Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
Muwaffak Abdulhak ◽  
David R Nerenz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Vein Thrombosis

Abstract BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P < .001), rehab discharge (odds ratio [OR] 0.52, P < .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P < .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

scholarly journals Ambulation on POD#0 Is Associated With Decreased Adverse Events After Elective Lumbar Spine Surgery: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Rachel J Hunt ◽  
Theresa A Elder ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Patient Variables ◽  
Multilevel Fusion

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality-improvement collaborative. Using MSSIC, we sought to identify the relationship between ambulation on the day of surgery (POD#0) and 90-d adverse events after lumbar surgery, specifically length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), PE/DVT, and disposition to a rehab facility. METHODS In 23295 lumbar surgery patients, matching was performed to ensure overlap on patient variables. Generalized estimating equations (GEE) models were run on the matched dataset to further account for patient demographics, medical history, and surgical intensity. RESULTS POD#0 ambulation was associated with decreased LOS (OR 0.83, P < .001), UR (OR 0.73, P = .008), UTI (OR 0.52, P = .001), ileus (OR 0.52, P < .001), 30-d (OR 0.84, P = .035) and 90-d (OR 0.86, P = .009) readmission, and rehab discharge (OR 0.52, P < .001) for all patients. POD#0 ambulation after single-level decompression (6244 patients) decreased LOS (OR 0.72, P < .001), UR (OR 0.73, P = .004), UTI (OR 0.43, P = .003), and rehab discharge (OR 0.18, P < .001). Ambulation after multilevel decompression (5526 patients) was associated with decreased LOS (OR 0.73, P < .001), UR (OR 0.75, P = .04), ileus (OR 0.60, P = .027), and rehab discharge (OR 0.44, P < .001). Ambulation after single-level fusion (5790 patients) decreased LOS (OR 0.85, P < .001), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.65, P = .004). Ambulation after multilevel fusion (5735 patients) decreased LOS (OR 0.88, P < .001), UTI (OR 0.60, P = .003), ileus (OR 0.51, P = .02), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.59, P < .001). No change in rate of or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related enhanced recovery after surgery (ERAS) programs.

scholarly journals P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

2021 ◽  
Vol 48 (s3) ◽  
pp. S83-S83
Author(s):  
O Ayling ◽  
C FIsher
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Physical Disability ◽  
Research Network ◽  
Lumbar Spine Surgery ◽  
Degenerative Disorders ◽  
Patient Reported ◽  
Euroqol 5D

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

2020 ◽  
pp. 1-23
Author(s):  
Zach Pennington ◽  
Ethan Cottrill ◽  
Daniel Lubelski ◽  
Jeff Ehresman ◽  
Nicholas Theodore ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Lumbar Spine Surgery ◽  
Complication Rates ◽  
Protocol Implementation ◽  
Eras Protocol ◽  
Adult Spine

OBJECTIVESpine surgery has been identified as a significant source of healthcare expenditures in the United States. Prolonged hospitalization has been cited as one source of increased spending, and there has been drive from providers and payors alike to decrease inpatient stays. One strategy currently being explored is the use of Enhanced Recovery After Surgery (ERAS) protocols. Here, the authors review the literature on adult spine ERAS protocols, focusing on clinical benefits and cost reductions. They also conducted a quantitative meta-analysis examining the following: 1) length of stay (LOS), 2) complication rate, 3) wound infection rate, 4) 30-day readmission rate, and 5) 30-day reoperation rate.METHODSUsing the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, CINAHL, and OVID Medline databases was conducted to identify all full-text articles in the English-language literature describing ERAS protocol implementation for adult spine surgery. A quantitative meta-analysis using random-effects modeling was performed for the identified clinical outcomes using studies that directly compared ERAS protocols with conventional care.RESULTSOf 950 articles reviewed, 34 were included in the qualitative analysis and 20 were included in the quantitative analysis. The most common protocol types were general spine surgery protocols and protocols for lumbar spine surgery patients. The most frequently cited benefits of ERAS protocols were shorter LOS (n = 12), lower postoperative pain scores (n = 6), and decreased complication rates (n = 4). The meta-analysis demonstrated shorter LOS for the general spine surgery (mean difference −1.22 days [95% CI −1.98 to −0.47]) and lumbar spine ERAS protocols (−1.53 days [95% CI −2.89 to −0.16]). Neither general nor lumbar spine protocols led to a significant difference in complication rates. Insufficient data existed to perform a meta-analysis of the differences in costs or postoperative narcotic use.CONCLUSIONSPresent data suggest that ERAS protocol implementation may reduce hospitalization time among adult spine surgery patients and may lead to reductions in complication rates when applied to specific populations. To generate high-quality evidence capable of supporting practice guidelines, though, additional controlled trials are necessary to validate these early findings in larger populations.

Presenteeism and Absenteeism Before and After Single-Level Lumbar Spine Surgery

2021 ◽  
Author(s):  
Mark Alan Fontana ◽  
Wasif Islam ◽  
Michelle A. Richardson ◽  
Cathlyn K. Medina ◽  
Eleni C. Kohilakis ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Single Level ◽  
Before And After

The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S95-S95
Author(s):  
Oliver G S Ayling ◽  
Tamir Ailon ◽  
John T Street ◽  
Nicolas Dea ◽  
Greg McIntosh ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Lumbar Spine Surgery ◽  
Patient Reported

scholarly journals Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

2021 ◽  
Vol 34 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Christine Park ◽  
Alessandra N. Garcia ◽  
Chad Cook ◽  
Christopher I. Shaffrey ◽  
Oren N. Gottfried
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Normal Weight ◽  
Lumbar Spine Surgery ◽  
Morbidly Obese ◽  
Lumbar Surgery ◽  
Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

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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