvic sagittal alignment parameters were measured, including sagittal vertical axis (SVA), lumbar lordosis, pelvic tilt, pelvic incidence, and pelvic incidence-lumbar lordosis mismatch. Primary outcome measure-discharge to a rehabilitation facility-was expressed as adjusted odds ratio (ORadj) following a multivariable logistical regression. Results Of the 83 patients in the study population, 11 (13.2%) were discharged to a rehabilitation facility. Preoperative SVA was equivalent. Postoperative SVA increased to 8.0 cm in the discharge-to-rehabilitation division versus a decrease to 3.6 cm in the discharge-to-home division (P<0.001). The odds of discharge to a rehabilitation facility increased by 25% for every 1-cm increase in postoperative sagittal balance (ORadj =1.27, P=0.014). The strongest predictor of discharge to rehabilitation was increasing decade of life (ORadj =3.13, P=0.201). Conclusions Correction of sagittal balance is associated with greater odds of discharge to home. These findings, coupled with the recognized implications of admission to a rehabilitation facility, will emphasize the importance of spine surgeons accounting for SVA into their surgical planning of MIS lumbar interbody fusions.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Hassan A Fadel
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Seokchun Lim
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Lara W Massie
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Hesham Mostafa Zakaria
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
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Park P, Chang V, Yeh HH, Schwalb JM, Nerenz DR, Schultz LR, Abdulhak MM, Easton R, Perez-Cruet M, Kashlan ON, Oppenlander ME, Szerlip NJ, Swong KN, Aleem IS. Impact of Michigan's new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine 2021; 34:531-536. [PMID: 33307531 DOI: 10.3171/2020.7.spine20729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery. METHODS Patient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated. RESULTS Patients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323). CONCLUSIONS There was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.
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Affiliation(s)
| | - Victor Chang
- 2Department of Neurosurgery, Henry Ford Hospital, Detroit
| | - Hsueh-Han Yeh
- 3Center for Health Policy and Health Service Research and
| | | | - David R Nerenz
- 2Department of Neurosurgery, Henry Ford Hospital, Detroit
| | - Lonni R Schultz
- 4Public Health Sciences Department, Henry Ford Health System, Detroit
| | | | - Richard Easton
- 5Department of Orthopaedic Surgery, Beaumont Health, Troy; and
| | | | | | | | | | | | - Ilyas S Aleem
- Departments of1Neurosurgery and
- 7Orthopaedic Surgery, University of Michigan, Ann Arbor
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Zervos TM, Bazydlo M, Tundo K, Macki M, Rock J. Risk Factors Associated with Symptomatic Deep Vein Thrombosis Following Elective Spine Surgery: A Case-Control Study. World Neurosurg 2020; 144:e460-e465. [PMID: 32889183 DOI: 10.1016/j.wneu.2020.08.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies provide insight into risk factors (RFs) associated with postoperative deep vein thrombosis (DVT) following elective spinal surgery. DVTs are detrimental in this population because of the risk of pulmonary embolization or surgical site hemorrhage with treatment. OBJECTIVE Elective spine surgery patients have a low incidence of DVT, thus a case-control study was selected to investigate RFs associated with postoperative, symptomatic DVT. METHODS Cases were matched to controls in a 1:2 ratio based on surgery type. Risk of having a prior DVT and choice of subcutaneous heparin dosing following surgery was analyzed in a multivariate regression model with other potentially confounding variables. RESULTS A total of 195 patients were included in this study. Independent of patient age, history of DVT was associated with postoperative symptomatic DVT (odds ratio [OR], 4.09; 95% confidence interval [CI], 1.22-13.78). Two versus 3 times daily postoperative heparin dosing (OR, 1.56; 95% CI, 0.32-7.56), surgery length (OR, 1.32; 95% CI, 0.98-1.79), and patient age (OR, 1.04; 95% CI, 1.0-1.08) were not statistically significant, independent RFs. Older age and longer length of surgery trended toward association with DVT without reaching significance. Length of stay was increased from 3-5 days (P < 0.001) in DVT patients compared with controls. CONCLUSIONS These results suggest that patients with a history of DVT undergoing elective spinal surgery are at higher risk of developing symptomatic DVT postoperatively resulting in significantly increased length of stay. Further studies on additional preoperative screening and medical optimization in elective spine surgery patients may help reduce the rate of symptomatic, postoperative DVT.
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Affiliation(s)
- Thomas M Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kelly Tundo
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jack Rock
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Zakaria HM, Massie LW, Elmenini J, Fakih M, Dakroub B, Chang V. The Effect of Physical Therapy on Time to Discharge After Lumbar Interbody Fusion. Clin Neurol Neurosurg 2020; 197:106157. [PMID: 32861038 DOI: 10.1016/j.clineuro.2020.106157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND With a lesser degree of tissue destruction, patients undergoing minimally-invasive spine surgery are primed to benefit from early mobilization, which can further enhance recovery and hasten rehabilitation. We aimed to determine the role of physical therapy on earlier discharge after minimally-invasive transforaminal lumbar interbody fusion (TLIF). METHODS Michigan Spine Surgery Improvement Collaborative (MSSIC) provided patients undergoing one- and two-level minimally-invasive TLIF for degenerative lumbar disease. The study population was divided into patients with a one-day length of stay (LOS 1), two days (LOS 2), and three or more days (LOS ≥ 3) to maintain three equal-time cohorts. On POD 0, physical therapy (or, in very rare circumstances, a spine-care-specialized nurse in patients arriving to the in-patient floors late after hours) must evaluate capacity to ambulate. RESULTS Of the 101 patients, the median day of first ambulation statistically significantly increased from the LOS 1 to LOS ≥ 3 cohort (P = 0.007). Mean distance ambulated decreased from 156.5 ± 123.1 feet in the LOS 1 group, 108.9 ± 83.9 feet in the LOS 2 group, to 69.2 ± 58.3 feet in the LOS ≥ 3 group (P = 0.002). Patient-reported outcomes did not differ among the three cohorts. Following a multivariable ordinal logistical regression controlling for disposition to rehab over home (ORadj = 5.47, P = 0.045), the odds of longer LOS decreased by 39% for every 50-feet ambulated (P = 0.002). CONCLUSIONS Time to first ambulation independently increases the odds of earlier discharge, regardless of comorbidity burden and surgical determinants.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Hesham Mostafa Zakaria
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Lara W Massie
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Jaafar Elmenini
- Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI 48201 USA
| | - Mohamed Fakih
- Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI 48201 USA
| | - Belal Dakroub
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA.
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Rates and risk factors associated with 90-day readmission following cervical spine fusion surgery: analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Spine J 2020; 20:708-716. [PMID: 31958576 DOI: 10.1016/j.spinee.2020.01.003] [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: 10/10/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Hospital readmission rates are an increasingly important focus. Identifying patients at risk for readmission can help decrease those rates and thus decrease the overall cost of care. PURPOSE We sought to report the rates and the risk factors associated with 90-day hospital readmission after degenerative cervical spine surgery via either an anterior or posterior approach. STUDY DESIGN Retrospective review of prospectively collected database PATIENT SAMPLE: Michigan Spine Surgery Improvement Collaborative (MSSIC) registry OUTCOME MEASURES: Hospital readmission at 90 days METHODS: The MSSIC registry prospectively enrolls patients undergoing surgery for degenerative cervical spine disease. The registry was queried over a 4-year period to determine patient characteristics and risk factors associated with unplanned readmission at 90 days following degenerative cervical spine fusion surgery through either an anterior or posterior approach. Univariate and multivariate regression modeling was used to compare patient characteristics and odds of readmission. RESULTS Of 3,762 patients who underwent an anterior approach, 202 (5.4%) were readmitted within 90 days. Of 693 patients who underwent a posterior approach, 85 (12.3%) were readmitted within 90 days. Risk factors associated with increased likelihood of readmission after the anterior approach were male sex (odds ratio [OR] 1.56, confidence interval [CI] 1.10-2.20), American Society of Anesthesiologists class >2 (OR 1.70, CI 1.26-2.30), and increased length of stay (OR 1.10, CI 1.03-1.19). Factors associated with decreased likelihood of readmission after the anterior approach were being independently ambulatory preoperatively (OR 0.59, CI 0.46-0.76) and holding private insurance (OR 0.67, CI 0.50-0.90). A history of previous spine surgery was associated with increased risk of readmission after the posterior approach (OR 1.76, CI 1.37-2.25). Pain was the most common single reason cited for readmission after either approach (9% anterior, 13% posterior). After an anterior approach, common surgical reasons for readmission include new radicular findings (8%), dysphagia (6%), and surgical site hematoma (5%), whereas common medical reasons include pneumonia (7%), infection outside the surgical site (6%), and an electrolyte issue. After a posterior approach, common surgical reasons for readmission after 90 days include surgical site infection (8%) and new radicular findings (6%), whereas common medical reasons include infection outside the surgical site (9%), urinary tract infection (8%), and an abdominal issue (8%). CONCLUSIONS Analysis of a large multicentered, spine-specific database for elective cervical spine fusion surgery demonstrated an unplanned 90-day readmission rate of 5.4% for the anterior approach and 12.3% for the posterior approach. Factors associated with readmission for the anterior approach include male sex, American Society of Anesthesiologists class >2, increased length of stay, holding private insurance, and being ambulatory preoperatively. A history of previous spine surgery was associated with increased odds of readmission after the posterior approach.
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Park P, Nerenz DR, Aleem IS, Schultz LR, Bazydlo M, Xiao S, Zakaria HM, Schwalb JM, Abdulhak MM, Oppenlander ME, Chang VW. Risk Factors Associated With 90-Day Readmissions After Degenerative Lumbar Fusion: An Examination of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry. Neurosurgery 2020; 85:402-408. [PMID: 30113686 DOI: 10.1093/neuros/nyy358] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most studies have evaluated 30-d readmissions after lumbar fusion surgery. Evaluation of the 90-d period, however, allows a more comprehensive assessment of factors associated with readmission. OBJECTIVE To assess the reasons and risk factors for 90-d readmissions after lumbar fusion surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) registry is a prospective, multicenter, and spine-specific database of patients surgically treated for degenerative disease. MSSIC data were retrospectively analyzed for causes of readmission, and independent risk factors impacting readmission were found by multivariate logistic regression. RESULTS Of 10 204 patients who underwent lumbar fusion, 915 (9.0%) were readmitted within 90 d, most commonly for pain (17%), surgical site infection (16%), and radicular symptoms (10%). Risk factors associated with increased likelihood of readmission were other race (odds ratio [OR] 1.81, confidence interval [CI] 1.22-2.69), coronary artery disease (OR 1.57, CI 1.25-1.96), ≥4 fused levels (OR 1.41, CI 1.06-1.88), diabetes (OR 1.34, CI 1.10-1.63), and surgery length (OR 1.09, CI 1.03-1.16). Factors associated with decreased risk were discharge to home (OR 0.63, CI 0.51-0.78), private insurance (OR 0.79, CI 0.65-0.97), ambulation same day of surgery (OR 0.81, CI 0.67-0.97), and spondylolisthesis diagnosis (OR 0.82, CI 0.68-0.97). Of those readmitted, 385 (42.1%) patients underwent another surgery. CONCLUSION Ninety-day readmission occurred in 9.0% of patients, mainly for pain, wound infection, and radicular symptoms. Increased focus on postoperative pain may decrease readmissions. Among factors impacting the likelihood of 90-d readmission, early postoperative ambulation may be most easily modifiable. Optimization of preexisting medical conditions could also potentially decrease readmission risk.
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Affiliation(s)
- Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Ilyas S Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lonni R Schultz
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Michael Bazydlo
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Shujie Xiao
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Hesham M Zakaria
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | | | | | - Victor W Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
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Macki M, Alvi MA, Kerezoudis P, Xiao S, Schultz L, Bazydlo M, Bydon M, Park P, Chang V. Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. J Neurosurg Spine 2020; 32:373-382. [PMID: 31756702 DOI: 10.3171/2019.8.spine19260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As compensation transitions from a fee-for-service to pay-for-performance healthcare model, providers must prioritize patient-centered experiences. Here, the authors' primary aim was to identify predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) was queried for all lumbar operations at the 1- and 2-year follow-ups. Predictors of patients' postoperative contentment were identified per the North American Spine Surgery (NASS) Patient Satisfaction Index, wherein satisfied patients were assigned a score of 1 ("the treatment met my expectations") or 2 ("I did not improve as much as I had hoped, but I would undergo the same treatment for the same outcome") and unsatisfied patients were assigned a score of 3 ("I did not improve as much as I had hoped, and I would not undergo the same treatment for the same outcome") or 4 ("I am the same or worse than before treatment"). Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios (RRadj). RESULTS Among 5390 patients with a 1-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by higher body mass index (RRadj =1.07, p < 0.001), African American race compared to white (RRadj = 1.51, p < 0.001), education level less than high school graduation compared to a high school diploma or equivalent (RRadj = 1.25, p = 0.008), smoking (RRadj = 1.34, p < 0.001), daily preoperative opioid use > 6 months (RRadj = 1.22, p < 0.001), depression (RRadj = 1.31, p < 0.001), symptom duration > 1 year (RRadj = 1.32, p < 0.001), previous spine surgery (RRadj = 1.32, p < 0.001), and higher baseline numeric rating scale (NRS)-back pain score (RRadj = 1.04, p = 0.002). Conversely, an education level higher than high school graduation, independent ambulation (RRadj = 0.90, p = 0.039), higher baseline NRS-leg pain score (RRadj = 0.97, p = 0.013), and fusion surgery (RRadj = 0.88, p = 0.014) decreased dissatisfaction.Among 2776 patients with a 2-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by a non-white race, current smoking (RRadj = 1.26, p = 0.004), depression (RRadj = 1.34, p < 0.001), symptom duration > 1 year (RRadj = 1.47, p < 0.001), previous spine surgery (RRadj = 1.28, p < 0.001), and higher baseline NRS-back pain score (RRadj = 1.06, p = 0.003). Conversely, at least some college education (RRadj = 0.87, p = 0.035) decreased the risk of dissatisfaction. CONCLUSIONS Both comorbid conditions and socioeconomic circumstances must be considered in counseling patients on postoperative expectations. After race, symptom duration was the strongest predictor of dissatisfaction; thus, patient-centered measures must be prioritized. These findings should serve as a tool for surgeons to identify at-risk populations that may need more attention regarding effective communication and additional preoperative counseling to address potential barriers unique to their situation.
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Affiliation(s)
| | | | | | | | - Lonni Schultz
- 4Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Michael Bazydlo
- 4Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Paul Park
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Jiang F, Wilson JRF, Badhiwala JH, Santaguida C, Weber MH, Wilson JR, Fehlings MG. Quality and Safety Improvement in Spine Surgery. Global Spine J 2020; 10:17S-28S. [PMID: 31934516 PMCID: PMC6947676 DOI: 10.1177/2192568219839699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Review article. OBJECTIVES A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. METHODS A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. RESULTS Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. CONCLUSION Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.
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Affiliation(s)
- Fan Jiang
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jamie R. F. Wilson
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jetan H. Badhiwala
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T2S8, Canada.
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Zakaria HM, Lipphardt M, Bazydlo M, Xiao S, Schultz L, Chedid M, Abdulhak M, Schwalb JM, Nerenz D, Easton R, Chang V. The Preoperative Risks and Two-Year Sequelae of Postoperative Urinary Retention: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC). World Neurosurg 2020; 133:e619-e626. [DOI: 10.1016/j.wneu.2019.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
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Zakaria HM, Bazydlo M, Schultz L, Abdulhak M, Nerenz DR, Chang V, Schwalb JM. Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery 2019; 87:320-328. [DOI: 10.1093/neuros/nyz501] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/02/2019] [Indexed: 01/13/2023] Open
Abstract
Abstract
BACKGROUND
While consistently recommended, the significance of early ambulation after surgery has not been definitively studied.
OBJECTIVE
To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery.
METHODS
The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured.
RESULTS
A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P < .001), rehab discharge (odds ratio [OR] 0.52, P < .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P < .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0.
CONCLUSION
POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.
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Affiliation(s)
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | | | - David R Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
- Center for Health Policy and Health Services Research, Henry Ford Hospital, Detroit, Michigan
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
- Center for Health Policy and Health Services Research, Henry Ford Hospital, Detroit, Michigan
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Zakaria HM, Mansour TR, Telemi E, Asmaro K, Macki M, Bazydlo M, Schultz L, Nerenz DR, Abdulhak M, Schwalb JM, Park P, Chang V. Use of Patient Health Questionnaire-2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine 2019; 31:794-801. [PMID: 31443085 DOI: 10.3171/2019.6.spine1963] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire-2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion. METHODS Data from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is ≥ 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage. RESULTS Multivariate analysis was performed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion. CONCLUSIONS A multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an inability to return to work and worse satisfaction up to 2 years after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - David R Nerenz
- 3Department of Public Health Sciences, Henry Ford Hospital, Detroit; and
| | | | | | - Paul Park
- 4Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Zakaria HM, Mansour TR, Telemi E, Asmaro K, Bazydlo M, Schultz L, Nerenz DR, Abdulhak M, Khalil JG, Easton R, Schwalb JM, Park P, Chang V. The Association of Preoperative Opioid Usage With Patient-Reported Outcomes, Adverse Events, and Return to Work After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery 2019; 87:142-149. [DOI: 10.1093/neuros/nyz423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractBACKGROUNDIt is important to delineate the relationship between opioid use and spine surgery outcomes.OBJECTIVETo determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry.METHODSPreoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naïve (no usage), new users (<6 wk), short-term users (6 wk-3 mo), intermediate-term users (3-6 mo), and chronic users (>6 mo). Multivariate generalized estimating equation models were constructed.RESULTSAll comparisons were to opioid-naïve patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P = .001), 1 yr (RR 0.89, P = .001), and 2 yr (RR 0.89, P = .005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P < .001), 1 yr (RR 1.17, P < .001), and 2 yr (RR 1.19, P = .002). Short-term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P < .001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P = .004), 1 yr (RR 0.85, P < .001), and 2 yr (RR 0.80, P = .003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P < .001).CONCLUSIONIn lumbar fusion patients and when compared to opioid-naïve patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.
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Affiliation(s)
| | - Tarek R Mansour
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Edvin Telemi
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Karam Asmaro
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Michael Bazydlo
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | | | - Jad G Khalil
- Department of Orthopedic Surgery, Beaumont Health, Royal Oak, Michigan
- Beaumont Hospital, Royal Oak, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan
| | - Richard Easton
- Orthopedic Surgery Beaumont Health, Troy, Michigan
- Beaumont Hospital, Troy, William Beaumont School of Medicine, Oakland University, Troy, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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Zakaria HM, Mansour T, Telemi E, Xiao S, Bazydlo M, Schultz L, Nerenz D, Perez-Cruet M, Seyfried D, Aleem IS, Easton R, Schwalb JM, Abdulhak M, Chang V. Patient Demographic and Surgical Factors that Affect Completion of Patient-Reported Outcomes 90 Days and 1 Year After Spine Surgery: Analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC). World Neurosurg 2019; 130:e259-e271. [PMID: 31207366 DOI: 10.1016/j.wneu.2019.06.058] [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: 01/14/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Michigan Spine Surgery Improvement Collaborative is a statewide multicenter quality improvement registry. Because missing data can affect registry results, we used MSSIC to find demographic and surgical characteristics that affect the completion of patient-reported outcomes (PROs) at 90 days and 1 year. METHODS A total of 24,404 patients who had lumbar surgery (17,813 patients) or cervical surgery (6591 patients) were included. Multivariate logistic regression models of patient disease were constructed to identify risk factors for failure to complete scheduled PRO surveys. RESULTS Patients ≥65 years old and female patients were both more likely to respond at 90 days and 1 year. Increasing education was associated with greater response rate at 90 days and 1 year. Whites and African Americans had no differences in response rates. Calling provided the highest response rate at 90 days and 1 year. For cervical spine patients, only discharge to rehabilitation increased completion rates, at 90 days but not 1 year. For lumbar spine patients, spondylolisthesis or stenosis (vs. herniated disc) had a greater response rate at 1 year. Patients with leg (vs. back) pain had a greater response only at 1 year. Patients with multilevel surgery had an increased response at 1 year. Patients who underwent fusion were more likely to respond at 90 days, but not 1 year. Discharge to rehabilitation increased response at 90 days and 1 year. CONCLUSIONS A multivariate analysis from a multicenter prospective database identified surgical factors that affect PRO follow-up, up to 1 year. This information can be helpful for imputing missing PRO data and could be used to strengthen data derived from large prospective databases.
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Affiliation(s)
| | - Tarek Mansour
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Edvin Telemi
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Shujie Xiao
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael Bazydlo
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Donald Seyfried
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ilyas S Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopaedic Surgery, Beaumont Health, Oakland University-William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
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Zakaria HM, Bazydlo M, Schultz L, Pahuta MA, Schwalb JM, Park P, Aleem I, Nerenz DR, Chang V. Adverse events and their risk factors 90 days after cervical spine surgery: analysis from the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine 2019; 30:602-614. [PMID: 30771759 DOI: 10.3171/2018.10.spine18666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide, multicenter quality improvement initiative. Using MSSIC data, the authors sought to identify 90-day adverse events and their associated risk factors (RFs) after cervical spine surgery. METHODS A total of 8236 cervical spine surgery cases were analyzed. Multivariable generalized estimating equation regression models were constructed to identify RFs for adverse events; variables tested included age, sex, diabetes mellitus, disc herniation, foraminal stenosis, central stenosis, American Society of Anesthesiologists Physical Classification System (ASA) class > II, myelopathy, private insurance, anterior versus posterior approach, revision procedures, number of surgical levels, length of procedure, blood loss, preoperative ambulation, ambulation day of surgery, length of hospital stay, and discharge disposition. RESULTS Ninety days after cervical spine surgery, adverse events identified included radicular findings (11.6%), readmission (7.7%), dysphagia requiring dietary modification (feeding tube or nothing by mouth [NPO]) (6.4%), urinary retention (4.7%), urinary tract infection (2.2%), surgical site hematoma (1.1%), surgical site infection (0.9%), deep vein thrombosis (0.7%), pulmonary embolism (0.5%), neurogenic bowel/bladder (0.4%), myelopathy (0.4%), myocardial infarction (0.4%), wound dehiscence (0.2%), claudication (0.2%), and ileus (0.2%). RFs for dysphagia included anterior approach (p < 0.001), fusion procedures (p = 0.030), multiple-level surgery when considering anterior procedures only (p = 0.037), and surgery duration (p = 0.002). RFs for readmission included ASA class > II (p < 0.001), while preoperative ambulation (p = 0.001) and private insurance (p < 0.001) were protective. RFs for urinary retention included increasing age (p < 0.001) and male sex (p < 0.001), while anterior-approach surgery (p < 0.001), preoperative ambulation (p = 0.001), and ambulation day of surgery (p = 0.001) were protective. Preoperative ambulation (p = 0.010) and anterior approach (p = 0.002) were protective of radicular findings. CONCLUSIONS A multivariate analysis from a large, multicenter, prospective database identified the common adverse events after cervical spine surgery, along with their associated RFs. This information can lead to more informed surgeons and patients. The authors found that early mobilization after cervical spine surgery has the potential to significantly decrease adverse events.
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Affiliation(s)
| | | | | | | | | | | | - Ilyas Aleem
- 5Orthopedics, University of Michigan, Ann Arbor, Michigan
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Elsamadicy AA, Adogwa O, Ongele M, Sergesketter AR, Tarnasky A, Lubkin DE, Drysdale N, Cheng J, Bagley CA, Karikari IO. Preoperative Hemoglobin Level is Associated with Increased Health Care Use After Elective Spinal Fusion (≥3 Levels) in Elderly Male Patients with Spine Deformity. World Neurosurg 2018; 112:e348-e354. [DOI: 10.1016/j.wneu.2018.01.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/28/2022]
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Kim DH, Morales M, Tai R, Hergenroeder G, Shah C, O'Leary J, Harrison N, Edquilang G, Paisley E, Allen-McBride E, Murphy A, Smith J, Gormley W, Spielman A. Quality Programs in Neurosurgery: The Memorial Hermann/University of Texas Experience. Neurosurgery 2017; 80:S65-S74. [PMID: 28375495 DOI: 10.1093/neuros/nyw158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Indexed: 11/14/2022] Open
Abstract
The importance of outcome measures is steadily increasing due to the rise of "pay for performance" and the advent of population health. In 2007, a quality initiative was started due to poor performance on rankings such as the University Health Consortium (UHC) report card. Inherent to all such efforts are common challenges: how to engage the providers; how to gather and ensure the accuracy of the data; how to attribute results to individuals; how to ensure permanent improvements. After analysis, a strategy was developed that included an initial focus on 3 metrics (mortality, infection rates, and complications), leadership from practicing neurosurgeons, protocol development and adherence, and subspecialization. In addition, it was decided that the metrics would initially apply to attending physicians only, but that the entire team would need to be involved. Once the fundamental elements were established, the process could be extended to other measures and providers. To support this effort, special information system tools were developed and a support team formed. As the program matured, measured outcomes improved and more metrics were added (to a current total of 48). For example, UHC mortality ratios (observed over expected) decreased by 75%. Infection rates decreased 80%. The program now involves all trainee physicians, advanced practice providers, nurses, and other staff. This paper describes the design, implementation, and results of this effort, and provides a practical guide that may be useful to other groups undertaking similar initiatives.
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Affiliation(s)
- Dong H Kim
- Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas
| | | | - Rahil Tai
- Memorial Hermann Healthcare System, Houston, Texas
| | - Georgene Hergenroeder
- Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas
| | - Chirag Shah
- Memorial Hermann Healthcare System, Houston, Texas
| | - Joanna O'Leary
- Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas
| | | | | | | | | | | | - Justin Smith
- Clear Path Solutions, Jamaica Plain, Massachusetts
| | - William Gormley
- Department of Neuro-surgery, Harvard Medical School, Cam-bridge, Massachusetts
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Kim DH. “The Coming Changes in Neurosurgical Practice”: A Supplement to Neurosurgery. Neurosurgery 2017; 80:S1-S3. [DOI: 10.1093/neuros/nyw145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/13/2016] [Indexed: 11/14/2022] Open
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Abraham P, Rennert RC, Martin JR, Ciacci J, Taylor W, Resnick D, Kasper E, Chen CC. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials. Surg Neurol Int 2016; 7:38. [PMID: 27127703 PMCID: PMC4838923 DOI: 10.4103/2152-7806.180297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 12/17/2022] Open
Abstract
Low back pain (LBP) is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions.
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Affiliation(s)
- Peter Abraham
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Joel R Martin
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Joseph Ciacci
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - William Taylor
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Daniel Resnick
- Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
| | - Ekkehard Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Clark C Chen
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
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