Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Neurosurgery ◽  
2020 ◽  
Author(s):  
Nitin Agarwal ◽  
Ezequiel Goldschmidt ◽  
Tavis Taylor ◽  
Souvik Roy ◽  
Stefanie C Altieri Dunn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Cohort Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Quality Improvement Initiative ◽  
Exact Test ◽  
Frail Patients ◽  
Increased Risk ◽  
Venous Thromboembolic

Abstract BACKGROUND With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

2018 ◽  
Vol 128 (5) ◽  
pp. 880-890 ◽  
Author(s):  
Atul Gupta ◽  
Junaid Nizamuddin ◽  
Dalia Elmofty ◽  
Sarah L. Nizamuddin ◽  
Avery Tung ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operating Room ◽  
Healthcare Utilization ◽  
Cohort Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Opioid Abuse ◽  
Hospital Length Of Stay ◽  
Opioid Overdose ◽  
Readmission Rates

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

scholarly journals Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Chia-shi Wang ◽  
Jia Yan ◽  
Robert Palmer ◽  
James Bost ◽  
Mattie Feasel Wolf ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
High Morbidity ◽  
Metropolitan Statistical Area ◽  
Childhood Nephrotic Syndrome ◽  
Steroid Dependent ◽  
Increased Risk ◽  
Serious Disease

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

scholarly journals Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1693
Author(s):  
Daryl Ramai ◽  
Khoi P. Dang-Ho ◽  
Anjali Kewalramani ◽  
Praneeth Bandaru ◽  
Rodolfo Sacco ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Encephalopathy ◽  
Length Of Stay ◽  
Risk Score ◽  
Cox Regression ◽  
Surrogate Marker ◽  
Hospital Length Of Stay ◽  
Frail Patients ◽  
Increased Risk ◽  
The Impact

Frailty represents a state of vulnerability to multiple internal physiologic factors, as well as external pressures, and has been associated with clinical outcomes. We aim to understand the impact of frailty on patients admitted with hepatocellular carcinoma (HCC) by using the validated Hospital Frailty Risk Score, which is implemented in several hospitals worldwide. We conducted a nation-wide retrospective cohort study to determine the effect of frailty on the risk of in-patient mortality, hepatic encephalopathy, length of stay and cost. Frailty was associated with a 4.5-fold increased risk of mortality and a 2.3-fold increased risk of hepatic encephalopathy. Adjusted Cox regression showed that frailty was correlated with increased risk of in-patient mortality (hazard ratio: 2.3, 95% CI 1.9–2.8, p < 0.001). Frail HCC patients had longer hospital stay (median 5 days) vs. non-frail HCC patients (median 3 days). Additionally, frail patients had higher total costs of hospitalization ($40,875) compared with non-frail patients ($31,667). Frailty is an independent predictor of hepatic encephalopathy and in-patient mortality. Frailty is a surrogate marker of hospital length of stay and cost.

Laparoscopic Shunt Revision Avoids Many Complications of Open Shunt Revision and Has Outcomes Similar to First-time Shunt Placement

2015 ◽  
Vol 81 (3) ◽  
pp. 305-308
Author(s):  
Heather Logghe ◽  
John Maa ◽  
Michael McDermott ◽  
Michael Oh ◽  
Jonathan Carter
Keyword(s):  
Length Of Stay ◽  
Retrospective Cohort ◽  
Operative Time ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Shunt Revision ◽  
Visceral Injury ◽  
Shunt Placement ◽  
Increased Risk ◽  
First Time

Open revision of abdominal shunts is associated with increased risk of wound infection, visceral injury, hernia, and shunt complications. We hypothesized that laparoscopic revision mitigates these risks to a level similar to initial (i.e., first-time) shunt placement. This was a single-center, multisurgeon, retrospective cohort study of patients who underwent either laparoscopic initial shunt placement or laparoscopic shunt revision over a 5-year period. Outcomes were operative time, length of stay, and 30-day complication rate. Sixty-nine patients underwent laparoscopic shunt revision and 99 patients underwent laparoscopic initial shunt placement. Operative times were nearly identical (75 vs 73 minutes, P = 0.63). There were no significant differences in blood loss or hospital length of stay. Abdominal complications and total complications did not differ between groups. Laparoscopic shunt revision avoided many of the known complications of open shunt revision and had outcomes similar to initial laparoscopic shunt placement.

Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary?

2013 ◽  
Vol 79 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Annabelle L. Fonseca ◽  
Kevin M. Schuster ◽  
Adrian A. Maung ◽  
Lewis J. Kaplan ◽  
Kimberly A. Davis
Keyword(s):  
Respiratory Failure ◽  
Small Bowel ◽  
Length Of Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
Nasogastric Decompression

Bowel rest, nasogastric (NG) decompression, and intravenous hydration are used to treat small bowel obstruction (SBO) conservatively; however, there are no data to support nasogastric tube (NGT) use in patients without active emesis. We aim to evaluate the use of nasogastric decompression in SBO and the safety of managing patients with SBO without the use of a NGT. A retrospective chart review was conducted of adult patients admitted to Yale New Haven Hospital over five years with the diagnosis of SBO. We compared patients who received NG decompression with those who did not. Outcome variables assessed were days to resolution, associated complications, hospital length of stay, and disposition. Of 290 patients who fit the criteria, 190 patients (65.52%) were managed conservatively. Fifty-five patients (18.97%) did not receive NGTs. Sixty-eight patients (23.45%) did not present with emesis; however, nearly 75 per cent of these patients received NGTs. Development of pneumonia and respiratory failure was significantly associated with NGT placement. Time to resolution and hospital length of stay were significantly higher in patients with NGTs. Patients with NG decompression had a significantly increased risk of pneumonia and respiratory failure as well as increased time to resolution and hospital length of stay.

scholarly journals Can Liposomal Bupivacaine Be Safely Utilized in Elective Spine Surgery?

2018 ◽  
Vol 9 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Luke Brown ◽  
Tristan Weir ◽  
Scott Koenig ◽  
Mark Shasti ◽  
Imran Yousaf ◽  
...  
Keyword(s):  
Relative Risk ◽  
Length Of Stay ◽  
Urinary Retention ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fusion Surgery ◽  
Liposomal Bupivacaine ◽  
Lumbar Decompression ◽  
Increased Risk ◽  
Significant Difference

Study Design: Single-blinded prospective randomized control trial. Objectives: To compare the incidence of adverse events (AEs) and hospital length of stay between patients who received liposomal bupivacaine (LB) versus a single saline injection, following posterior lumbar decompression and fusion surgery for degenerative spondylosis. Methods: From 2015 to 2016, 59 patients undergoing posterior lumbar decompression and fusion surgery were prospectively enrolled and randomized to receive either 60 mL injection of 266 mg LB or 60 mL of 0.9% sterile saline, intraoperatively. Outcome measures included the incidence of postoperative AEs and hospital length of stay. Results: The most common AEs in the treatment group were nausea (39.3%), emesis (18.1%), and hypotension (18.1%). Nausea (23%), constipation (19.2%), and urinary retention (15.3%) were most common in the control group. Patients who received LB had an increased risk of developing nausea (relative risk [RR] = 1.7; 95% confidence interval [CI] = 0.75-3.8), emesis (RR = 2.3; 95% CI = 0.51-10.7), and headaches (RR = 2.36; 95% CI = 0.26-21.4). Patients receiving LB had a decreased risk of developing constipation (RR = 0.78; 95% CI = 0.25-2.43), urinary retention (RR = 0.78; 95% CI = 0.21-2.85), and pruritus (RR = 0.78; 95% = 0.21-2.8) postoperatively. Relative risk values mentioned above failed to reach statistical significance. No significant difference in the hospital length of stay between both groups was found (3.9 vs 3.9 days; P = .92). Conclusion: Single-dose injections of LB to the surgical site prior to wound closure did not significantly increase or decrease the incidence or risk of developing AEs postoperatively. Furthermore, no significant difference was found in the hospital length of stay between both groups.

scholarly journals Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

2015 ◽  
Vol 123 (6) ◽  
pp. 1301-1311 ◽  
Author(s):  
Felix Kork ◽  
Felix Balzer ◽  
Claudia D. Spies ◽  
Klaus-Dieter Wernecke ◽  
Adit A. Ginde ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Hospital Length ◽  
Noncardiac Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Risk Of Death ◽  
Postoperative Changes ◽  
Increased Risk

Abstract Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P &lt; 0.001) and a longer HLOS of 5 days (P &lt; 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but &lt; 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P &lt; 0.001) and 2 days longer HLOS (P &lt; 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P &lt; 0.05) and a 3-day longer HLOS (P &lt; 0.01) when undergoing noncardiac surgery. Conclusions Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes.

Sign in / Sign up

Export Citation Format

Share Document