The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation Following Multilevel Thoracic and Lumbar Spine Surgery: A Propensity Score Matched Analysis

Neurosurgery ◽  
2018 ◽  
Vol 85 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Subaraman Ramchandran ◽  
Louis M Day ◽  
Breton Line ◽  
Aaron J Buckland ◽  
Peter Passias ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Propensity Score ◽  
Spine Surgery ◽  
Fluid Administration ◽  
Lumbar Spine Surgery ◽  
Thoracic And Lumbar Spine ◽  
The Impact

scholarly journals Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review

2021 ◽  
Author(s):  
Alice Giotta Lucifero ◽  
Cristian Gragnaniello ◽  
Matias Baldoncini ◽  
Alvaro Campero ◽  
Gabriele Savioli ◽  
...  
Keyword(s):  
At Risk ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Iliac Vein ◽  
Lumbar Spine Surgery ◽  
Common Iliac Vein ◽  
Suture Repair ◽  
Vascular Injuries ◽  
Mesh Terms ◽  
Thoracic And Lumbar Spine

Abstract Purpose To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. Methods PubMed, Medline, and Embase databases were utilized for a comprehensive literature search based on keywords and mesh terms to find articles reporting iatrogenic vascular injury during thoracic and lumbar spine surgery. English articles published in the last ten years were selected. The search was refined based on best match and relevance. Results Fifty-six articles were eligible, for a cumulative volume of 261 lesions. Vascular injuries occurred in 82% of instrumented procedures and in 59% during anterior approaches. The common iliac vein (CIV) was the most involved vessel, injured in 49% of anterior lumbar approaches. Common iliac artery, CIV, and aorta were affected in 40%, 28%, and 28% of posterior approaches, respectively. Segmental arteries were injured in 68% of lateral approaches. Direct vessel laceration occurred in 81% of cases and recognized intraoperatively in 39% of cases. Conclusions Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.

scholarly journals Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

2017 ◽  
Vol 7 (3) ◽  
pp. 213-219 ◽  
Author(s):  
David N. Bernstein ◽  
David Brodell ◽  
Yue Li ◽  
Paul T. Rubery ◽  
Addisu Mesfin
Keyword(s):  
United States ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
International Classification Of Diseases ◽  
The United States ◽  
Lumbar Spine Surgery ◽  
Economic Downturn ◽  
Classification Of Diseases ◽  
Lumbar Spinal ◽  
The Impact

Study Design: Retrospective database analysis. Objective: The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. Methods: The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. Results: From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). Conclusions: The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

Risk factors for delayed extubation in thoracic and lumbar spine surgery: a retrospective analysis of 135 patients

2013 ◽  
Vol 28 (2) ◽  
pp. 161-166 ◽  
Author(s):  
Fenghua Li ◽  
Reza Gorji ◽  
Richard Tallarico ◽  
Charles Dodds ◽  
Katharina Modes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Retrospective Analysis ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Thoracic And Lumbar Spine ◽  
Delayed Extubation

scholarly journals The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110266
Author(s):  
Gregory S. Kazarian ◽  
Michael E. Steinhaus ◽  
Han Jo Kim
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Postoperative Infection ◽  
Corticosteroid Injection ◽  
Meta Analysis ◽  
Significant Risk ◽  
Lumbar Spine Surgery ◽  
Injection Timing ◽  
The Impact

Study Design/Setting: Systematic review/meta-analysis. Objectives: The objective of this review was to assess how the risk of infection following lumbar spine surgery varies as a function of the timing of preoperative corticosteroid spinal injections (CSIs). Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. PubMed and EMBASE databases were searched and data was pooled for meta-analysis. Results: Six studies were identified for inclusion. Two (33.3%) demonstrated a significant relationship between the timing of preoperative CSIs and the risk of postoperative infection, while 4 (66.7%) demonstrated no impact. A total of 2.5% (110/4,448) of patients who underwent CSI <1 month before surgery experienced a postoperative infection, as compared to 1.2% (1,466/120, 943) of controls, which was statistically significant (RR = 1.986 95% CI 1.202-3.282 P = 0.007). A total of 1.6% (25/1,600) of patients who underwent CSI 0-3 months before surgery experienced a postoperative infection, as compared to 1.6% (201/12, 845) of controls (RR = 0.887 95% CI 0.586-1.341, P = 0.569). A total of 1.1% (199/17 870) of patients who underwent CSI 3-6 months before surgery experienced a postoperative infection, as compared to 1.3% (1,382/102, 572) of controls (RR = 1.053 95% CI 0.704-1.575, P = 0.802). Differences in infection risk for 0-3 months and 3-6 months were not statistically significant. Conclusions: CSIs <1 month prior to lumbar spine surgery are a significant risk factor for infection, while CSIs beyond that point showed no such association. Surgeons should consider avoiding CSIs <1 month of the use of CSIs of the spine.

The Impact of Current Smoking and Smoking Cessation on Short-Term Morbidity Risk After Lumbar Spine Surgery

Spine ◽  
2016 ◽  
Vol 41 (7) ◽  
pp. 577-584 ◽  
Author(s):  
Christopher T. Martin ◽  
Yubo Gao ◽  
Kyle R. Duchman ◽  
Andrew J. Pugely
Keyword(s):  
Smoking Cessation ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Short Term ◽  
Current Smoking ◽  
Morbidity Risk ◽  
The Impact

scholarly journals Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

2019 ◽  
Vol 10 (7) ◽  
pp. 844-850
Author(s):  
Mitchell S. Fourman ◽  
Jeremy D. Shaw ◽  
Chinedu O. Nwasike ◽  
Lorraine A. T. Boakye ◽  
Malcolm E. Dombrowski ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Wound Drainage ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Potential Safety ◽  
Risk Patients ◽  
The Impact

Study Design: Retrospective cohort study. Objective: To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients. Methods: Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion. Results: A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients ( P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent. Conclusions: Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.

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