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Kim J, Kim SW, Choi JK, Oh JK, Kim TH. Diagnostic trends of preoperative venous thromboembolism and its clinical implications in patients who underwent surgery for degenerative spinal diseases. Spine J 2023; 23:1838-1847. [PMID: 37704049 DOI: 10.1016/j.spinee.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND CONTEXT Although the risk of postoperative venous thromboembolism (VTE) in patients who undergo surgery for degenerative spinal disease has received attention, patients experiencing prolonged pain and disability while awaiting or considering surgery have not received adequate attention regarding the risk of VTE. PURPOSE To investigate the epidemiology of preoperative VTE in patients undergoing surgery for degenerative spinal disease. DESIGN Retrospective cohort study using a nationwide database. PATIENT SAMPLE Patients who underwent surgery for degenerative spinal disease. OUTCOME MEASURES Preoperative occurrence of VTE. METHODS Data from 2014 to 2018 were obtained from the Korean National Health Insurance claims database. The occurrence of preoperative VTE within a 1-year period divided into 12 time intervals of 30 days each was investigated. The patients were categorized into two groups based on the presence of preoperative VTE. Multivariable logistic regression analysis was conducted to identify the factors associated with preoperative VTE. To validate the relationship between degenerative spinal disease and preoperative VTE, the diagnostic trends of preoperative VTE were analyzed in accordance with the identified risk factors. RESULTS The overall incidence of preoperative VTE was 50 per 10,000 individuals. Multivariable analysis revealed that VTE occurred more frequently in older patients with specific medical comorbidities, particularly in those with a lumbar spinal lesion accompanied by arthritis of the hip, knee, or shoulder. We also found that the incidence rates of preoperative VTE, as well as the gradient of their increase, began to rise approximately 2 to 3 months prior to the index surgery, peaking just before the index surgery. This diagnostic trend was consistently observed in all patients irrespective of the presence of other risk factors. CONCLUSIONS The incidence of preoperative VTE in patients with degenerative spinal disease exhibited a sharp increase immediately before surgery, with similar rates to those of postoperative VTE. Clinicians managing patients with degenerative spinal disease should be vigilant for preoperative as well as postoperative VTE.
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Affiliation(s)
- Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea
| | - Seok Woo Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Jin Kwan Choi
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Jae-Keun Oh
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Tae-Hwan Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
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Moskven E, Banaszek D, Sayre EC, Gara A, Bryce E, Wong T, Ailon T, Charest-Morin R, Dea N, Dvorak MF, Fisher CG, Kwon BK, Paquette S, Street JT. Effectiveness of prophylactic intranasal photodynamic disinfection therapy and chlorhexidine gluconate body wipes for surgical site infection prophylaxis in adult spine surgery. Can J Surg 2023; 66:E550-E560. [PMID: 37967971 PMCID: PMC10664804 DOI: 10.1503/cjs.016922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Current measures to prevent spinal surgical site infection (SSI) lack compliance and lead to antimicrobial resistance. We aimed to examine the effectiveness of bundled preoperative intranasal photodynamic disinfection therapy (nPDT) and chlorhexidine gluconate (CHG) body wipes in the prophylaxis of spine SSIs in adults, as well as determine our institutional savings attributable to the use of this strategy and identify adverse events reported with nPDT-CHG. METHODS We performed a 14-year prospective observational interrupted time-series study in adult (age > 18 yr) patients undergoing emergent or elective spine surgery with 3 time-specific cohorts: before rollout of our institution's nPDT-CHG program (2006-2010), during rollout (2011-2014) and after rollout (2015-2019). We used unadjusted bivariate analysis to test for temporal changes across patient and surgical variables, and segmented regression to estimate the effect of nPDT-CHG on the annual SSI incidence rates per period. We used 2 models to estimate the cost of nPDT-CHG to prevent 1 additional SSI per year and the annual cumulative cost savings through SSI prevention. RESULTS Over the study period, 13 493 patients (mean 964 per year) underwent elective or emergent spine surgery. From 2006 to 2019, the mean age, mean Charlson Comorbidity Index (CCI) score and mean Spine Surgical Invasiveness Index (SSII) score increased from 48.4 to 58.1 years, from 1.7 to 2.6, and from 15.4 to 20.5, respectively (p < 0.001). Unadjusted analysis confirmed a significant decrease in the annual number (74.6 to 26.8) and incidence (7.98% to 2.67%) of SSIs with nPDT-CHG (p < 0.001). After adjustment for mean age, mean CCI score and mean SSII score, segmented regression showed an absolute reduction in the annual SSI incidence rate of 3.36% per year (p < 0.001). The estimated annual cost to prevent 1 additional SSI per year was about $1350-$1650, and the estimated annual cumulative cost savings were $2 484 856-$2 495 016. No adverse events were reported with nPDT-CHG. CONCLUSION Preoperative nPDT-CHG administration is an effective prophylactic strategy for spinal SSIs, with significant cost savings. Given its rapid action, minimal risk of antimicrobial resistance, broad-spectrum activity and high compliance rate, preoperative nPDT-CHG decolonization should be the standard of care for all patients undergoing emergent or elective spine surgery.
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Affiliation(s)
- Eryck Moskven
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Daniel Banaszek
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Eric C Sayre
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Aleksandra Gara
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Elizabeth Bryce
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Titus Wong
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Tamir Ailon
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Raphaële Charest-Morin
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Nicolas Dea
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Marcel F Dvorak
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Charles G Fisher
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Brian K Kwon
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - Scott Paquette
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
| | - John T Street
- From the Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC (Moskven, Banaszek, Ailon, Charest-Morin, Dea, Dvorak, Fisher, Kwon, Paquette, Street); Arthritis Research Canada, Richmond, BC (Sayre); the Department of Infection Control, Quality and Patient Safety, Vancouver General Hospital, Vancouver, BC (Gara); and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC (Bryce, Wong)
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Liu X, Hou Y, Shi H, Zhao T, Shi H, Shi J, Shi G. A meta-analysis of risk factors for non-superficial surgical site infection following spinal surgery. BMC Surg 2023; 23:129. [PMID: 37194060 DOI: 10.1186/s12893-023-02026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is the most common complications in spinal surgery. In SSI, non-superficial surgical site infections are more likely to result in poor clinical outcomes. It has been reported that there are multiple factors contributing to postoperative non-superficial SSI, but still remains controversial. Therefore, the aim of this meta-analysis is to investigate the potential risk factors for non-superficial SSI following spinal surgery. METHODS A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until September 2022. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction and quality evaluation of the obtained literature. The Newcastle-Ottawa Scale (NOS) score was used for quality evaluation, and meta-analysis was performed by STATA 14.0 software. RESULTS A total of 3660 relevant articles were initially identified and 11 articles were finally included in this study for data extraction and meta-analysis. The results of meta-analysis showed that the diabetes mellitus, obesity, using steroids, drainage time and operative time were related to the non-superficial SSI. The OR values (95%CI) of these five factors were 1.527 (1.196, 1.949); 1.314 (1.128, 1.532); 1.687(1.317, 2.162); 1.531(1.313, 1.786) and 4.255(2.612, 6.932) respectively. CONCLUSIONS Diabetes mellitus, obesity, using steroids, drainage time and operative time are the current risk factors for non-superficial SSI following spinal surgery. In this study, operative time is the most important risk factor resulting in postoperative SSI.
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Affiliation(s)
- Xiaowen Liu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Hongyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Tianyi Zhao
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Haoyang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Guodong Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China.
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Ren R, Dominy C, Bueno B, Pasik S, Markowitz J, Yeshoua B, Cho B, Arvind V, Valliani AA, Kim J, Cho S. Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion. Neurospine 2023; 20:290-300. [PMID: 37016876 PMCID: PMC10080455 DOI: 10.14245/ns.2244816.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/10/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: The “weekend effect” occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF.Methods: All ECSF patients > 18 years were retrospectively identified from the 2016–2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates.Results: Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism.Conclusion: Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.
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Affiliation(s)
- Renee Ren
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Calista Dominy
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Bueno
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Pasik
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Markowitz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brandon Yeshoua
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varun Arvind
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aly A. Valliani
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corresponding Author Samuel Cho Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
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