scholarly journals The impact of surgical wait time on patient-based outcomes in posterior lumbar spine surgery (by J. Braybrooke et al.)

2007 ◽  
Vol 16 (11) ◽  
pp. 1840-1841 ◽  
Author(s):  
Brian J. C. Freeman
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Wait Time ◽  
Lumbar Spine Surgery ◽  
The Impact ◽  
Surgical Wait Time

scholarly journals Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

2017 ◽  
Vol 7 (3) ◽  
pp. 213-219 ◽  
Author(s):  
David N. Bernstein ◽  
David Brodell ◽  
Yue Li ◽  
Paul T. Rubery ◽  
Addisu Mesfin
Keyword(s):  
United States ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
International Classification Of Diseases ◽  
The United States ◽  
Lumbar Spine Surgery ◽  
Economic Downturn ◽  
Classification Of Diseases ◽  
Lumbar Spinal ◽  
The Impact

Study Design: Retrospective database analysis. Objective: The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. Methods: The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. Results: From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). Conclusions: The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

scholarly journals The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110266
Author(s):  
Gregory S. Kazarian ◽  
Michael E. Steinhaus ◽  
Han Jo Kim
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Postoperative Infection ◽  
Corticosteroid Injection ◽  
Meta Analysis ◽  
Significant Risk ◽  
Lumbar Spine Surgery ◽  
Injection Timing ◽  
The Impact

Study Design/Setting: Systematic review/meta-analysis. Objectives: The objective of this review was to assess how the risk of infection following lumbar spine surgery varies as a function of the timing of preoperative corticosteroid spinal injections (CSIs). Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. PubMed and EMBASE databases were searched and data was pooled for meta-analysis. Results: Six studies were identified for inclusion. Two (33.3%) demonstrated a significant relationship between the timing of preoperative CSIs and the risk of postoperative infection, while 4 (66.7%) demonstrated no impact. A total of 2.5% (110/4,448) of patients who underwent CSI <1 month before surgery experienced a postoperative infection, as compared to 1.2% (1,466/120, 943) of controls, which was statistically significant (RR = 1.986 95% CI 1.202-3.282 P = 0.007). A total of 1.6% (25/1,600) of patients who underwent CSI 0-3 months before surgery experienced a postoperative infection, as compared to 1.6% (201/12, 845) of controls (RR = 0.887 95% CI 0.586-1.341, P = 0.569). A total of 1.1% (199/17 870) of patients who underwent CSI 3-6 months before surgery experienced a postoperative infection, as compared to 1.3% (1,382/102, 572) of controls (RR = 1.053 95% CI 0.704-1.575, P = 0.802). Differences in infection risk for 0-3 months and 3-6 months were not statistically significant. Conclusions: CSIs <1 month prior to lumbar spine surgery are a significant risk factor for infection, while CSIs beyond that point showed no such association. Surgeons should consider avoiding CSIs <1 month of the use of CSIs of the spine.

The Impact of Current Smoking and Smoking Cessation on Short-Term Morbidity Risk After Lumbar Spine Surgery

Spine ◽  
2016 ◽  
Vol 41 (7) ◽  
pp. 577-584 ◽  
Author(s):  
Christopher T. Martin ◽  
Yubo Gao ◽  
Kyle R. Duchman ◽  
Andrew J. Pugely
Keyword(s):  
Smoking Cessation ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Short Term ◽  
Current Smoking ◽  
Morbidity Risk ◽  
The Impact

scholarly journals Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

2019 ◽  
Vol 10 (7) ◽  
pp. 844-850
Author(s):  
Mitchell S. Fourman ◽  
Jeremy D. Shaw ◽  
Chinedu O. Nwasike ◽  
Lorraine A. T. Boakye ◽  
Malcolm E. Dombrowski ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Wound Drainage ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Potential Safety ◽  
Risk Patients ◽  
The Impact

Study Design: Retrospective cohort study. Objective: To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients. Methods: Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion. Results: A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients ( P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent. Conclusions: Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.

Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1037-1045 ◽  
Author(s):  
Clinton J Devin ◽  
Anthony L Asher ◽  
Kristin R Archer ◽  
Anshit Goyal ◽  
Inamullah Khan ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Return To Work ◽  
Spine Surgery ◽  
Important Determinant ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Predominant Symptom ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND The impact of symptom characteristics on outcomes of spine surgery remains elusive. OBJECTIVE To determine the impact of symptom location, severity, and duration on outcomes following lumbar spine surgery. METHODS We queried the Quality Outcomes Database (QOD) for patients undergoing elective lumbar spine surgery for lumbar degenerative spine disease. Multivariable regression was utilized to determine the impact of preoperative symptom characteristics (location, severity, and duration) on improvement in disability, quality of life, return to work, and patient satisfaction at 1 yr. Relative predictor importance was determined using an importance metric defined as Wald χ2 penalized by degrees of freedom. RESULTS A total of 22 022 subjects were analyzed. On adjusted analysis, we found patients with predominant leg pain were more likely to be satisfied (P &lt; .0001), achieve minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) (P = .002), and return to work (P = .03) at 1 yr following surgery without significant difference in Euro-QoL-5D (EQ-5D) (P = .09) [ref = predominant back pain]. Patients with equal leg and back pain were more likely to be satisfied (P &lt; .0001), but showed no significant difference in achieving MCID (P = .22) or return to work (P = .07). Baseline numeric rating scale-leg pain and symptom duration were most important predictors of achieving MCID and change in EQ-5D. Predominant symptom was not found to be an important determinant of return to work. Worker's compensation was found to be most important determinant of satisfaction and return to work. CONCLUSION Predominant symptom location is a significant determinant of functional outcomes following spine surgery. However, pain severity and duration have higher predictive importance. Return to work is more dependent on sociodemographic features as compared to symptom characteristics.

The Impact of Uncontrolled Diabetes in Patients undergoing Degenerative Lumbar Spine Surgery

2014 ◽  
Vol 14 (11) ◽  
pp. S81
Author(s):  
Javier Guzman ◽  
Branko Skovrlj ◽  
Andrew Hecht ◽  
Sheeraz A. Qureshi ◽  
Samuel K. Cho
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Degenerative Lumbar Spine ◽  
Uncontrolled Diabetes ◽  
The Impact

scholarly journals Diabetes is associated with greater leg pain and worse patient-reported outcomes at 1 year after lumbar spine surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kosei Nagata ◽  
Hideki Nakamoto ◽  
Masahiko Sumitani ◽  
So Kato ◽  
Yuichi Yoshida ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Postoperative Recovery ◽  
Diabetic Group ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Patient Reported ◽  
Patients With Diabetes ◽  
The Impact

AbstractAlthough patients with diabetes reportedly have more back pain and worse patient-reported outcomes than those without diabetes after lumbar spine surgery, the impact of diabetes on postoperative recovery in pain or numbness in other regions is not well characterized. In this study, the authors aimed to elucidate the impact of diabetes on postoperative recovery in pain/numbness in four areas (back, buttock, leg, and sole) after lumbar spine surgery. The authors retrospectively reviewed 993 patients (152 with diabetes and 841 without) who underwent decompression and/or fixation within three levels of the lumbar spine at eight hospitals during April 2017–June 2018. Preoperative Numerical Rating Scale (NRS) scores in all four areas, Oswestry Disability Index (ODI), and Euro quality of life 5-dimension (EQ-5D) were comparable between the groups. The diabetic group showed worse ODI/EQ-5D and greater NRS scores for leg pain 1 year after surgery than the non-diabetic group. Although other postoperative NRS scores tended to be higher in the diabetic group, the between-group differences were not significant. Diabetic neuropathy caused by microvascular changes may induce irreversible nerve damage especially in leg area. Providers can use this information when counseling patients with diabetes about the expected outcomes of spine surgery.

scholarly journals Quantifying the collective influence of social determinants of health using conditional and cluster modeling

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241868
Author(s):  
Zachary D. Rethorn ◽  
Alessandra N. Garcia ◽  
Chad E. Cook ◽  
Oren N. Gottfried
Keyword(s):  
Socioeconomic Status ◽  
Lumbar Spine ◽  
Social Determinants Of Health ◽  
Spine Surgery ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Lumbar Spine Surgery ◽  
Cluster Modeling ◽  
Collective Influence ◽  
The Impact

Objectives Our objective was to analyze the collective effect of social determinants of health (SDoH) on lumbar spine surgery outcomes utilizing two different statistical methods of combining variables. Methods This observational study analyzed data from the Quality Outcomes Database, a nationwide United States spine registry. Race/ethnicity, educational attainment, employment status, insurance payer, and gender were predictors of interest. We built two models to assess the collective influence of SDoH on outcomes following lumbar spine surgery—a stepwise model using each number of SDoH conditions present (0 of 5, 1 of 5, 2 of 5, etc) and a clustered subgroup model. Logistic regression analyses adjusted for age, multimorbidity, surgical indication, type of lumbar spine surgery, and surgical approach were performed to identify the odds of failing to demonstrate clinically meaningful improvements in disability, back pain, leg pain, quality of life, and patient satisfaction at 3- and 12-months following lumbar spine surgery. Results Stepwise modeling outperformed individual SDoH when 4 of 5 SDoH were present. Cluster modeling revealed 4 distinct subgroups. Disparities between the younger, minority, lower socioeconomic status and the younger, white, higher socioeconomic status subgroups were substantially wider compared to individual SDoH. Discussion Collective and cluster modeling of SDoH better predicted failure to demonstrate clinically meaningful improvements than individual SDoH in this cohort. Viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDoH on outcomes.

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