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Moody D, Showery J, Lador R, Hernandez I, Prasarn ML. Is Routine Use of External Spinal Orthoses Necessary After Operative Stabilization of Cervical Spine Injuries? Clin Spine Surg 2024; 37:178-181. [PMID: 38637927 DOI: 10.1097/bsd.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Retrospective Review. OBJECTIVE The purpose of this study is to evaluate the efficacy of postoperative cervical orthoses to prevent fixation failure and loss of reduction after operative treatment of cervical spine fractures. SUMMARY OF BACKGROUND DATA While cervical orthoses are most times tolerated in trauma patients, it is not clear that postoperative bracing is effective at reducing the rate of fixation failure or nonunion in this patient population. Cervical collars may delay rehabilitation, increase the risk of dysphagia and aspiration, and can contribute to skin breakdown. METHODS All patients who underwent operative stabilization for cervical spine injuries at a single institution between January 2015 and August 2019 were identified through the institutional Research Electronic Data Capture (REDcap) database. Patient data, including cervical spine injury, surgery, post-operative orthosis use, and secondary surgeries for loss of reduction or infection, were recorded for all patients meeting the inclusion criteria. The primary outcome was the loss of reduction or failure of fixation, requiring revision surgery. Statistical analysis was performed using Jamovi (Version 1.1) statistical software. RESULTS In all, 201 patients meeting inclusion and exclusion criteria were identified within the study period. Overall, 133 (66.2%) patients were treated with a cervical orthosis postoperatively and 68 (33.8%) patients were allowed to mobilize as tolerated without a cervical orthosis. Fixation failure and loss of reduction occurred in 4 (1.99%) patients. Of these 4, three patients were treated with a cervical orthosis postoperatively. There was no significant difference in the risk of instrumentation failure between patients in the postoperative orthosis and no orthosis groups ( P =0.706). CONCLUSION The use of cervical orthoses after operative stabilization of cervical spine injuries remains controversial. There was no statistically significant difference in hardware failure or loss of fixation between patients treated in cervical orthoses postoperatively and those who were not.
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Affiliation(s)
| | | | - Ran Lador
- University of Texas Health Science Center
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2
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Barbosa TP, Raposo AR, Cunha PD, Cruz Oliveira N, Lobarinhas A, Varanda P, Direito-Santos B. Rehabilitation after cervical and lumbar spine surgery. EFORT Open Rev 2023; 8:626-638. [PMID: 37526242 PMCID: PMC10441252 DOI: 10.1530/eor-23-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
The total number of spine surgeries is increasing, with a variable percentage of patients remaining symptomatic and functionally impaired after surgery. Rehabilitation has been widely recommended, although its effects remain unclear due to lack of research on this matter. The aim of this comprehensive review is to resume the most recent evidence regarding postoperative rehabilitation after spine surgery and make recommendations. The effectiveness of cervical spine surgery on the outcomes is moderate to good, so most physiatrists and surgeons agree that patients benefit from a structured postoperative rehabilitation protocol and despite best timing to start rehabilitation is still unknown, most programs start 4-6 weeks after surgery. Lumbar disc surgery has shown success rates between 78% and 95% after 2 years of follow-up. Postoperative rehabilitation is widely recommended, although its absolute indication has not yet been proven. Patients should be educated to start their own postoperative rehabilitation immediately after surgery until they enroll on a rehabilitation program usually 4-6 weeks post-intervention. The rate of lumbar interbody fusion surgery is increasing, particularly in patients over 60 years, although studies report that 25-45% of patients remain symptomatic. Despite no standardized rehabilitation program has been defined, patients benefit from a cognitive-behavioral physical therapy starting immediately after surgery with psychological intervention, patient education and gradual mobilization. Formal spine rehabilitation should begin at 2-3 months postoperatively. Rehabilitation has benefits on the recovery of patients after spine surgery, but further investigation is needed to achieve a standardized rehabilitation approach.
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Cerillo JL, Becsey AN, Sanghadia CP, Root KT, Lucke-Wold B. Spine Bracing: When to Utilize-A Narrative Review. BIOMECHANICS (BASEL, SWITZERLAND) 2023; 3:136-154. [PMID: 36949902 PMCID: PMC10029751 DOI: 10.3390/biomechanics3010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient's spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians' understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.
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Affiliation(s)
- John L. Cerillo
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL 33759, USA
| | | | - Chai P. Sanghadia
- Department of Molecular and Cellular Biology, University of Arizona, Tucson, AZ 85721, USA
| | - Kevin T. Root
- College of Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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Nourian SMA, Mozafari S, Farzinnia S, Saeidi M, Bahrami M. Evaluation of postoperative bracing on unstable traumatic lumbar fractures after pedicle screw fixation. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:168-174. [PMID: 36160671 PMCID: PMC9490152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Fractures of the thoracolumbar and lumbar regions are very important. There is still debate on the use of braces after surgical operations. The current study aims to evaluate and report the outcomes of postoperative bracing following pedicle screw fixation in patients with thoracolumbar and lumbar fractures in Iran. METHODS This is a clinical trial performed from 2012 to 2022 on 144 patients diagnosed with lumbar and thoracolumbar fractures. Demographic data of patients including age and gender were obtained. Patients' fractures were classified as Frankel (A to E) in terms of clinical and neurological manifestations. Patient's quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). All patients underwent surgical fixation of the fracture. Patients were then randomized into two groups using Random Allocation Software. The first group received post-operation bracing and the second group did not receive braces. Thus, radiographic and clinical evaluation data of 1, 3, and 12 months after surgery were used to determine bone fusion. RESULTS The most common mechanisms of trauma included falling from a height in 99 patients (68.7%), vehicle accidents in 39 patients (27.1%), and the most common fracture sites were the L1 vertebrae in 73 patients (50.7%), 111 patients (77.1%) had burst fractures, and 105 patients (72.3%) had no neurological defects (Frankel E). At the beginning of the study, there were no significant differences between the two groups regarding the mentioned data, patients' QOL, and pain severity. All patients (100%) had early mobilization. Most patients (85.4%) did not report persistent back pain 12 months after surgeries. 90.2% returned to their daily activities and all patients (100%) had full fusion based on radiologic data. The QOL and pain severity of patients improved significantly compared to baseline (P < 0.001 for both). CONCLUSION The use or non-use of braces did not affect the treatment results. As a result, patients who have received pedicle screw fixation for unstable thoracolumbar fractures do not require braces in the postoperative period.
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Affiliation(s)
| | - Safura Mozafari
- Department of Emergency Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Saeed Farzinnia
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Milad Saeidi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mahshid Bahrami
- Assistant Professor, Department of Radiology, Isfahan University of Medical SciencesIsfahan, Iran
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Lin PI, Chen TH, Chung HH, Su TM, Ma CC, Ou TC. Factors Associated with Postoperative Rehospitalization in Patients with Cervical Disc Herniation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031687. [PMID: 35162713 PMCID: PMC8835259 DOI: 10.3390/ijerph19031687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023]
Abstract
Cervical disc herniation (CDH) is a prevalent disease because of the poor living habits of and great pressure in modern society. Patients experience hand numbness, neck stiffness, soreness, and weakness due to neck nerve root compression, which leads to a gradual increase of neurosurgery outpatients. Although poor posture by the overuse of computers is possibly the origin of CDH, analysis of related factors causing the rehospitalization for CDH patients after surgery in Taiwan is not commonly reported. Thus, the present study focused on the demographics and surgery-related treatment on the relevance of rehospitalization for CDH patients after surgery. The design of the study was retrospective, and we collected data by medical record review, which was derived from the inpatient surgery data of patients at a medical center in southern Taiwan. The study lasted two years from 1 January 2017 to 31 December 2018, and a total of 248 patients underwent surgery for intervertebral disc protrusion in the neck. The retrospective study adopted narrative statistics, the chi-squared test, and binary logistic regression analysis to identify factors affecting postoperative rehospitalization. Among 248 postoperative patients with intervertebral disc protrusion, 178 underwent cervical fusion surgery, and 32 were rehospitalized after surgery for one-year follow up, accounting for an overall prevalence rate of 12.9%. There were no significant differences in sex, age, occupation, hypertension, anterior cervical discectomy and fusion, artificial disc replacement, hybrid surgery, and postoperative cervical coil use (p > 0.05). The results of binary logistic regression analysis showed statistically significant differences in abnormal body mass index (p = 0.0187, 95% CI = 1.238-10.499), diabetes (p = 0.0137, 95% CI = 1.288-9.224) and cervical vertebral surgery hospital days (p = 0.0004, 95% CI = 1.028-1.102), predicting the outcome of rehospitalization for CDH patients after surgery. The above results showed that abnormal body mass index, diabetes, and cervical vertebral surgery hospitalization days impacted rehospitalization in CDH patients after surgery. Thus, to prevent diabetes, weight control must be monitored, and maintaining correct posture can reduce CDH and decrease the rate of rehospitalization after surgery, which provides a critical reference for hospital managers and clinical staff.
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Affiliation(s)
- Pei-I Lin
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Tai-Hsiang Chen
- Administrative Office, Weihope Clinic, Kaohsiung 804, Taiwan;
- College of Management, Yuan Ze University, Taoyuan 320, Taiwan
| | - Hsien-Hui Chung
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County 907, Taiwan;
| | - Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - Chen-Chung Ma
- Department of Healthcare Administration, I-Shou University, Kaohsiung 824, Taiwan
- Correspondence: (C.-C.M.); (T.-C.O.); Tel.: +886-7615-1100 (ext. 7602) (C.-C.M.); +886-2263-0588 (ext. 6091) (T.-C.O.)
| | - Tzu-Chi Ou
- Department of Medical Education, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei 236, Taiwan
- Correspondence: (C.-C.M.); (T.-C.O.); Tel.: +886-7615-1100 (ext. 7602) (C.-C.M.); +886-2263-0588 (ext. 6091) (T.-C.O.)
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6
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Glauser G, Winter E, Caplan IF, Goodrich S, McClintock SD, Srinivas SK, Malhotra NR. Composite Score for Outcome Prediction in Gynecologic Surgery Patients. J Healthc Qual 2021; 43:163-173. [PMID: 32134807 DOI: 10.1097/jhq.0000000000000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The LACE+ index is a well-studied metric that compacts patient data in an effort to assess readmission risk. PURPOSE Assess the capacity of LACE+ scores for predicting short-term undesirable outcomes in an entire single-center population of patients undergoing gynecologic surgery. IMPORTANCE AND RELEVANCE TO HEALTHCARE QUALITY Proactive identification of high-risk patients, with tools such as the LACE+ index, may serve as the first step toward appropriately engaging resources for reducing readmissions. METHODS This study was a retrospective analysis that used coarsened exact matching. All gynecologic surgery cases over 2 years within a single health system (n = 12,225) were included for analysis. Outcomes of interest were unplanned readmission, emergency room (ER) evaluation, and return to surgery. Composite LACE+ scores were separated into quartiles and matched. For outcome comparison, matched patients were assessed by LACE+ quartile, using Q4 as the reference group. RESULTS Increasing LACE+ score reflected a higher rate of readmission (p = .003, p = .001) and visits to the ER at 30 postoperative days (p < .001). CONCLUSION The data presented here suggest that LACE+ index is a viable metric for patient outcome prediction following gynecologic surgery.
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Sinha S, Caplan I, Schuster J, Piazza M, Glauser G, Sharma N, Welch WC, Osiemo B, Mcclintock S, Ozturk AK, Malhotra NR. Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery. Asian J Neurosurg 2020; 15:333-337. [PMID: 32656128 PMCID: PMC7335149 DOI: 10.4103/ajns.ajns_35_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. Methods Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing at a three-hospital urban academic medical center (2013-2017) were undertaken (n = 906). Patient demographics and comorbidities were analyzed. Test of independence, Mann-Whitney-Wilcoxon test, and logistic regression were used to assess differences in length of stay (LOS), discharge disposition/need for postacute care, quality-adjusted life year (QALY), surgical site infection (SSI), hospital cost, total cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results Among the study population, 863 patients were braced and 43 were not braced. No difference was seen between the two groups in short-term outcomes from surgery including LOS (P = 0.836), discharge disposition (P = 0.226), readmission (P = 1.000), ER visits (P = 0.281), SSI (P = 1.000), and QALY gain (P = 0.319). However, the braced group incurred a significantly higher direct hospital cost (median increase of 41.43%, P < 0.001) compared to the unbraced cohort (bracing cost excluded). There was no difference in graft type (P = 0.145) or comorbidities (P = 0.20-1.00) such as obesity (P = 1.000), smoking (P = 1.000), chronic obstructive pulmonary disease (P = 1.000), hypertension (P = 0.805), coronary artery disease (P = 1.000), congestive heart failure (P = 1.000), and total number of comorbidities (P = 0.228). Conclusion Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes but will reduce cost.
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Affiliation(s)
- Saurabh Sinha
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ian Caplan
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - James Schuster
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew Piazza
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Departments of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nikhil Sharma
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Charles Welch
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Benjamin Osiemo
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.,Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA, USA
| | - Scott Mcclintock
- Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA, USA
| | - Ali Kemal Ozturk
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Neil Rainer Malhotra
- Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Departments of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA, USA
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Caplan IF, Sinha S, Osiemo B, McClintock SD, Schuster JM, Smith H, Glauser G, Sharma N, Ozturk AK, Ali ZS, Malhotra NR. The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery. Int J Spine Surg 2020; 14:151-157. [PMID: 32355619 DOI: 10.14444/7022] [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] [Indexed: 11/20/2022] Open
Abstract
Background Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Here, we study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in multilevel ACDF. Methods Retrospective cohort analyses of all consecutive patients undergoing multilevel ACDF with or without bracing from 2013 to 2017 was undertaken (n = 616). Patient demographics and comorbidities were analyzed. Tests of independence and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility [ARF], or skilled nursing facility [SNF]), quality-adjusted life year (QALY), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results Amongst the study population, 553 were braced and 63 were not braced. There was no difference in comorbidities (P > .05) such as obesity, smoking, chronic obstructive pulmonary disease, hypertension, coronary artery disease, congestive heart failure, and problem list number. A significant difference in American Society of Anesthesiologists (ASA) score was found, with more ASA 2 patients in the braced cohort and more ASA 3 patients in the unbraced cohort (P = .007). LOS was extended for the unbraced group (median 156.9 ± 211.4 versus 86.67 ± 130.6 h, P = .003), and ER visits within 30 days were 0.21 times less likely in the braced group (P = .006). There was no difference in readmission (P = .181), QALY gain (P = .968), and direct costs (P = .689). Conclusion Bracing following multilevel cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner.
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Affiliation(s)
- Ian F Caplan
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Saurabh Sinha
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania.,West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
| | - Scott D McClintock
- West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
| | - James M Schuster
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Harvey Smith
- University of Pennsylvania Perelman School of Medicine, Department of Orthopedic Surgery, Philadelphia, Pennsylvania
| | - Gregory Glauser
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Nikhil Sharma
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Ali K Ozturk
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Zarina S Ali
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania.,Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, Pennsylvania
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Glauser G, Osiemo B, Goodrich S, McClintock SD, Weber KL, Levin LS, Malhotra NR. Assessment of Short-Term Patient Outcomes Following Overlapping Orthopaedic Surgery at a Large Academic Medical Center. J Bone Joint Surg Am 2020; 102:654-663. [PMID: 32058352 DOI: 10.2106/jbjs.19.00554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Overlapping surgery is a long-standing practice that has not been well studied. The aim of this study was to assess whether overlapping surgery is associated with untoward outcomes for orthopaedic patients. METHODS Coarsened exact matching was used to assess the impact of overlap on outcomes among elective orthopaedic surgical interventions (n = 18,316) over 2 years (2014 and 2015) at 1 health-care system. Overlap was categorized as any overlap, and subcategories of exclusively beginning overlap and exclusively end overlap. Study subjects were matched on the Charlson comorbidity index score, duration of surgery, surgical costs, body mass index, length of stay, payer, and race, among others. Serious unanticipated events were studied. RESULTS A total of 3,395 patients had any overlap and were matched (a match rate of 90.8% of 3,738). For beginning and end overlap, matched groups were created, with a match rate of 95.2% of 1043 and 94.7% of 863, respectively. Among matched patients, any overlap did not predict an unanticipated return to surgery at 30 days (8.2% for any overlap and 8.3% for no overlap; p = 0.922) or 90 days (14.1% and 14.1%, respectively; p = 1.000). Patients who had surgery with any overlap demonstrated no difference compared with controls with respect to reoperation, readmission, or emergency room (ER) visits at 30 or 90 days (a reoperation rate of 3.1% and 3.2%, respectively [p = 0.884] at 30 days and 4.2% and 3.5% [p = 0.173] at 90 days; a readmission rate of 10.3% and 11.0% [p = 0.352] at 30 days and 5.5% and 5.2% [p = 0.570] at 90 days; and an ER visit rate of 5.2% and 4.6% [p = 0.276] at 30 days and 4.8% and 4.3% [p = 0.304] at 90 days). Patients with surgical overlap showed reduced mortality compared with controls during follow-up (1.8% and 2.6%, respectively; p = 0.029). Patients with beginning and/or end overlap had a similar lack of association with serious unanticipated events; however, patients with end overlap showed an increased unexpected rate of return to the operating room after reoperation at 90 days (13.3% versus 9.7%; p = 0.015). CONCLUSIONS Nonconcurrent overlapping surgery was not associated with adverse outcomes in a large, matched orthopaedic surgery population across 1 academic health system. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gregory Glauser
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Stephen Goodrich
- McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Kristy L Weber
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L Scott Levin
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Glauser G, Goodrich S, McClintock SD, Dimentberg R, Guzzo TJ, Malhotra NR. Evaluation of Short-term Outcomes Following Overlapping Urologic Surgery at a Large Academic Medical Center. Urology 2020; 138:30-36. [DOI: 10.1016/j.urology.2019.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
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Glauser G, Ali ZS, Gardiner D, Ramayya AG, Pessoa R, Grady MS, Welch WC, Zager EL, Sim E, Haughey V, Wells B, Restuccia M, Tait G, Fala G, Malhotra NR. Assessing the utility of an IoS application in the perioperative care of spine surgery patients: the NeuroPath Pilot study. Mhealth 2019; 5:40. [PMID: 31620467 PMCID: PMC6789206 DOI: 10.21037/mhealth.2019.09.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/23/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In an attempt to improve care while decreasing costs and postoperative pain, we developed a novel IoS mobile health application, NeuroPath. The objective of this innovative app is to integrate enhanced recovery after surgery (ERAS) principles, patient education, and real-time pain and activity monitoring in a home setting with unencumbered two-way communication. METHODS The NeuroPath application was built over 18 months, with support from Apple, Medable, the Department of Information-Technology and the Department of Neurosurgery. Target areas addressed by NeuroPath include patient prep for surgery, perioperative risk mitigation, activity monitoring, wound care, and opioid use management. These target areas are monitored through a provider app, which is downloaded to the care providers IPad Mini. The provider app permits real time viewing of wound healing (patient incision photographs), activity levels, pain levels, and narcotic usage. Participants are given a daily To-Do list, via the Care Card section of the interface. The To-Do list presents the patient with specific tasks for exercise, instructions to wash incision area, pre-operative instructions, directions for discussing medication with care team, among other patient specific recommendations. RESULTS Of the 30 patients enrolled in the pilot study, there was a range of activity on the app. Patients with high involvement in the app logged in nearly every day from a week pre-op to >45 days post-op. Data for patients that utilized the app and uploaded regularly show trends of appropriately healing wounds, decreasing levels of pain, increasing step counts, and discontinuation of narcotics. CONCLUSIONS This pilot study of the NeuroPath app demonstrates its potential utility for improving quality of patient care without increased costs. Participants who regularly used the app showed consistent improvement throughout the post-operative recovery period (increasing ambulation, decreasing pain and guided reduction in narcotic usage).
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zarina S. Ali
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Gardiner
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ashwin G. Ramayya
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Pessoa
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - M. Sean Grady
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - William C. Welch
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eric L. Zager
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Esther Sim
- Corporate Information Services, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Virginia Haughey
- Corporate Information Services, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Brian Wells
- Corporate Information Services, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Michael Restuccia
- Corporate Information Services, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Gordon Tait
- Corporate Information Services, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Glenn Fala
- Corporate Information Services, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Neil R. Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
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