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Pernik MN, Hicks WH, Akbik OS, Nguyen ML, Luu I, Traylor JI, Deme PR, Dosselman LJ, Hall K, Wingfield SA, Aoun SG, Bagley CA. Response to the Letter to the Editor on "Psoas Muscle Index as a Predictor of Perioperative Outcomes in Geriatric Patients Undergoing Spine Surgery". Global Spine J 2024; 14:1450-1451. [PMID: 37939318 DOI: 10.1177/21925682231214658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Affiliation(s)
- Mark N Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - William H Hicks
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Omar S Akbik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Madelina L Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Ivan Luu
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Jeffrey I Traylor
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Palvasha R Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Luke J Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Sarah A Wingfield
- Geriatrics Division, Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX, USA
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, TX, USA
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Pernik MN, Hicks WH, Akbik OS, Nguyen ML, Luu I, Traylor JI, Deme PR, Dosselman LJ, Hall K, Wingfield SA, Aoun SG, Bagley CA. Psoas Muscle Index as a Predictor of Perioperative Outcomes in Geriatric Patients Undergoing Spine Surgery. Global Spine J 2023; 13:2016-2024. [PMID: 35034500 PMCID: PMC10556882 DOI: 10.1177/21925682211072626] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Single-center retrospective study. OBJECTIVE The objective of this study was to evaluate the association of psoas muscle mass defined sarcopenia with perioperative outcomes in geriatric patients undergoing elective spine surgery. METHODS We included geriatric patients undergoing thoracolumbar spinal surgery. Total psoas surface area (TPA) was measured on preoperative axial computerized tomography or magnetic resonance imaging at the L3 vertebra and normalized to the L3 vertebral body area. Patients were divided into quartiles by normalized TPA, and the fourth quartile (Q4) was compared to quartiles 1-3 (Q1-3). Outcomes included perioperative transfusions, length of stay (LOS), delirium, pseudoarthrosis, readmission, discharge disposition, revision surgery, and mortality. RESULTS Of the patients who met inclusion criteria (n = 196), the average age was 73.4 y, with 48 patients in Q4 and 148 patients in Q1-3. Q4 normalized TPA cut-off was <1.05. Differences in Q4 preoperative characteristics included significantly lower body mass index, baseline creatinine, and a greater proportion of females (Table 1). Q4 patients received significantly more postoperative red blood cell and platelet transfusions and had longer ICU LOS (P < .05; Table 2). There was no difference in intraoperative transfusion volumes, delirium, initiation of walking, discharge disposition, readmission, pseudoarthrosis, or revision surgery (Tables 2 and 3). Mortality during follow-up was higher in Q4 but was not statistically significant (P = .075). CONCLUSION Preoperative TPA in geriatric patients undergoing elective spine surgery is associated with increased need for intensive care and postoperative blood transfusion. Preoperative normalized TPA is a convenient measurement and could be included in geriatric preoperative risk assessment algorithms.
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Affiliation(s)
- Mark N. Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - William H. Hicks
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Omar S. Akbik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Madelina L. Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Ivan Luu
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Palvasha R. Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Luke J. Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Sarah A. Wingfield
- Department of Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, TX, USA
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Berger M, Eleswarpu SS, Cooter M, Ray AM, Wingfield SA, Heflin MT, Bengali S, Udani AD. Developing a Real-Time Electroencephalogram-Guided Anesthesia-Management Curriculum for Educating Residents: A Single-Center Randomized Controlled Trial. Anesth Analg 2022; 134:159-170. [PMID: 34709008 PMCID: PMC8678191 DOI: 10.1213/ane.0000000000005677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time series data and the corresponding spectral information for intraoperative anesthetic titration, or what effect this might have on outcomes. METHODS We developed an electronic learning curriculum (ELC) that covered EEG spectrogram interpretation and its use in anesthetic titration. Anesthesiology residents at a single academic center were randomized to receive this ELC and given spectrogram monitors for intraoperative use versus standard residency curriculum alone without intraoperative spectrogram monitors. We hypothesized that this intervention would result in lower inhaled anesthetic administration (measured by age-adjusted total minimal alveolar concentration [MAC] fraction and age-adjusted minimal alveolar concentration [aaMAC]) to patients ≥60 old during the postintervention period (the primary study outcome). To study this effect and to determine whether the 2 groups were administering similar anesthetic doses pre- versus postintervention, we compared aaMAC between control versus intervention group residents both before and after the intervention. To measure efficacy in the postintervention period, we included only those cases in the intervention group when the monitor was actually used. Multivariable linear mixed-effects modeling was performed for aaMAC fraction and hospital length of stay (LOS; a non-prespecified secondary outcome), with a random effect for individual resident. A multivariable linear mixed-effects model was also used in a sensitivity analysis to determine if there was a group (intervention versus control group) by time period (post- versus preintervention) interaction for aaMAC. Resident EEG knowledge difference (a prespecified secondary outcome) was compared with a 2-sided 2-group paired t test. RESULTS Postintervention, there was no significant aaMAC difference in patients cared for by the ELC group (n = 159 patients) versus control group (N = 325 patients; aaMAC difference = -0.03; 95% confidence interval [CI], -0.09 to 0.03; P =.32). In a multivariable mixed model, the interaction of time period (post- versus preintervention) and group (intervention versus control) led to a nonsignificant reduction of -0.05 aaMAC (95% CI, -0.11 to 0.01; P = .102). ELC group residents (N = 19) showed a greater increase in EEG knowledge test scores than control residents (N = 20) from before to after the ELC intervention (6-point increase; 95% CI, 3.50-8.88; P < .001). Patients cared for by the ELC group versus control group had a reduced hospital LOS (median, 2.48 vs 3.86 days, respectively; P = .024). CONCLUSIONS Although there was no effect on mean aaMAC, these results demonstrate that this EEG-ELC intervention increased resident knowledge and raise the possibility that it may reduce hospital LOS.
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Affiliation(s)
| | | | - Mary Cooter
- Duke University Medical Center, Durham, NC, USA
| | - Anna M. Ray
- Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Shahrukh Bengali
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Pernik MN, Deme PR, Nguyen ML, Aoun SG, Adogwa O, Hall K, Stewart NA, Dosselman LJ, El Tecle NE, McDonald SR, Bagley CA, Wingfield SA. Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium. J Am Geriatr Soc 2020; 69:1240-1248. [PMID: 33382460 DOI: 10.1111/jgs.17006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measures is variable in perioperative care. The aim of our study was to assess the impact of our Perioperative Optimization of Senior Health Program (UTSW POSH) on postoperative delirium in patients undergoing elective spine surgery. STUDY DESIGN The UTSW POSH program is an interdisciplinary perioperative initiative involving geriatrics, surgery, and anesthesiology to improve care for high-risk geriatric patients undergoing elective spine surgery. Preoperatively, enrolled patients (n = 147) were referred for a geriatric assessment and optimization for surgery. Postoperatively, patients were co-managed by the primary surgical team and the geriatrics consult service. UTSW POSH patients were retrospectively compared to a matched historical control group (n = 177) treated with usual care. Main outcomes included postoperative delirium and provider recognition of delirium. RESULTS UTSW POSH patients were significantly older (75.5 vs 71.5 years; P < .001), had more comorbidities (8.02 vs 6.58; P < .001), and were more likely to undergo pelvic fixation (36.1% vs 17.5%; P < .001). The incidence of postoperative delirium was lower in the UTSW POSH group compared to historical controls, although not statistically significant (11.6% vs 19.2%; P = .065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N = 106) in the UTSW POSH group (11.7% vs 28.9%, P = .03). There was a threefold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs 23.5%; P = .001). CONCLUSIONS This study suggests that interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.
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Affiliation(s)
- Mark N Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Palvasha R Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Madelina L Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Owoicho Adogwa
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Nick A Stewart
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Luke J Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, St Louis University Hospital, St. Louis, Missouri, USA
| | - Shelley R McDonald
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.,Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Sarah A Wingfield
- Department of Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, Texas, USA
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Christian ZK, Youssef CA, Aoun SG, Afuwape O, Barrie U, Johnson ZD, El Ahmadieh TY, Hall K, Peinado Reyes V, Wingfield SA, Bagley CA. Smoking has a dose-dependent effect on the incidence of preoperative opioid consumption in female geriatric patients with spine disease. J Clin Neurosci 2020; 81:173-177. [PMID: 33222910 DOI: 10.1016/j.jocn.2020.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Tobacco use and narcotic medication have been associated with worse functional outcomes after surgery. Our goal was to investigate potential associations between smoking and preoperative opioid consumption in a geriatric population undergoing spine surgery, and their impact on postoperative outcomes. The records of 536 consecutive patients aged more than 65 years who underwent elective spinal surgery between November 2014 and August 2017 at a single institution were reviewed. Primary outcomes included rates of preoperative opioid consumption and postoperative hospital length of stay and complications. Males were more likely to be smokers than females (p < 0.001), whereas females were more likely to take opioid analgesics preoperatively (p = 0.022). Women with a history of smoking were more likely to have increased preoperative opioid consumption compared to those with no history of smoking (63.64% vs. 42.04%; p < 0.001). Such a relationship was not found in men. Subgroups analysis of female patients with a history of tobacco use comparing current and former smoker status showed that both groups exhibited increased preoperative opioid consumption compared to patients who never smoked (88.89% vs 42.04%; p < 0.001 for current users; 59.42% vs 42.04% for former users; p = 0.008). There was also a dose-depended relationship between smoking and increased preoperative opioid consumption. Geriatric female spine patients with a history of smoking have a higher incidence of preoperative opioid consumption. Opioid intake appears to increase with the number of pack-years, both in patients with a history of smoking and in those who currently smoke.
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Affiliation(s)
- Zachary K Christian
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Carl A Youssef
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Salah G Aoun
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States.
| | - Olusoji Afuwape
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Umaru Barrie
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Zachary D Johnson
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Tarek Y El Ahmadieh
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Kristen Hall
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States
| | - Valery Peinado Reyes
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States
| | - Sarah A Wingfield
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Geriatric Medicine, United States
| | - Carlos A Bagley
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Medical Center, Department of Orthopedic Surgery, United States; UT Southwestern Spine Center, United States
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Abstract
Cancer screening is an important tool for reducing morbidity and mortality in the elderly. In this article, performance characteristics of commonly used screening tests for colorectal, lung, prostate, breast, and cervical cancers are discussed. Guidelines are emphasized and key issues to consider in screening older adults are highlighted.
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Affiliation(s)
- Sarah A Wingfield
- Geriatric Medicine, Duke University Medical Center, Box 3003, Durham, NC 27710, USA
| | - Mitchell T Heflin
- Department of Medicine, Division of Geriatrics, Center for the Study of Aging and Human Development, Duke University Medical Center, Duke University, Box 3003, Durham, NC 27710, USA.
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