Primary and Revision Posterior Lumbar Fusion Have Similar Short-Term Complication Rates

Spine ◽  
2016 ◽  
Vol 41 (2) ◽  
pp. E101-E106 ◽  
Author(s):  
Bryce A. Basques ◽  
Pablo J. Diaz-Collado ◽  
Benjamin J. Geddes ◽  
Andre M. Samuel ◽  
Adam M. Lukasiewicz ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Complication Rates ◽  
Short Term ◽  
Posterior Lumbar Fusion

scholarly journals Does the ranking of surgeons in a publicly available online platform correlate with objective outcomes?

2017 ◽  
Vol 127 (2) ◽  
pp. 353-359 ◽  
Author(s):  
Kimon Bekelis ◽  
Symeon Missios ◽  
Shannon Coy ◽  
Jeremiah N. Johnson
Keyword(s):  
New York ◽  
Lumbar Fusion ◽  
New York State ◽  
Mixed Effects ◽  
Complication Rates ◽  
Posterior Lumbar Fusion ◽  
Rehabilitation Facility ◽  
Time Period ◽  
Multivariable Regression ◽  
Objective Outcomes

OBJECTIVEThe accuracy of public reporting in health care, especially from private vendors, remains an issue of debate. The authors investigated the association of the publicly reported physician complication rates in an online platform with real-world adverse outcomes of the same physicians for patients undergoing posterior lumbar fusion.METHODSThe authors performed a cohort study involving physicians performing posterior lumbar fusions between 2009 and 2013 who were registered in the Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data over the same time period from ProPublica, a private company. Mixed-effects multivariable regression models were used to investigate the association of publicly available complication rates with the rate of discharge to a rehabilitation facility, length of stay, mortality, and hospitalization charges for the same surgeons.RESULTSDuring the selected study period, there were 8,457 patients in New York State who underwent posterior lumbar fusion performed by the 56 surgeons represented in the ProPublica Surgeon Scorecard over the same time period. Using a mixed-effects multivariable regression model, the authors demonstrated that publicly reported physician-level complication rates were not associated with the rate of discharge to a rehabilitation facility (OR 0.97, 95% CI 0.72–1.31), length of stay (adjusted difference −0.1, 95% CI −0.5 to 0.2), mortality (OR 0.87, 95% CI 0.49–1.55), and hospitalization charges (adjusted difference $18,735, 95% CI −$59,177 to $96,647). Similarly, no association was observed when utilizing propensity score–adjusted models, and when restricting the cohort to a predefined subgroup of Medicare patients.CONCLUSIONSAfter merging a comprehensive all-payer posterior lumbar fusion cohort in New York State with data from the ProPublica Surgeon Scorecard over the same time period, the authors observed no association of publicly available physician complication rates with objective outcomes.

National Complication Rates and Disposition After Posterior Lumbar Fusion for Acquired Spondylolisthesis

Spine ◽  
2009 ◽  
Vol 34 (18) ◽  
pp. 1963-1969 ◽  
Author(s):  
Paul S. Kalanithi ◽  
Chirag G. Patil ◽  
Maxwell Boakye
Keyword(s):  
Lumbar Fusion ◽  
Complication Rates ◽  
Posterior Lumbar Fusion

scholarly journals Diabetes Is Predictive of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion

2020 ◽  
pp. 219256822094848
Author(s):  
Annie E. Arrighi-Allisan ◽  
Sean N. Neifert ◽  
Jonathan S. Gal ◽  
Lawrence Zeldin ◽  
Jeffrey H. Zimering ◽  
...  
Keyword(s):  
Emergency Room ◽  
Emergency Room Visit ◽  
Lumbar Fusion ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Adverse Outcomes ◽  
Complication Rates ◽  
Posterior Lumbar Fusion ◽  
Prolonged Length ◽  
Comorbidity Burden

Study Design: Retrospective cohort study. Objective: The present study analyzes complication rates and episode-based costs for patients with and without diabetes mellitus (DM) following posterior lumbar fusion (PLF). Methods: PLF cases at a single institution from 2008 to 2016 were queried (n = 3226), and demographic and perioperative data were analyzed. Patients with and without the diagnosis of DM were compared using chi-square, Student’s t test, and multivariable regression modeling. Results: Patients with diabetes were older (63.10 vs 56.48 years, P < .001) and possessed a greater number of preoperative comorbidities (47.84% of patients had Elixhauser Comorbidity Index >0 vs 42.24%, P < .001) than did patients without diabetes. When controlling for preexisting differences, diabetes remained a significant risk factor for prolonged length of stay (OR = 1.59, 95% CI 1.26-2.01, P < .001), intensive care unit stay (OR = 1.52, 95% CI 1.07-2.17, P = .021), nonhome discharge (OR = 1.86, 95% CI 1.46-2.37, P < .001), 30-day readmission (OR = 2.15, 95% CI 1.28-3.60, P = .004), 90-day readmission (OR = 1.65, 95% CI 1.05-2.59, P = .031), 30-day emergency room visit (OR = 2.15, 95% CI 1.27-3.63, P = .004), and 90-day emergency room visit (OR = 2.27, 95% CI 1.41-3.65, P < .001). Cost modeling controlling for overall comorbidity burden demonstrated that diabetes was associated with a $1709 increase in PLF costs (CI $344-$3074, P = .014). Conclusions: The present findings indicate a correlation between diabetes and a multitude of postoperative adverse outcomes and increased costs, thus illustrating the substantial medical and financial burdens of diabetes for PLF patients. Future studies should explore preventive measures that may mitigate these downstream effects.

Rheumatoid Arthritis Increases Risk of Medical Complications Following Posterior Lumbar Fusion

2021 ◽  
Author(s):  
Joshua Bell ◽  
Sean Sequeira ◽  
Pramod Kamalapathy ◽  
Varun Puvanesarajah ◽  
Hamid Hassanzadeh
Keyword(s):  
Rheumatoid Arthritis ◽  
Lumbar Fusion ◽  
Medical Complications ◽  
Posterior Lumbar Fusion

scholarly journals Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

2020 ◽  
Author(s):  
Eitan Podgaetz ◽  
Vani Konda
Keyword(s):  
Third Space ◽  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Invasive Techniques ◽  
Per Oral

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.

scholarly journals Using Predictive Modeling and Supervised Machine Learning to Identify Patients at Risk for Venous Thromboembolism Following Posterior Lumbar Fusion

2021 ◽  
pp. 219256822110193
Author(s):  
Kevin Y. Wang ◽  
Ijezie Ikwuezunma ◽  
Varun Puvanesarajah ◽  
Jacob Babu ◽  
Adam Margalit ◽  
...  
Keyword(s):  
Machine Learning ◽  
At Risk ◽  
Venous Thromboembolism ◽  
Risk Stratification ◽  
Predictive Model ◽  
Predictive Modeling ◽  
Lumbar Fusion ◽  
Posterior Lumbar Fusion ◽  
Single Level ◽  
Patients At Risk

Study Design: Retrospective review. Objective: To use predictive modeling and machine learning to identify patients at risk for venous thromboembolism (VTE) following posterior lumbar fusion (PLF) for degenerative spinal pathology. Methods: Patients undergoing single-level PLF in the inpatient setting were identified in the National Surgical Quality Improvement Program database. Our outcome measure of VTE included all patients who experienced a pulmonary embolism and/or deep venous thrombosis within 30-days of surgery. Two different methodologies were used to identify VTE risk: 1) a novel predictive model derived from multivariable logistic regression of significant risk factors, and 2) a tree-based extreme gradient boosting (XGBoost) algorithm using preoperative variables. The methods were compared against legacy risk-stratification measures: ASA and Charlson Comorbidity Index (CCI) using area-under-the-curve (AUC) statistic. Results: 13, 500 patients who underwent single-level PLF met the study criteria. Of these, 0.95% had a VTE within 30-days of surgery. The 5 clinical variables found to be significant in the multivariable predictive model were: age > 65, obesity grade II or above, coronary artery disease, functional status, and prolonged operative time. The predictive model exhibited an AUC of 0.716, which was significantly higher than the AUCs of ASA and CCI (all, P < 0.001), and comparable to that of the XGBoost algorithm ( P > 0.05). Conclusion: Predictive analytics and machine learning can be leveraged to aid in identification of patients at risk of VTE following PLF. Surgeons and perioperative teams may find these tools useful to augment clinical decision making risk stratification tool.

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