89. Is academic department teaching status associated with adverse outcomes after lumbar fusion for degenerative spine diseases?

Abstract BACKGROUND: Adjacent segment disease is an important complication after fusion of degenerative lumbar spines. However, the role of body mass index (BMI) in adjacent segment disease has been addressed less. OBJECTIVE: To examine the relationship between BMI and adjacent segment disease after lumbar fusion for degenerative spine diseases. METHODS: For this retrospective study, we enrolled 190 patients undergoing lumbar fusion surgery for degeneration. BMI at admission was documented. Adjacent segment disease was defined by integration of the clinical presentations and radiographic criteria based on the morphology of the dural sac on magnetic resonance images. RESULTS: Adjacent segment disease was identified in 13 of the 190 patients, accounting for 6.8%. The interval between surgery and diagnosis as adjacent segment disease ranged from 21 to 66 months. Five of the 13 patients required subsequent surgical intervention for clinically relevant adjacent segment disease. In the logistic regression model, BMI was a risk factor for adjacent segment disease after lumbar fusion for degenerative spine diseases (odds ratio, 1.68; 95% confidence interval, 1.27-2.21; P < .001). Any increase of 1 mean value in BMI would increase the adjacent segment disease rate by 67.6%. The patients were subdivided into 2 groups based on BMI, and up to 11.9% of patients with BMI ≥25 kg/m2 were diagnosed as having adjacent segment disease at the last follow-up. CONCLUSION: BMI is a risk factor for adjacent segment disease in patients undergoing lumbar fusion for degenerative spine diseases. Because BMI is clinically objective and modifiable, controlling body weight before or after surgery may provide opportunities to reduce the rate of adjacent segment disease and to improve the outcome of fusion surgery.

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Issues in medical tourism: A presentation of three patients with degenerative spine diseases

Nigerian Journal of Basic and Clinical Sciences ◽

10.4103/0331-8540.176043 ◽

2016 ◽

Vol 13 (1) ◽

pp. 59

Author(s):

MohammedKabir Abubakar ◽

KabirMusa Adamu

Keyword(s):

Medical Tourism ◽

Degenerative Spine ◽

Spine Diseases

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State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Journal of Neurosurgery Spine ◽

10.3171/2019.4.spine18915 ◽

2019 ◽

Vol 31 (1) ◽

pp. 1-14 ◽

Cited By ~ 8

Author(s):

Patrick C. Reid ◽

Simon Morr ◽

Michael G. Kaiser

Keyword(s):

Lumbar Fusion ◽

Surgical Approaches ◽

Degenerative Spine ◽

Effective Technique ◽

Lumbar Degenerative Disease ◽

State Of The Union ◽

Operative Planning ◽

Degenerative Lumbar Disease ◽

Diagnostic Modalities ◽

Spine Disease

Lumbar fusion is an accepted and effective technique for the treatment of lumbar degenerative disease. The practice has evolved continually since Albee and Hibbs independently reported the first cases in 1913, and advancements in both technique and patient selection continue through the present day. Clinical and radiological indications for surgery have been tested in trials, and other diagnostic modalities have developed and been studied. Fusion practices have also advanced; instrumentation, surgical approaches, biologics, and more recently, operative planning, have undergone stark changes at a seemingly increasing pace over the last decade. As the general population ages, treatment of degenerative lumbar disease will become a more prevalent—and costlier—issue for surgeons as well as the healthcare system overall. This review will cover the evolution of indications and techniques for fusion in degenerative lumbar disease, with emphasis on the evidence for current practices.

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Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

Neurosurgical FOCUS ◽

10.3171/2017.10.focus17563 ◽

2018 ◽

Vol 44 (1) ◽

pp. E5 ◽

Cited By ~ 20

Author(s):

Chloe O’Connell ◽

Tej Deepak Azad ◽

Vaishali Mittal ◽

Daniel Vail ◽

Eli Johnson ◽

...

Keyword(s):

Preoperative Diagnosis ◽

Negative Binomial ◽

Lumbar Fusion ◽

Private Insurance ◽

Adverse Outcomes ◽

Economic Outcomes ◽

Opioid Use ◽

Discharge Home ◽

Increased Risk ◽

Secondary Outcomes

OBJECTIVEPreoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs.METHODSA retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug–use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs.RESULTSThe authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (β = 0.25, p < 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17–1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95–0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03–1.25), revision fusions (OR 1.15, 95% CI 1.05–1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04–1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84–1.01). Preoperative depression also resulted in increased costs at 1 (β = 0.06, p < 0.001) and 2 (β = 0.09, p < 0.001) years postoperatively.CONCLUSIONSAlthough these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.

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Lumbar herniated disc treatment with percutaneous hydrodiscectomy

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.09.778 ◽

2018 ◽

Vol 64 (9) ◽

pp. 778-782 ◽

Cited By ~ 1

Author(s):

Antonio Silvinato ◽

Ricardo S. Simões ◽

Renata F. Buzzini ◽

Wanderley M. Bernardo

Keyword(s):

Herniated Disc ◽

Treatment Modalities ◽

Evidence Based ◽

Treatment Intervention ◽

Clinical Question ◽

Degenerative Spine ◽

Eligibility Criteria ◽

Lower Back ◽

Spine Diseases ◽

Based Medicine

SUMMARY Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.

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Patient-Specific Factors Associated With Dissatisfaction After Elective Surgery for Degenerative Spine Diseases

Neurosurgery ◽

10.1227/neu.0000000000000768 ◽

2015 ◽

Vol 77 (2) ◽

pp. 157-163 ◽

Cited By ~ 42

Author(s):

Silky Chotai ◽

Ahilan Sivaganesan ◽

Scott L. Parker ◽

Matthew J. McGirt ◽

Clinton J. Devin

Keyword(s):

Elective Surgery ◽

Patient Specific ◽

Degenerative Spine ◽

Factors Associated ◽

Spine Diseases ◽

Specific Factors

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Impact of admission month and hospital teaching status on outcomes in subarachnoid hemorrhage: evidence against the July effect

Journal of Neurosurgery ◽

10.3171/2011.8.jns11324 ◽

2012 ◽

Vol 116 (1) ◽

pp. 157-163 ◽

Cited By ~ 35

Author(s):

Robert J. McDonald ◽

Harry J. Cloft ◽

David F. Kallmes

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Mortality ◽

Hospital Admissions ◽

Adverse Outcomes ◽

Discharge Disposition ◽

July Effect ◽

Teaching Status ◽

Discharge Status ◽

The Impact ◽

Hospital Characteristics

Object The authors sought to identify the presence of a “July effect,” a transient increase in adverse outcomes during July, among a cohort of spontaneous subarachnoid hemorrhage (SAH) admissions recorded in the National Inpatient Sample (NIS). Methods The discharge status, admission month, patient demographics, treatment parameters, and hospital characteristics among spontaneous SAH admissions were extracted from the 2001–2008 NIS. Multivariate regression was used to determine whether an unfavorable discharge status and/or in-hospital mortality significantly increased in summer months in a pattern suggestive of a July effect. Additional models were generated to assess the impact of hospital teaching status on these outcomes. Results Among 57,663,486 hospital admissions from the 2001–2008 NIS, 52,879 cases of spontaneous SAH (ICD-9-CM 430) were treated at teaching (36,914 cases [70%]) and nonteaching (15,965 cases [30%]) facilities. Regression models failed to reveal a July effect for in-hospital mortality (χ2 = 0.75, p = 1.000) or unfavorable discharges (χ2 = 1.69, p = 0.999) among monthly SAH admissions, although they did suggest a significant reduction in these outcomes (in-hospital mortality, OR = 0.89, p < 0.001; unfavorable discharges, OR = 0.88, p < 0.001) among teaching hospitals as compared with nonteaching hospitals after adjustment for disparities in demographic, treatment, and hospital characteristics. Conclusions The discharge disposition among SAH admissions within the NIS was not suggestive of a July effect but did reveal that teaching institutions have significantly lower rates of adverse outcomes when compared with nonteaching hospitals. Note, however, that the origins of this difference related to teaching status remain unclear.

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