Risk factors for prolonged length of stay in patients undergoing surgery for intramedullary spinal cord tumors

2021 ◽  
Vol 91 ◽  
pp. 396-401
Author(s):  
Romaric Waguia ◽  
Timothy Y. Wang ◽  
Vikram A. Mehta ◽  
Luis Ramirez ◽  
Edwin McCray ◽  
...  
2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi153-vi153
Author(s):  
Romaric Waguia Kouam ◽  
Timothy Wang

Abstract INTRODUCTION Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to these metrics, it is important to illustrate the risk factors for prolonged length of stay and their association with post-op complications with the ultimate goal of improving patient selection and preoperative optimization. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factor influencing prolonged length of stay and post-op complications. RESULTS A total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above ( OR 1.89; p=0.0005), dependent functional status ( OR 2.76; p=0.0035) and transfer from facilities other than home ( OR 8.12; p< 0.0001) were independent predictors of prolonged length of stay ( >5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). CONCLUSION Our study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.


2019 ◽  
Vol 30 (5) ◽  
pp. 655-663 ◽  
Author(s):  
Wei Shi ◽  
Shan Wang ◽  
Huifang Zhang ◽  
Guoqin Wang ◽  
Yi Guo ◽  
...  

OBJECTIVELaminoplasty has been used in recent years as an alternative approach to laminectomy for preventing spinal deformity after resection of intramedullary spinal cord tumors (IMSCTs). However, controversies exist with regard to its real role in maintaining postoperative spinal alignment. The purpose of this study was to examine the incidence of progressive spinal deformity in patients who underwent laminoplasty for resection of IMSCT and identify risk factors for progressive spinal deformity.METHODSData from IMSCT patients who had undergone laminoplasty at Beijing Tsinghua Changgung Hospital between January 2014 and December 2016 were retrospectively reviewed. Univariate tests and multivariate logistic regression analysis were used to assess the statistical relationship between postoperative spinal deformity and radiographic, clinical, and surgical variables.RESULTSOne hundred five patients (mean age 37.0 ± 14.5 years) met the criteria for inclusion in the study. Gross-total resection (> 95%) was obtained in 79 cases (75.2%). Twenty-seven (25.7%) of the 105 patients were found to have spinal deformity preoperatively, and 10 (9.5%) new cases of postoperative progressive deformity were detected. The mean duration of follow-up was 27.6 months (SD 14.5 months, median 26.3 months, range 6.2–40.7 months). At last follow-up, the median functional scores of the patients who did develop progressive spinal deformity were worse than those of the patients who did not (modified McCormick Scale: 3 vs 2, and p = 0.04). In the univariate analysis, age (p = 0.01), preoperative spinal deformity (p < 0.01), extent of tumor involvement (p < 0.01), extent of abnormal tumor signal (p = 0.02), and extent of laminoplasty (p < 0.01) were identified as factors associated with postoperative progressive spinal deformity. However, in subsequent multivariate logistic regression analysis, only age ≤ 25 years and preoperative spinal deformity emerged as independent risk factors (p < 0.05), increasing the odds of postoperative progressive deformity by 4.1- and 12.4-fold, respectively (p < 0.05).CONCLUSIONSProgressive spinal deformity was identified in 25.7% patients who had undergone laminoplasty for IMSCT resection and was related to decreased functional status. Younger age (≤ 25 years) and preoperative spinal deformity increased the risk of postoperative progressive spinal deformity. The risk of postoperative deformity warrants serious reconsideration of providing concurrent fusion during IMSCT resection or close follow-up after laminoplasty.


2014 ◽  
Vol 13 (6) ◽  
pp. 613-621 ◽  
Author(s):  
Raheel Ahmed ◽  
Arnold H. Menezes ◽  
Olatilewa O. Awe ◽  
Kelly B. Mahaney ◽  
James C. Torner ◽  
...  

Object Spinal deformity in pediatric patients with intramedullary spinal cord tumors (IMSCTs) may be either due to neurogenic disability or due to secondary effects of spinal decompression. It is associated with functional decline and impairment in health-related quality-of-life measures. The authors sought to identify the long-term incidence of spinal deformity in individuals who had undergone surgery for IMSCTs as pediatric patients and the risk factors and overall outcomes in this population. Methods Treatment records for pediatric patients (age < 21 years) who underwent surgical treatment for histology-proven primary IMSCTs between 1975 and 2010 were reviewed. All patients were evaluated in consultation with the pediatric orthopedics service. Clinical records were reviewed for baseline and follow-up imaging studies, surgical fusion treatment, and long-term skeletal and disease outcomes. Results The authors identified 55 patients (30 males and 25 females) who were treated for pediatric IMSCTs between January 1975 and January 2010. The mean duration of follow-up (± SEM) was 11.4 ± 1.3 years (median 9.3 years, range 0.2–37.2 years). Preoperative skeletal deformity was diagnosed in 11 (20%) of the 55 patients, and new-onset postoperative deformity was noted in 9 (16%). Conservative management with observation or external bracing was sufficient in 8 (40%) of these 20 cases. Surgical fusion was necessary in 11 (55%). Posterior surgical fusion was sufficient in 6 (55%) of these 11 cases, while combined anterior and posterior fusion was undertaken in 5 (45%). Univariate and multivariate analysis of clinical and surgical treatment variables indicated that preoperative kyphoscoliosis (p = 0.0032) and laminectomy/laminoplasty at more than 4 levels (p = 0.05) were independently associated with development of spinal deformity that necessitated surgical fusion. Functional scores and 10-year disease survival outcomes were similar between the 2 groups. Conclusions Long-term follow-up is essential to monitor for delayed development of spinal deformity, and regular surveillance imaging is recommended for patients with underlying deformity. The authors' extended follow-up highlights the risk factors associated with development of spinal deformity in patients treated for pediatric IMSCTs. Surgical fusion allows patients who develop progressive deformity to achieve long-term functional and survival outcomes comparable to those of patients who do not develop progressive deformity.


2007 ◽  
Vol 107 (6) ◽  
pp. 463-468 ◽  
Author(s):  
Kevin C. Yao ◽  
Matthew J. McGirt ◽  
Kaisorn L. Chaichana ◽  
Shlomi Constantini ◽  
George I. Jallo

1986 ◽  
Vol 26 (4) ◽  
pp. 311-317 ◽  
Author(s):  
Toshihiro YASUI ◽  
Akira HAKUBA ◽  
Junsuke KATSUYAMA ◽  
Shuro NISHIMURA

2015 ◽  
Vol 5 (9) ◽  
pp. 461-473 ◽  
Author(s):  
S. V. Kaiser ◽  
L.-A. Bakel ◽  
M. J. Okumura ◽  
A. D. Auerbach ◽  
J. Rosenthal ◽  
...  

Spinal Cord ◽  
2014 ◽  
Vol 52 (10) ◽  
pp. 769-773 ◽  
Author(s):  
H Arima ◽  
T Hasegawa ◽  
D Togawa ◽  
Y Yamato ◽  
S Kobayashi ◽  
...  

Neurosurgery ◽  
1997 ◽  
Vol 41 (6) ◽  
pp. 1327-1336 ◽  
Author(s):  
Nobu Morota ◽  
Vedran Deletis ◽  
Shlomi Constantini ◽  
Markus Kofler ◽  
Henry Cohen ◽  
...  

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