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Lainé G, Le Huec JC, Blondel B, Fuentes S, Fiere V, Parent H, Lucas F, Roussouly P, Tassa O, Bravant E, Berthiller J, Barrey CY. Factors influencing complications after 3-columns spinal osteotomies for fixed sagittal imbalance from multiple etiologies: a multicentric cohort study about 286 cases in 273 patients. Eur Spine J 2022; 31:3673-3686. [PMID: 36192454 DOI: 10.1007/s00586-022-07410-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/14/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Spinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies. METHODS The study consisted of a blinded retrospective analysis of prospectively collected data from a large multicenter cohort of patients who underwent 3-columns (3C) spinal osteotomy, between January 2010 and January 2017. Clinical and radiological data were compared pre- and post-operatively. Complications and their risk factors were analyzed. RESULTS Two hundred eighty-six 3C osteotomies were performed in 273 patients. At 1 year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p < 0.001). A total of 164 patients (59.2%) experienced at least 1 complication (277 complications). Complications-free survival rates were only 30% at 5 years. Most of those were mechanical (35.2%), followed by general (17.6%), surgical site infection (17.2%) and neurological (10.9%). Pre-operative neurological status [RR = 2.3 (1.32-4.00)], operative time (+ 19% of risk each additional hour) and combined surgery [RR = 1.76 (1.08-2.04)] were assessed as risk factors for overall complication (p < 0.05). The use of patient-specific rods appeared to be significantly associated with less overall complications [RR = 0.5 (0.29-0.89)] (p = 0.02). CONCLUSION Spinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication.
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Affiliation(s)
- G Lainé
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
| | - J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux University, Bordeaux, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - V Fiere
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - H Parent
- Clinique Saint Léonard, Trélazé, France
| | - F Lucas
- Hopital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | - P Roussouly
- Centre Médico-Chirurgical Des Massues, Croix Rouge, Lyon, France
| | - O Tassa
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - E Bravant
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
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Schott AM, Termoz A, Viprey M, Tazarourte K, Vecchia CD, Bravant E, Perreton N, Nighoghossian N, Cakmak S, Meyran S, Ducreux B, Pidoux C, Bony T, Douplat M, Potinet V, Sigal A, Xue Y, Derex L, Haesebaert J. Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study. BMC Health Serv Res 2021; 21:12. [PMID: 33397363 PMCID: PMC7783982 DOI: 10.1186/s12913-020-05982-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Optimizing access to recanalization therapies in acute ischemic stroke patients is crucial. Our aim was to measure the short and long term effectiveness, at the acute phase and 1 year after stroke, of four sets of actions implemented in the Rhône County. Methods The four multilevel actions were 1) increase in stroke units bed capacity and development of endovascular therapy; 2) improvement in knowledge and skills of healthcare providers involved in acute stroke management using a bottom-up approach; 3) development and implementation of new organizations (transportation routes, pre-notification, coordination by the emergency call center physician dispatcher); and 4) launch of regional public awareness campaigns in addition to national campaigns. A before-and-after study was conducted with two identical population-based cohort studies in 2006–7 and 2015–16 in all adult ischemic stroke patients admitted to any emergency department or stroke unit of the Rhône County. The primary outcome criterion was in-hospital management times, and the main secondary outcome criteria were access to reperfusion therapy (either intravenous thrombolysis or endovascular treatment) and pre-hospital management times in the short term, and 12-month prognosis measured by the modified Rankin Scale (mRS) in the long term. Results Between 2015–16 and 2006–7 periods ischemic stroke patients increased from 696 to 717, access to reperfusion therapy increased from 9 to 23% (p < 0.0001), calls to emergency call-center from 40 to 68% (p < 0.0001), first admission in stroke unit from 8 to 30% (p < 0.0001), and MRI within 24 h from 18 to 42% (p < 0.0001). Onset-to-reperfusion time significantly decreased from 3h16mn [2 h54-4 h05] to 2h35mn [2 h05-3 h19] (p < 0.0001), mainly related to a decrease in delay from admission to imaging. A significant decrease of disability was observed, as patients with mild disability (mRS [0–2]) at 12 months increased from 48 to 61% (p < 0.0001). Pre-hospital times, however, did not change significantly. Conclusions We observed significant improvement in access to reperfusion therapy, mainly through a strong decrease of in-hospital management times, and in 12-month disability after the implementation of four sets of actions between 2006 and 2016 in the Rhône County. Reducing pre-hospital times remains a challenge.
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Affiliation(s)
- A M Schott
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France. .,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
| | - A Termoz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - M Viprey
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - K Tazarourte
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Emergency Department - HEH, Hospices Civils de Lyon, Lyon, France
| | - C Della Vecchia
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
| | - E Bravant
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Perreton
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Nighoghossian
- Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - S Cakmak
- Hôpital Nord Ouest, Primary Stroke Center, Villefranche-sur-Saône, France
| | - S Meyran
- Emergency Department, Hôpital St Joseph St Luc, Lyon, France
| | - B Ducreux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - C Pidoux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - T Bony
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - M Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - V Potinet
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - A Sigal
- Emergency Department, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Y Xue
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - L Derex
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - J Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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