scholarly journals C2 Versus C3 as the Upper Instrumented Vertebra for Cervicothoracic Posterior Laminectomy and Fusion Demonstrate Equivalent Postoperative Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan K Badiee ◽  
Andrew Kai-Hong Chan ◽  
Joshua Rivera ◽  
Chih-Chang Chang ◽  
Dean Chou ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Short Term ◽  
Radiographic Outcomes ◽  
Baseline Characteristics ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic ◽  
Laminectomy And Fusion

Abstract INTRODUCTION For patients undergoing posterior cervical laminectomy and fusion (PCLF) with an upper thoracic lower instrumented vertebra (LIV), the evidence is unclear as to whether C2 vs C3 is the ideal upper instrumented vertebra (UIV). This study analyzes short-term postoperative outcomes for PCLF comparing cervicothoracic constructs with UIV at C2 and C3. METHODS Adult patients with degenerative cervical spine disease undergoing PCLF from 2012 to 2018 at a single center were identified. Patients with UIV at C2 or C3 and a lower instrumented vertebra (LIV) at T1 or T2 were included. Univariate analysis was performed using Student's t-test, Chi-squared test, or Fisher's exact test. Multivariate regression including variables significant at P = .20 determined the effect of UIV on clinical and radiographic outcomes. RESULTS A total of 74 patients were included, of whom 30 (40.5%) and 44 (59.5%) had a UIV at C2 and C3, respectively. Mean follow-up time was 13.8 mo. Baseline characteristics including age (C2 62.4 vs C3 63.0, P = .80) and preoperative Nurick score (C2 2.3 vs C3 2.2, P = .57) were similar across groups, though the C2 UIV group had a higher rate of revision surgery (23.3% vs 2.7%, P = .006) and diabetes (40.0% vs 9.1%, P = .003). Multivariate analysis of clinical outcomes showed no significant differences, including in the rate of postoperative complications (OR: 1.5, P = .62), discharge home (OR: 1.2, P = .35), hospital length of stay (ß = −1.17 d, P = .28) or Nurick score (ß = −0.46, P = .22). Differences in radiographic outcomes including postoperative cervical lordosis (ß = −7.4 degrees, P = .09) and cSVA (ß = −8.9 degrees, P = .08) approached but did not reach significance. CONCLUSION In a study of PCLF with upper thoracic LIV, there were no significant short-term clinical or radiographic differences between a C2 and C3 UIV when adjusting for baseline characteristics. These results may aid surgeons considering PCLF for degenerative cervical spinal disease.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

Same-Day versus Conventional Different-Day Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy: A Multi-Center Retrospective Study

2018 ◽  
Vol 84 (10) ◽  
pp. 1679-1683
Author(s):  
Mohammed H. Al-Temimi ◽  
Charles Trujillo ◽  
Mital Shah ◽  
Sriram Rangarajan ◽  
Edwin Kim ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Success Rate ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Postoperative Morbidity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Retrograde ◽  
Kaiser Permanente ◽  
Estimated Blood Loss ◽  
Baseline Characteristics

Same-day endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (LC) could potentially reduce hospital length of stay (HLOS). Patients undergoing same-day procedures (N = 164) between 2012 and 2014 were compared with different-day procedures performed in the second half of 2014 (N = 276), in the Kaiser Permanente Southern California database. Both groups had comparable baseline characteristics. ERCP success rate (97.5% vs 93.5%), overall postoperative morbidity (3.66% vs 3.99%), and retained stones (2.5% vs 5.8%) were not different between groups ( P > 0.05); however, HLOS was shorter in the same-day group (2.99 ± 2.34 vs 3.84 ± 2.52 days, P < 0.001). Morbidity, procedure success, and HLOS were not different in the same-day group, whether ERCP was performed before or after LC ( P > 0.05). In the same-day group, those undergoing single anesthesia had higher BMI (40.1 ± 10.8 vs 30.3 ± 6.6) and were more likely to have gastric bypass (30% vs 0%) than those undergoing separate anesthesia sessions ( P < 0.01). Longer HLOS (4.8 ± 3.5 vs 2.9 ± 2.2 days) and higher estimated blood loss (65 ± 90 mL vs 20 ± 29 mL) were also associated with the single-anesthetic session ( P < 0.01). ERCP performed on the same day of LC reduces HLOS without increasing morbidity. This approach does not affect postoperative morbidity and ERCP success rate, whether ERCP was performed before or after LC.

What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

2021 ◽  
pp. 1-7
Author(s):  
M. Omar Iqbal ◽  
Amer F. Samdani ◽  
Joshua M. Pahys ◽  
Peter O. Newton ◽  
Suken A. Shah ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Posterior Spinal Fusion ◽  
Research Society ◽  
Curve Correction ◽  
Scoliosis Research Society ◽  
Lenke Classification ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

scholarly journals Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Doniel Drazin ◽  
Miriam Nuno ◽  
Faris Shweikeh ◽  
Alexander R. Vaccaro ◽  
Eli Baron ◽  
...  
Keyword(s):  
Patient Safety ◽  
Lumbar Spine ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Compression Fracture ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nationwide Inpatient Sample Database ◽  
Average Patient ◽  
National Trends

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty.Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004–2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety.Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p<.0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p≤.001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6–2.5), nonroutine discharge (OR 1.6, CI: 1.6–1.7), complications (OR 1.1, CI: 1.0–1.1), and safety related events (OR 1.1, CI: 1.0–1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety.Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

scholarly journals Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

2015 ◽  
Vol 9 (1-2) ◽  
pp. 48 ◽  
Author(s):  
Aziz M. Khambati ◽  
Elias Wehbi ◽  
Walid A. Farhat
Keyword(s):  
Length Of Stay ◽  
Surgical Outcomes ◽  
Laparoscopic Approach ◽  
Hospital Length ◽  
Single Site ◽  
Hospital Length Of Stay ◽  
Short Term ◽  
Tertiary Center ◽  
Single Site Surgery

Introduction: Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada.Methods: We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/ devices were used to perform the procedures. Access was achieved through a transumbilical incision.Results: A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed.Conclusions: There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.

scholarly journals Patient-Reported Outcomes Following Multi-Ligament Knee Injuries With or Without Internal Brace Augmentation and the Role of Patient Access to Rehabilitation (174)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0029
Author(s):  
Shane Korber ◽  
Ioanna Bolia ◽  
Neilan Benvergnu ◽  
Brian Panish ◽  
Tristan Juhan ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Postoperative Outcomes ◽  
Short Term ◽  
Postoperative Rehabilitation ◽  
Limited Access ◽  
Patient Reported ◽  
Internal Brace ◽  
The Mean ◽  
Baseline Characteristics

Objectives: (1) To compare the postoperative outcomes in patient who underwent multifilament knee reconstruction (MLKR) with or without internal brace augmentation and (2) To examine potential differences in outcomes of patients with different access to postoperative rehabilitation following MLKR. Methods: Adult patients sustaining a multifilament knee injury (MLKI) from 2007 to 2020 who were surgically treated by a single surgeon were retrospectively identified and invited to participate. Patients with incomplete follow up data were excluded. Data recorded included patient demographics, intraoperative procedure performed (with versus without use of internal brace), patient access to rehabilitation after surgery (limited versus full access) and postoperative patient reported outcomes. The last included the Multiligament Quality of Life Questionnaire (MLQOL), PROMIS Computer Adaptive Testing (CAT) for Physical Function, Mobility, and Pain Interference, and the Lysholm Knee Questionnaire. Descriptive statistics were conducted using STATA. Comparison of the postoperative outcomes was performed between patients who received or did not receive internal brace during MLKR and those who had limited versus full access to postoperative rehabilitation, using descriptive statistics (STATA). The level of statistical significance was set at <0.05. Results: A total of 85 (15 females,70 males) patients met the inclusion criteria. Of those, 62 patients (13 females, 49 males underwent MLKR without internal brace augmentation (NIB group) and 23 patients (2 females, 11 males) underwent MLKR with internal brace augmentation (IB group). Patient age and BMI were similar between the IB and NIB groups (Table 1). The mean follow-up time was 5.2+/-0.6 years on the NIB group and 1.5+/-0.1 years in the IB group (p<0.0001). The comparison of baseline characteristics and postoperative outcomes in MLKR patients in the NIB and IB groups is shown in Table 1. There was no difference in any of the postoperative outcome scores between patients in the NIB and IB groups who underwent MLKR. Access to rehabilitation data were available for 83 patients. Of those, 69 patients (12 females, 57 males) had full access to rehabilitation and 17 patients (3 females, 14 males) had limited access to postoperative rehabilitation. The mean follow- up time was similar between patients with versus limited access to rehabilitation (mean time was 2.6 years and 2.2 years respectively, p=0.96). The baseline patient characteristics were similar between the last two subgroups. However, patients with limited access to postoperative rehabilitation had significantly lower PROMIS Pain (p=0.018) and PROMIS Physical Function (p=0.025) scores compared to patients with full access to rehabilitation. The comparison of baseline characteristics and postoperative outcomes in MLKR patients with limited versus full access to postoperative rehabilitation is presented in Table 2. Conclusions: Internal bracing augmentation did not result in significant improvement of postoperative outcomes in patients undergoing MLKR, compared to the traditional technique without the use of internal brace, at short-term follow up. Postoperative rehabilitation is critical in patients who undergo MLKR, as patients with limited access to may experience worse outcomes at short term follow up in comparison to those who have full access to rehabilitation services. The socioeconomic status of the MLKR candidates should be examined preoperatively, and efforts should be made to grant these patients access to postoperative rehabilitation in order to optimize their clinical outcomes.

Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful?

2018 ◽  
Vol 42 (10) ◽  
pp. 2295-2300 ◽  
Author(s):  
Stéphane Poitras ◽  
Kendrick Au ◽  
Kristi Wood ◽  
Geoffrey Dervin ◽  
Paul E. Beaulé
Keyword(s):  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Short Term ◽  
Term Function
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