THE SEVERITY OF PREOPERATIVE HBA1C AND PREDICTING POSTOPERATIVE COMPLICATIONS IN SPINE SURGERY

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

Download Full-text

Correlating Psychological Comorbidities and Outcomes After Spine Surgery

Global Spine Journal ◽

10.1177/2192568219886595 ◽

2019 ◽

Vol 10 (7) ◽

pp. 929-939

Author(s):

Keith L. Jackson ◽

Jacob Rumley ◽

Matthew Griffith ◽

Uzondu Agochukwu ◽

John DeVine

Keyword(s):

Postoperative Complications ◽

Literature Review ◽

Spine Surgery ◽

Surgical Outcomes ◽

Relevant Literature ◽

Psychological Disorders ◽

Spinal Pain ◽

Screening Tools ◽

Screening Criteria ◽

Psychological Comorbidities

Study Design: Literature review. Objective: The aim of this literature review is to examine the effects of psychological disorders on postoperative complications, surgical outcomes, and long-term narcotic use. We also hope to detail the value of preoperative identification and treatment of these pathologies. Methods: A series of systematic reviews of the relevant literature examining the effects of psychological disorders and spine surgery was conducted using PubMed and Cochrane databases. Results: Combined, the database queries yielded 2275 articles for consideration. After applying screening criteria, 96 articles were selected for inclusion. Patients with underlying psychological disease have higher rates of delirium, readmission, longer hospital stays, and higher rates of nonroutine discharge following spine surgery. They also have higher rates of chronic postoperative narcotic use and may experience worse surgical outcomes. Because of these defined issues, researchers have developed multiple screening tools to help identify patients with psychological disorders preoperatively for potential treatment. Treatment of these disorders prior to surgery may significantly improve surgical outcomes. Conclusion: Patients with psychological disorders represent a unique population with respect to their higher rates of spinal pain complaints, postoperative complications, and worsened functional outcomes. However, proper identification and treatment of these conditions prior to surgery may significantly improve many outcome measures in this population. Future investigations in this field should attempt to develop and validate current strategies to identify and treat individuals with psychological disorders before surgery to further improve outcomes.

Download Full-text

Letter to the Editor: Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women?

The International Journal of Spine Surgery ◽

10.14444/7035 ◽

2020 ◽

Vol 14 (3) ◽

pp. 267-268

Author(s):

Omolola Fakunle ◽

Ndéye Guisse

Keyword(s):

Postoperative Complications ◽

Spine Surgery ◽

Men And Women ◽

Letter To The Editor

Download Full-text

Usefulness of Timed Up and Go (TUG) Test for Prediction of Adverse Outcomes in Patients Undergoing Thoracolumbar Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyz480 ◽

2019 ◽

Vol 86 (3) ◽

pp. E273-E280

Author(s):

Gregoris Komodikis ◽

Vedavyas Gannamani ◽

Sivaram Neppala ◽

Michael Li ◽

Geno J Merli ◽

...

Keyword(s):

Postoperative Complications ◽

Spine Surgery ◽

Test Performance ◽

Tertiary Care ◽

Skilled Nursing Facility ◽

Thoracolumbar Spine ◽

Adverse Outcomes ◽

Care Hospital ◽

High Grade ◽

Timed Up And Go

Abstract BACKGROUND Spine surgery rates have increased and the high postoperative morbidity in these patients result in increased costs. Consequently, it is essential to identify patients at risk of adverse outcomes. OBJECTIVE To assess whether preoperative Timed Up and Go (TUG) test performance can predict high-grade postoperative complications. METHODS A prospective cohort study of patients undergoing elective thoracolumbar spine surgery in a tertiary care hospital between 2017 and 2018. Patients were assessed preoperatively and assigned to the slow-TUG group if unable to perform or test performance time was ≥18.4 s. Primary outcome: high-grade postoperative complications. Secondary outcomes: overall complications, length of stay (LOS), discharge to healthcare facility, readmission and emergency department (ED) presentation. Patients were followed-up until 6 wk after surgery. RESULTS One hundred three patients (mean age 62.95 ± 10.97 yr) were enrolled. Slow-TUG group were more likely to be classified as American Society of Anaesthesiology (ASA) class 3 (74.1% vs 47.4%, P = .02), non-independent (25.9% vs 5.3%, P < .01), and frail (92.3% vs 42.1%, P < .01). TUG was an independent predictor of high-grade complications (adjusted odds ratio (OR): 4.97, 95% CI: 1.18-22.47), overall complications (OR: 3.77, 95% CI: 1.33-11.81), discharge to a skilled-nursing facility (OR: 3.2, 95% CI: 1.00-10.70), readmission within 6 wk of surgery (OR: 9.14, 95% CI: 2.39-41.26) and LOS (adjusted incident rate ratio (IRR): 1.45, 95% CI: 1.16-1.80). CONCLUSION Compared to traditional risk factors, TUG is an important predictor of adverse postoperative outcomes and may be used preoperatively to identify high-risk thoracolumbar surgery patients.

Download Full-text

2016 Research Grant Award Winner: The severity of preoperative HbA1c and predicting postoperative complications in spine surgery

The Spine Journal ◽

10.1016/j.spinee.2020.05.561 ◽

2020 ◽

Vol 20 (9) ◽

pp. S32

Author(s):

Tomoko Tanaka ◽

Toby Bradford ◽

Michael Gardner ◽

Norman S. Litofsky

Keyword(s):

Postoperative Complications ◽

Spine Surgery ◽

Award Winner ◽

Research Grant

Download Full-text

The 5-Item Modified Frailty Index is Predictive of 30-Day Postoperative Complications in Patients Undergoing Spine Surgery

Spine ◽

10.1097/brs.0000000000003936 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Katherine E. Pierce ◽

Sara Naessig ◽

Nicholas Kummer ◽

Kylan Larsen ◽

Waleed Ahmad ◽

...

Keyword(s):

Postoperative Complications ◽

Spine Surgery ◽

Frailty Index ◽

Modified Frailty Index

Download Full-text

Delayed extubation in spine surgery is associated with increased postoperative complications and hospital episode-based resource utilization

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2021.110636 ◽

2022 ◽

Vol 77 ◽

pp. 110636

Author(s):

Jonathan Gal ◽

Samuel Hunter ◽

David Reich ◽

Eric Franz ◽

Samuel DeMaria ◽

...

Keyword(s):

Postoperative Complications ◽

Resource Utilization ◽

Spine Surgery ◽

Hospital Episode ◽

Delayed Extubation

Download Full-text

Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

Global Spine Journal ◽

10.1177/2192568220979821 ◽

2021 ◽

pp. 219256822097982

Author(s):

Krishna V. Suresh ◽

Kevin Wang ◽

Ishaan Sethi ◽

Bo Zhang ◽

Adam Margalit ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Spine Surgery ◽

Postoperative Infection ◽

Lumbar Fusion ◽

Adult Patients ◽

Cochrane Library ◽

Cardiac Events ◽

Level Of Evidence ◽

Increased Risk

Study Design: Systematic review. Objectives: Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD). Methods: We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries. Results: Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria. PCF and ACDF: Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay. PLF: Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores. LD: LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation. Conclusion: In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification. Level of Evidence: III

Download Full-text