The impact of bisphosphonates on postoperative complication rates in osteoporotic patients undergoing posterior lumbar fusion

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

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Does the ranking of surgeons in a publicly available online platform correlate with objective outcomes?

Journal of Neurosurgery ◽

10.3171/2016.8.jns16583 ◽

2017 ◽

Vol 127 (2) ◽

pp. 353-359 ◽

Cited By ~ 5

Author(s):

Kimon Bekelis ◽

Symeon Missios ◽

Shannon Coy ◽

Jeremiah N. Johnson

Keyword(s):

New York ◽

Lumbar Fusion ◽

New York State ◽

Mixed Effects ◽

Complication Rates ◽

Posterior Lumbar Fusion ◽

Rehabilitation Facility ◽

Time Period ◽

Multivariable Regression ◽

Objective Outcomes

OBJECTIVEThe accuracy of public reporting in health care, especially from private vendors, remains an issue of debate. The authors investigated the association of the publicly reported physician complication rates in an online platform with real-world adverse outcomes of the same physicians for patients undergoing posterior lumbar fusion.METHODSThe authors performed a cohort study involving physicians performing posterior lumbar fusions between 2009 and 2013 who were registered in the Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data over the same time period from ProPublica, a private company. Mixed-effects multivariable regression models were used to investigate the association of publicly available complication rates with the rate of discharge to a rehabilitation facility, length of stay, mortality, and hospitalization charges for the same surgeons.RESULTSDuring the selected study period, there were 8,457 patients in New York State who underwent posterior lumbar fusion performed by the 56 surgeons represented in the ProPublica Surgeon Scorecard over the same time period. Using a mixed-effects multivariable regression model, the authors demonstrated that publicly reported physician-level complication rates were not associated with the rate of discharge to a rehabilitation facility (OR 0.97, 95% CI 0.72–1.31), length of stay (adjusted difference −0.1, 95% CI −0.5 to 0.2), mortality (OR 0.87, 95% CI 0.49–1.55), and hospitalization charges (adjusted difference $18,735, 95% CI −$59,177 to $96,647). Similarly, no association was observed when utilizing propensity score–adjusted models, and when restricting the cohort to a predefined subgroup of Medicare patients.CONCLUSIONSAfter merging a comprehensive all-payer posterior lumbar fusion cohort in New York State with data from the ProPublica Surgeon Scorecard over the same time period, the authors observed no association of publicly available physician complication rates with objective outcomes.

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National Complication Rates and Disposition After Posterior Lumbar Fusion for Acquired Spondylolisthesis

Spine ◽

10.1097/brs.0b013e3181ae2243 ◽

2009 ◽

Vol 34 (18) ◽

pp. 1963-1969 ◽

Cited By ~ 120

Author(s):

Paul S. Kalanithi ◽

Chirag G. Patil ◽

Maxwell Boakye

Keyword(s):

Lumbar Fusion ◽

Complication Rates ◽

Posterior Lumbar Fusion

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Demographic Predictors of Treatment and Complications for Spinal Disorders: Part 2, Lumbar Spine Trauma

Neurospine ◽

10.14245/ns.2142614.307 ◽

2021 ◽

Vol 18 (4) ◽

pp. 725-732

Author(s):

Omar Al Jammal ◽

Julian Gendreau ◽

Bejan Alvandi ◽

Neal A. Patel ◽

Nolan J. Brown ◽

...

Keyword(s):

Lumbar Spine ◽

Postoperative Complication ◽

Surgical Management ◽

Traumatic Injury ◽

Demographic Factors ◽

Complication Rates ◽

Spine Trauma ◽

Teaching Status ◽

The Impact ◽

To Receive

Objective: To study the impact of demographic factors on management of traumatic injury to the lumbar spine and postoperative complication rates.Methods: Data was obtained from the National Inpatient Sample (NIS) between 2010–2014. International Classification of Diseases, 9th revision, Clinical Modification codes identified patients diagnosed with lumbar fractures or dislocations due to trauma. A series of multivariate regression models determined whether demographic variables predicted rates of complication and revision surgery.Results: A total of 38,249 patients were identified. Female patients were less likely to receive surgery and to receive a fusion when undergoing surgery, had higher complication rates, and more likely to undergo revision surgery. Medicare and Medicaid patients were less likely to receive surgical management for lumbar spine trauma and less likely to receive a fusion when operated on. Additionally, we found significant differences in surgical management and postoperative complication rates based on race, insurance type, hospital teaching status, and geography.Conclusion: Substantial differences in the surgical management of traumatic injury to the lumbar spine, including postoperative complications, among individuals of demographic factors such as age, sex, race, primary insurance, hospital teaching status, and geographic region suggest the need for further studies to understand how patient demographics influence management and complications for traumatic injury to the lumbar spine.

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Diabetes Is Predictive of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion

Global Spine Journal ◽

10.1177/2192568220948480 ◽

2020 ◽

pp. 219256822094848

Author(s):

Annie E. Arrighi-Allisan ◽

Sean N. Neifert ◽

Jonathan S. Gal ◽

Lawrence Zeldin ◽

Jeffrey H. Zimering ◽

...

Keyword(s):

Emergency Room ◽

Emergency Room Visit ◽

Lumbar Fusion ◽

Significant Risk ◽

Significant Risk Factor ◽

Adverse Outcomes ◽

Complication Rates ◽

Posterior Lumbar Fusion ◽

Prolonged Length ◽

Comorbidity Burden

Study Design: Retrospective cohort study. Objective: The present study analyzes complication rates and episode-based costs for patients with and without diabetes mellitus (DM) following posterior lumbar fusion (PLF). Methods: PLF cases at a single institution from 2008 to 2016 were queried (n = 3226), and demographic and perioperative data were analyzed. Patients with and without the diagnosis of DM were compared using chi-square, Student’s t test, and multivariable regression modeling. Results: Patients with diabetes were older (63.10 vs 56.48 years, P < .001) and possessed a greater number of preoperative comorbidities (47.84% of patients had Elixhauser Comorbidity Index >0 vs 42.24%, P < .001) than did patients without diabetes. When controlling for preexisting differences, diabetes remained a significant risk factor for prolonged length of stay (OR = 1.59, 95% CI 1.26-2.01, P < .001), intensive care unit stay (OR = 1.52, 95% CI 1.07-2.17, P = .021), nonhome discharge (OR = 1.86, 95% CI 1.46-2.37, P < .001), 30-day readmission (OR = 2.15, 95% CI 1.28-3.60, P = .004), 90-day readmission (OR = 1.65, 95% CI 1.05-2.59, P = .031), 30-day emergency room visit (OR = 2.15, 95% CI 1.27-3.63, P = .004), and 90-day emergency room visit (OR = 2.27, 95% CI 1.41-3.65, P < .001). Cost modeling controlling for overall comorbidity burden demonstrated that diabetes was associated with a $1709 increase in PLF costs (CI $344-$3074, P = .014). Conclusions: The present findings indicate a correlation between diabetes and a multitude of postoperative adverse outcomes and increased costs, thus illustrating the substantial medical and financial burdens of diabetes for PLF patients. Future studies should explore preventive measures that may mitigate these downstream effects.

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The influence of smoking in minimally invasive spinal fusion surgery

Open Medicine ◽

10.1515/med-2021-0223 ◽

2021 ◽

Vol 16 (1) ◽

pp. 198-206

Author(s):

Wolfgang Senker ◽

Harald Stefanits ◽

Matthias Gmeiner ◽

Wolfgang Trutschnig ◽

Christian Radl ◽

...

Keyword(s):

Lumbar Spine ◽

Minimally Invasive ◽

Postoperative Complication ◽

Complication Rate ◽

Clinical Effectiveness ◽

Complication Rates ◽

Spinal Fusion Surgery ◽

The Difference ◽

A Prospective Study ◽

The Impact

Abstract Background The impact of smoking on spinal surgery has been studied extensively, but few investigations have focused on minimally invasive surgery (MIS) of the spine and the difference between complication rates in smokers and non-smokers. We evaluated whether a history of at least one pack-year preoperatively could be used to predict adverse peri- and postoperative outcomes in patients undergoing minimally invasive fusion procedures of the lumbar spine. In a prospective study, we assessed the clinical effectiveness of MIS in an unselected population of 187 patients. Methods We evaluated perioperative and postoperative complication rates in MIS fusion techniques of the lumbar spine in smoking and non-smoking patients. MIS fusion was performed using interbody fusion procedures and/or posterolateral fusion alone. Results Smokers were significantly younger than non-smokers. We did not encounter infection at the site of surgery or severe wound healing disorder in smokers. We registered no difference between the smoking and non-smoking groups with regard to peri- or postoperative complication rate, blood loss, or length of stay in hospital. We found a significant influence of smoking (p = 0.049) on the overall perioperative complication rate. Conclusion MIS fusion techniques seem to be a suitable tool for treating degenerative spinal disorders in smokers.

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Primary and Revision Posterior Lumbar Fusion Have Similar Short-Term Complication Rates

Spine ◽

10.1097/brs.0000000000001094 ◽

2016 ◽

Vol 41 (2) ◽

pp. E101-E106 ◽

Cited By ~ 9

Author(s):

Bryce A. Basques ◽

Pablo J. Diaz-Collado ◽

Benjamin J. Geddes ◽

Andre M. Samuel ◽

Adam M. Lukasiewicz ◽

...

Keyword(s):

Lumbar Fusion ◽

Complication Rates ◽

Short Term ◽

Posterior Lumbar Fusion

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The Impact of Groin Surgery during Childhood on the Incidence of Inguinal Hernia Repair and Its Postoperative Complications in Adult Life

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1641598 ◽

2018 ◽

Vol 29 (03) ◽

pp. 271-275

Author(s):

Arestis Sokratous ◽

Johanna Österberg ◽

Gabriel Sandblom

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Postoperative Complication ◽

Inguinal Hernia Repair ◽

Adult Life ◽

Operation Time ◽

Study Cohort ◽

Complication Rates ◽

Increased Risk ◽

The Impact

Background Pediatric inguinal hernia, hydrocele, and cryptorchidism are common congenital anomalies affecting children, and require surgical intervention in some cases. The association between surgical treatment of these conditions and acquired inguinal hernia later in life is poorly understood. The aim of this cohort study was to examine the effect of groin surgery during childhood on the incidence and surgical outcome of inguinal hernia repair in adult life. Materials and Methods Data from the Swedish Inpatient Register and the Swedish Hernia Register were cross-linked using the patient personal identity numbers. The incidence of inguinal hernia repair in patients 15 years or older in the study cohort, as well as postoperative complication rates, were compared with the expected incidence and complication rates extrapolated from the general Swedish population in 2014, stratifying for age and gender. Results Note that 68,238 children aged 0 to 14 years were found to have undergone groin surgery between 1964 and 1998. The median follow-up time after an operation in the groin was 30.8 years (21.0–50.0). Of those, 1,118 were found to have undergone inguinal hernia repair as adults (> 15 years old) between 1992 and 2013. The incidence of inguinal hernia repair in the cohort was significantly higher than that expected (1.43 [1.33–1.53]), both for men (1.32 [1.25–1.41]) and women (4.30 [3.28–5.55]). The incidence was also increased in the subgroup of patients that had undergone more than one procedure during childhood. No significant impact on postoperative complication rate, reoperation rate, or operation time was identified. Conclusion Individuals undergoing surgery in the groin during childhood are at increased risk for acquired inguinal hernia surgery later in life. Inguinal surgery during childhood did not affect the outcome of hernia repair in adult age.

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The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

Journal of Neurosurgery Spine ◽

10.3171/2020.5.spine20457 ◽

2020 ◽

Vol 33 (6) ◽

pp. 812-821

Author(s):

Scott L. Zuckerman ◽

Clinton J. Devin ◽

Vincent Rossi ◽

Silky Chotai ◽

E. Hunter Dyer ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Discharge Planning ◽

Lumbar Fusion ◽

Nonparametric Tests ◽

Learning System ◽

Design Quality ◽

Implementation Phase ◽

Healthcare Improvement ◽

The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

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Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19223 ◽

2019 ◽

Vol 24 (6) ◽

pp. 722-727

Author(s):

Aladine A. Elsamadicy ◽

Andrew B. Koo ◽

Megan Lee ◽

Adam J. Kundishora ◽

Christopher S. Hong ◽

...

Keyword(s):

Quality Of Care ◽

Idiopathic Scoliosis ◽

Affective Disorder ◽

Affective Disorders ◽

Complication Rates ◽

Total Cost ◽

Adolescent Patients ◽

Perioperative Complication ◽

The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

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