1
|
Passias PG, Williamson TK, Kummer NA, Pellisé F, Lafage V, Lafage R, Serra-Burriel M, Smith JS, Line B, Vira S, Gum JL, Haddad S, Sánchez Pérez-Grueso FJ, Schoenfeld AJ, Daniels AH, Chou D, Klineberg EO, Gupta MC, Kebaish KM, Kelly MP, Hart RA, Burton DC, Kleinstück F, Obeid I, Shaffrey CI, Alanay A, Ames CP, Schwab FJ, Hostin RA, Bess S. Cost Benefit of Implementation of Risk Stratification Models for Adult Spinal Deformity Surgery. Global Spine J 2023:21925682231212966. [PMID: 38081300 DOI: 10.1177/21925682231212966] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN/SETTING Retrospective cohort study. OBJECTIVE Assess the extent to which defined risk factors of adverse events are drivers of cost-utility in spinal deformity (ASD) surgery. METHODS ASD patients with 2-year (2Y) data were included. Tertiles were used to define high degrees of frailty, sagittal deformity, blood loss, and surgical time. Cost was calculated using the Pearl Diver registry and cost-utility at 2Y was compared between cohorts based on the number of risk factors present. Statistically significant differences in cost-utility by number of baseline risk factors were determined using ANOVA, followed by a generalized linear model, adjusting for clinical site and surgeon, to assess the effects of increasing risk score on overall cost-utility. RESULTS By 2 years, 31% experienced a major complication and 23% underwent reoperation. Patients with ≤2 risk factors had significantly less major complications. Patients with 2 risk factors improved the most from baseline to 2Y in ODI. Average cost increased by $8234 per risk factor (R2 = .981). Cost-per-QALY at 2Y increased by $122,650 per risk factor (R2 = .794). Adjusted generalized linear model demonstrated a significant trend between increasing risk score and increasing cost-utility (r2 = .408, P < .001). CONCLUSIONS The number of defined patient-specific and surgical risk factors, especially those with greater than two, were associated with increased index surgical costs and diminished cost-utility. Efforts to optimize patient physiology and minimize surgical risk would likely reduce healthcare expenditures and improve the overall cost-utility profile for ASD interventions.Level of evidence: III.
Collapse
Affiliation(s)
- Peter G Passias
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, NY, NY, USA
| | - Tyler K Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nicholas A Kummer
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, NY, NY, USA
| | - Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Miguel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton Line
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Shaleen Vira
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Frank Kleinstück
- Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Christopher I Shaffrey
- Spine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acıbadem University, Istanbul, Turkey
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| |
Collapse
|
2
|
Liu Z, Wang H, Wu H, Pan L, Ning T, Cao Y. Reduction quality in lateral view of X-ray and hypoalbuminemia are associated with postoperative mortality in elderly pertrochanteric fracture patients. Quant Imaging Med Surg 2023; 13:7247-7257. [PMID: 37869351 PMCID: PMC10585535 DOI: 10.21037/qims-23-424] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/17/2023] [Indexed: 10/24/2023]
Abstract
Background Pertrochanteric fracture is one of the most prevalent public health issues across the world for the elderly population. The purpose of this study was to investigate the association between surgical factors and postoperative mortality in patients with intramedullary nail-treated pertrochanteric fractures. Methods A retrospective cohort study was designed to evaluate the pertrochanteric fracture patients treated with intramedullary nail between January 2016 to February 2021. The surgical factors included the Dorr morphology, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification of fractures, the tip-apex distance (TAD), location of the cephalic screw, reduction quality in anterior-posterior (AP) and lateral views, the integrity of the lateral wall, and the design of cephalic screws. Using univariate and multivariate Cox proportional hazard models, the association between these risk factors and postoperative mortality in patients with this type of fractures was evaluated. Results A total of 169 pertrochanteric fracture patients treated with intramedullary nails were included in our study, with the average age of 82.68±5.93 years. The mortality rates at 3 months, 1 year, and the end of follow-up were 4.14%, 11.24%, and 26.04%, respectively. According to the univariate Cox analysis, age, gender, preoperative levels of hemoglobin (Hb) and albumin (Alb) were associated with a poor overall survival (OS) (P<0.05). After multivariate adjustment, the pre-operative level of Alb (P<0.001) and the reduction in lateral view (P<0.001) were shown to be independent risk factors for poor OS. Conclusions The preoperative hypoalbuminemia and reduction quality in lateral view were associated with postoperative mortality in our study. Therefore, optimizing both parameters could improve the prognosis in elderly pertrochanteric fracture patients.
Collapse
Affiliation(s)
- Zhenning Liu
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Hao Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Hao Wu
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Liping Pan
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Taiguo Ning
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| |
Collapse
|
3
|
Rao VM, Feng AL, Deschler DG, Kaufman HL, Lin DT, Miller D, Richmon JD, Shalhout SZ, Varvares MA, Emerick KS. Surgical factors affecting regionally metastatic cutaneous squamous cell carcinoma to the parotid gland. Head Neck 2023; 45:1080-1087. [PMID: 36891633 DOI: 10.1002/hed.27304] [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] [Received: 07/08/2022] [Revised: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Understanding the impact of surgical treatment on regionally metastatic cutaneous squamous cell carcinoma (cSCC). METHODS Retrospective series of 145 patients undergoing parotidectomy and neck dissection for regionally metastatic cSCC to the parotid. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) analyzed over 3 years. Multivariate analysis was completed using Cox proportional hazard models. RESULTS OS was 74.5%, DSS was 85.5% and DFS was 64.8%. On multivariate analysis, immune status (HR = 3.225[OS], 5.119[DSS], 2.071[DFS]) and lymphovascular invasion (HR = 2.380[OS], 5.237[DSS], 2.595[DFS]) were predictive for OS, DSS, and DFS. Margin status (HR = 2.296[OS], 2.499[DSS]) and ≥18 resected nodes (HR = 0.242[OS], 0.255[DSS]) were predictive of OS and DSS, while adjuvant therapy was predictive of DSS (p = 0.018). CONCLUSIONS Immunosuppression and lymphovascular invasion portended worse outcomes in patients with metastatic cSCC to the parotid. Microscopically positive margins and <18 nodes resected are associated with worse OS and DSS, while patients receiving adjuvant therapy had improved DSS.
Collapse
Affiliation(s)
- Vishwanatha M Rao
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard L Kaufman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - David Miller
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Z Shalhout
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Dandurand C, Mashayekhi MS, McIntosh G, Street JT, Fisher CG, Finkelstein J, Abraham E, Paquet J, Hall H, Wai E, Fourney DR, Bailey CS, Christie SD, Soroceanu A, Johnson M, Kelly A, Marion TE, Nataraj A, Santaguida C, Warren D, Hogan TG, Manson N, Phan P, Ahn H, Rampersaud YR, Blanchard J, Thomas K, Dea N, Charest-Morin R. Patient, clinical, surgical, and institutional factors associated with length of stay in scheduled degenerative thoracolumbar spine surgery: National Multicenter Cohort Analysis from the Canadian Spine Outcomes and Research Network. J Neurosurg Spine 2022; 38:446-456. [PMID: 36681949 DOI: 10.3171/2022.11.spine22662] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/15/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Length of stay (LOS) is a contributor to costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for thoracolumbar degenerative pathology. The secondary objective was to examine variability in LOS and institutional strategies used to decrease LOS. METHODS This is a retrospective study of prospectively collected data from a multicentric cohort enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective thoracolumbar surgery (discectomy [1 or 2 levels], laminectomy [1 or 2 levels], and posterior instrumented fusion [up to 5 levels]). Prolonged LOS was defined as LOS greater than the median. Logistic regression models were used to determine factors associated with prolonged LOS for each procedure. A survey was sent to the principal investigators of the participating healthcare institutions to understand institutional practices that are used to decrease LOS. RESULTS A total of 3700 patients were included (967 discectomies, 1094 laminectomies, and 1639 fusions). The median LOSs for discectomy, laminectomy, and fusion were 0.0 (IQR 1.0), 1.0 (IQR 2.0), and 4.0 (IQR 2.0) days, respectively. On multivariable analysis, predictors of prolonged LOS for discectomy were having more leg pain, higher Oswestry Disability Index (ODI) scores, symptom duration more than 2 years, having undergone an open procedure, occurrence of an adverse event (AE), and treatment at an institution without protocols to reduce LOS (p < 0.05). Predictors of prolonged LOS for laminectomy were increased age, living alone, higher ODI scores, higher BMI, open procedures, longer operative time, AEs, and treatment at an institution without protocols to reduce LOS (p < 0.05). For posterior instrumented fusion, predictors of prolonged LOS were older age, living alone, more comorbidities, higher ODI scores, longer operative time, AEs, and treatment at an institution without protocols to reduce LOS (p < 0.05). The laminectomy group had the largest variability in LOS (SD 4.4 days, range 0-133 days). Three hundred fifty-four patients (22%) had an LOS above the 75th percentile. Ten institutions (53%) had either Enhanced Recovery After Surgery or standardized protocols in place. CONCLUSIONS Among the factors identified in this study, worse baseline ODI scores, experiencing AEs, and treatment at an institution without protocols aimed at reducing LOS were predictive of prolonged LOS in all surgical groups. The laminectomy group had the largest variability in LOS.
Collapse
Affiliation(s)
- Charlotte Dandurand
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Mohammad S Mashayekhi
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Greg McIntosh
- 12Canadian Spine Outcomes and Research Network, Canadian Spine Society, Markdale, Ontario
| | - John T Street
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Charles G Fisher
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Joel Finkelstein
- 13Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Edward Abraham
- 8Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | - Jérôme Paquet
- 2Centre Hospitalier Universitaire de Québec, Hôpital Enfant-Jésus, Québec City, Québec
| | - Hamilton Hall
- 9Department of Surgery, University of Toronto, Ontario
| | - Eugene Wai
- 5Department of Surgery, Ottawa Hospital, Ottawa, Ontario
| | - Daryl R Fourney
- 17Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Christopher S Bailey
- 3London Health Sciences Centre, Combined Neurosurgical and Orthopaedic Spine Program, Western University, London, Ontario
| | - Sean D Christie
- 8Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | | | - Michael Johnson
- 6Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba
| | - Adrienne Kelly
- 16Department of Surgery, Northern Ontario School of Medicine, Sault Ste. Marie, Ontario
| | - Travis E Marion
- 15Department of Surgery, Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario
| | - Andrew Nataraj
- 4Department of Surgery, University of Alberta Hospital, Edmonton, Alberta
| | | | - Daniel Warren
- 19Department of Neurosurgery, Vancouver Island Health Authority, Victoria, British Columbia; and
| | - Thomas Guy Hogan
- 20Department of Orthopaedic Surgery, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
| | - Neil Manson
- 10Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick
| | - Philippe Phan
- 5Department of Surgery, Ottawa Hospital, Ottawa, Ontario
| | - Henry Ahn
- 9Department of Surgery, University of Toronto, Ontario
| | - Y Raja Rampersaud
- 11University Health Network, Toronto Western Hospital, Toronto, Ontario
| | - Jocelyn Blanchard
- 14Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec
| | | | - Nicolas Dea
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Raphaële Charest-Morin
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
5
|
Passias PG, Naessig S, Kummer N, Passfall L, Lafage R, Lafage V, Line B, Diebo BG, Protopsaltis T, Kim HJ, Eastlack R, Soroceanu A, Klineberg EO, Hart RA, Burton D, Bess S, Schwab F, Shaffrey CI, Smith JS, Ames CP. Predicting development of severe clinically relevant distal junctional kyphosis following adult cervical deformity surgery, with further distinction from mild asymptomatic episodes. J Neurosurg Spine 2021:1-8. [PMID: 34920417 DOI: 10.3171/2021.8.spine21533] [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: 05/17/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This retrospective cohort study aimed to develop a formal predictive model distinguishing between symptomatic and asymptomatic distal junctional kyphosis (DJK). In this study the authors identified a DJK rate of 32.2%. Predictive models were created that can be used with high reliability to help distinguish between severe symptomatic DJK and mild asymptomatic DJK through the use of surgical factors, radiographic parameters, and patient variables. METHODS Patients with cervical deformity (CD) were stratified into asymptomatic and symptomatic DJK groups. Symptomatic: 1) DJK angle (DJKA) > 10° and either reoperation due to DJK or > 1 new-onset neurological sequela related to DJK; or 2) either a DJKA > 20° or ∆DJKA > 20°. Asymptomatic: ∆DJK > 10° in the absence of neurological sequelae. Stepwise logistic regressions were used to identify factors associated with these types of DJK. Decision tree analysis established cutoffs. RESULTS A total of 99 patients with CD were included, with 32.2% developing DJK (34.3% asymptomatic, 65.7% symptomatic). A total of 37.5% of asymptomatic patients received a reoperation versus 62.5% symptomatic patients. Multivariate analysis identified independent baseline factors for developing symptomatic DJK as follows: pelvic incidence (OR 1.02); preoperative cervical flexibility (OR 1.04); and combined approach (OR 6.2). Having abnormal hyperkyphosis in the thoracic spine, more so than abnormal cervical lordosis, was a factor for developing symptomatic disease when analyzed against asymptomatic patients (OR 1.2). Predictive modeling identified factors that were predictive of symptomatic versus no DJK, as follows: myelopathy (modified Japanese Orthopaedic Association score 12-14); combined approach; uppermost instrumented vertebra C3 or C4; preoperative hypermobility; and > 7 levels fused (area under the curve 0.89). A predictive model for symptomatic versus asymptomatic disease (area under the curve 0.85) included being frail, T1 slope minus cervical lordosis > 20°, and a pelvic incidence > 46.3°. Controlling for baseline deformity and disability, symptomatic patients had a greater cervical sagittal vertical axis (4-8 cm: 47.6% vs 27%) and were more malaligned according to their Scoliosis Research Society sagittal vertical axis measurement (OR 0.1) than patients without DJK at 1 year (all p < 0.05). Despite their symptomatology and higher reoperation rate, outcomes equilibrated in the symptomatic cohort at 1 year following revision. CONCLUSIONS Overall, 32.2% of patients with CD suffered from DJK. Symptomatic DJK can be predicted with high reliability. It can be further distinguished from asymptomatic occurrences by taking into account pelvic incidence and baseline cervicothoracic deformity severity.
Collapse
Affiliation(s)
- Peter G Passias
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Sara Naessig
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Nicholas Kummer
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Lara Passfall
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Renaud Lafage
- 2Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- 3Lenox Hill Hospital, Northwell Health, Department of Orthopaedics, New York, New York
| | - Breton Line
- 4Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Bassel G Diebo
- 5Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn, New York
| | | | - Han Jo Kim
- 2Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Robert Eastlack
- 6Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Alex Soroceanu
- 7Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada
| | - Eric O Klineberg
- 8Department of Orthopaedic Surgery, University of California, Davis, California
| | - Robert A Hart
- 9Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Douglas Burton
- 10Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Shay Bess
- 4Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Frank Schwab
- 3Lenox Hill Hospital, Northwell Health, Department of Orthopaedics, New York, New York
| | | | - Justin S Smith
- 12Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Christopher P Ames
- 13Department of Neurological Surgery, University of California, San Francisco, California
| |
Collapse
|
6
|
Argenson JN, Arndt M, Babis G, Battenberg A, Budhiparama N, Catani F, Chen F, de Beaubien B, Ebied A, Esposito S, Ferry C, Flores H, Giorgini A, Hansen E, Hernugrahanto KD, Hyonmin C, Kim TK, Koh IJ, Komnos G, Lausmann C, Loloi J, Lora-Tamayo J, Lumban-Gaol I, Mahyudin F, Mancheno-Losa M, Marculescu C, Marei S, Martin KE, Meshram P, Paprosky WG, Poultsides L, Saxena A, Schwechter E, Shah J, Shohat N, Sierra RJ, Soriano A, Stefánsdóttir A, Suleiman LI, Taylor A, Triantafyllopoulos GK, Utomo DN, Warren D, Whiteside L, Wouthuyzen-Bakker M, Yombi J, Zmistowski B. Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S399-S419. [PMID: 30348550 DOI: 10.1016/j.arth.2018.09.025] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Key Words
- acute periprosthetic joint infection (PJI)
- antibiotic combination
- antibiotic duration
- antibiotic therapy
- antibiotic treatment
- biofilm
- chronic obstructive pulmonary disease (COPD)), and C-reactive protein (CRP) >115 mg/L (C), rheumatoid arthritis (R), indication prosthesis (I), male (M), exchange of mobile components (E), age > 80 years (80) (CRIME80) scores
- chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein (CRP) >115 mg/L (KLIC) score
- contraindications
- debridement antibiotics and retention of the prosthesis
- debridement, antibiotics, implant retention (DAIR)
- emergency management
- exchange of modular components
- failed debridement, antibiotics, implant retention (DAIR) management
- fluoroquinolone
- gram-negative acute periprosthetic joint infection (PJI)
- indications
- infection recurrence
- intra-articular antibiotic infusion
- irrigation
- irrigation and debridement
- irrigation solution
- length of antibiotics
- megaprosthesis
- methicillin-resistant Staphylococcus aureus (MRSA)
- pathogen identification
- patient optimization
- periprosthetic joint infection (PJI) recurrence
- povidone-iodine
- rifampicin
- risk stratification
- surgical factors
- surgical intervention
- surgical outcome
- surgical outcomes
- surgical site infection (SSI) recurrence
- surgical timing
- treatment failure
- treatment success
- two-stage exchange arthroplasty
- unicompartmental knee arthroplasty debridement, antibiotics, implant retention (DAIR)
Collapse
|
7
|
Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz B(BA, Mann B, Nwosu SK, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:2586-2594. [PMID: 28696164 PMCID: PMC5675127 DOI: 10.1177/0363546517712952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction. HYPOTHESIS Certain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. RESULTS A total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2.38-4.35; 95% CI, 1.03-10.00). The use of a metal interference screw for current femoral fixation resulted in significantly better outcomes for the 2-year KOOS symptoms, pain, and QOL subscales ( P ≤ .05; OR range, 1.70-1.96; 95% CI, 1.00-3.33) as well as WOMAC stiffness subscale ( P = .041; OR, 1.75; 95% CI, 1.02-3.03). Not performing notchplasty at revision significantly improved 2-year outcomes for the IKDC ( P = .013; OR, 1.47; 95% CI, 1.08-1.99), KOOS activities of daily living (ADL) and QOL subscales ( P ≤ .04; OR range, 1.40-1.41; 95% CI, 1.03-1.93), and WOMAC stiffness and ADL subscales ( P ≤ .04; OR range, 1.41-1.49; 95% CI, 1.03-2.05). Factors before revision ACL reconstruction that increased the risk of poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher BMI, female sex, and a shorter time since the patient's last ACL reconstruction. Prior femoral fixation, prior femoral tunnel aperture position, and knee flexion angle at the time of revision graft fixation were not found to affect 2-year outcomes in this revision cohort. CONCLUSION There are certain surgical variables that the physician can control at the time of revision ACL reconstruction that can modify clinical outcomes at 2 years. Whenever possible, opting for an anteromedial portal or transtibial surgical exposure, choosing a metal interference screw for femoral fixation, and not performing notchplasty are associated with significantly better 2-year clinical outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | | |
Collapse
|