scholarly journals Predictive Factors for Discharge Destination Following Posterior Lumbar Spinal Fusion: A Canadian Spine Outcome and Research Network (CSORN) Study

2018 ◽  
Vol 9 (4) ◽  
pp. 403-408 ◽  
Author(s):  
Mina W. Morcos ◽  
Fan Jiang ◽  
Greg McIntosh ◽  
Henry Ahn ◽  
Nicolas Dea ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Transfusion ◽  
Lumbar Fusion ◽  
Living Alone ◽  
Research Network ◽  
Discharge Destination ◽  
Disability Score ◽  
Fusion Surgery ◽  
Multilevel Fusion

Study Design: Ambispective cohort study. Objective: Patients spend on average 3 to 7 days in hospital after lumbar fusion surgery. Patients who are unable to be discharged home may require a prolonged hospital stay while awaiting a bed at a rehabilitation facility, adding cost and imposing a considerable burden on the health care system. Our objective is to identify patient or procedure related predictors of discharge destination for patients undergoing posterior lumbar fusion. Methods: Analysis of data from the Canadian Spine Outcomes and Research Network. Patients who underwent lumbar fusion for degenerative pathology between 2008 and 2015 were identified. Multivariable logistic regression analysis was used to identify independent predictors of the discharge destination. Results: A total of 643 patients were identified from the database, 87.1% of the patients (N = 560) were discharged home while 12.9% (N = 83) required discharge to nonhome facilities. Using multivariate logistic regression analysis, the predictors for discharge to a facility rather than home were identified including: increasing age (odds ratio [OR] 1.045, 95% confidence interval [CI] 1.017 -1.075, P < .002), increasing body mass index (BMI) (OR 1.069, 95% CI 1.021 -1.118, P < .004), increasing disability score (OR 1.025, 95% CI 1.004 -1.046, P < .02), living alone preoperatively (OR 1.916, 95% CI 1.004-3.654, P < .05), increasing operating time (OR 1.005, 95% CI 1.003 -1.008, P < .0001), need for blood transfusion (OR 3.32, 95% CI 1.687-6.528, P < .001), and multilevel fusion surgery (OR 1.142, 95% CI 1.007 -1.297, P < .04). Conclusions: Older age, high BMI, living alone, high disability score, extended surgical time, blood transfusion, and multilevel fusion are significant factors that increase the odds of being discharged to facilities other than home. Level of Evidence: Level 3.

Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network

2021 ◽  
pp. 219256822098547
Author(s):  
Nathan Evaniew ◽  
Ganesh Swamy ◽  
W. Bradley Jacobs ◽  
Jacques Bouchard ◽  
Roger Cho ◽  
...  
Keyword(s):  
Back Pain ◽  
Degenerative Disc Disease ◽  
Short Form ◽  
Lumbar Fusion ◽  
Research Network ◽  
Disc Disease ◽  
Fusion Surgery ◽  
Degenerative Disc ◽  
Lumbar Fusion Surgery ◽  
Related Quality

Study Design: Uncontrolled retrospective observational study. Objectives: Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We analyzed data that were prospectively collected from consecutive patients at 11 centers between 2015 and 2019. Our primary outcome was change in patient-reported back pain at 12 months of follow-up, and our secondary outcomes were satisfaction, disability, health-related quality of life, and rates of adverse events. Results: Among 84 patients, we observed a statistically significant improvement of back pain at 12 months that exceeded the threshold of Minimum Clinically Important Difference (MCID) (mean change -3.7 points, SD 2.6, p < 0.001, MCID = 1.2; 77% achieved MCID), and 81% reported being “somewhat” or “extremely” satisfied. We also observed improvements of Oswestry Disability Index (-17.3, SD 16.6), Short Form-12 Physical Component Summary (10.3, SD 9.6) and Short Form-12 Mental Component Summary (3.1, SD 8.3); all p < 0.001). The overall rate of adverse events was 19%. Conclusions: Among a highly selective group of patients undergoing lumbar fusion surgery for degenerative disc disease, most experienced a clinically significant improvement of back pain as well as significant improvements of disability and health-related quality of life, with high satisfaction at 1 year of follow-up. These findings suggest that surgery for this indication may provide some benefit, and that further research is warranted.

scholarly journals Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis

2019 ◽  
Vol 10 (2) ◽  
pp. 160-168
Author(s):  
Mark A. Davison ◽  
Daniel T. Lilly ◽  
Shyam A. Desai ◽  
Victoria D. Vuong ◽  
Jessica Moreno ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Racial Differences ◽  
Lumbar Fusion ◽  
Multivariate Logistic Regression Analysis ◽  
Lumbar Stenosis ◽  
Opioid Use ◽  
Fusion Surgery ◽  
Lumbar Fusion Surgery ◽  
Opioid Medications ◽  
Clinical Records

Study Design: Retrospective cohort study. Objectives: To assess for racial differences in opioid utilization prior to and after lumbar fusion surgery for patients with lumbar stenosis or spondylolisthesis. Methods: Clinical records from patients with lumbar stenosis or spondylolisthesis undergoing primary <3-level lumbar fusion from 2007 to 2016 were gathered from a comprehensive insurance database. Records were queried by International Classification of Diseases diagnosis/procedure codes and insurance-specific generic drug codes. Opioid use 6 months prior, through 2 years after surgery was assessed. Multivariate regression analysis was employed to investigate independent predictors of opioid use following lumbar fusion. Results: A total of 13 257 patients underwent <3-level posterior lumbar fusion. The cohort racial distribution was as follows: 80.9% white, 7.0% black, 1.0% Hispanic, 0.2% Asian, 0.2% North American Native, 0.8% “Other,” and 9.8% “Unknown.” Overall, 57.8% patients utilized opioid medications prior to index surgery. When normalized by the number opiate users, all racial cohort saw a reduction in pills disbursed and dollars billed following surgery. Preoperatively, Hispanics had the largest average pills dispensed (222.8 pills/patient) and highest average amount billed ($74.67/patient) for opioid medications. The black cohort had the greatest proportion of patients utilizing preoperative opioids (61.8%), postoperative opioids (87.1%), and long-term opioid utilization (72.7%), defined as use >1 year after index operation. Multivariate logistic regression analysis indicated Asian patients (OR 0.422, 95% CI 0.191-0.991) were less likely to use opioids following lumbar fusion. Conclusions: Racial differences exist in perioperative opioid utilization for patients undergoing lumbar fusion surgery for spinal stenosis or spondylolisthesis. Future studies are needed corroborate our findings.

scholarly journals Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

2020 ◽  
Author(s):  
Shan-Jin Wang ◽  
Shu-Bao Zhang ◽  
Yu-Yang Yi ◽  
Hao-Wei Xu ◽  
De-Sheng Wu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Lumbar Lordosis ◽  
Lumbar Fusion ◽  
Multivariate Logistic Regression Analysis ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
The Ideal

Abstract Background Symptomatic adjacent segment disease (ASDis) is a major complication following spinal fusion. Sagittal spinopelvic imbalance may contribute to the development of ASDis. However, the exact ideal correction of LL is unknown for different ages of people to prevent ASDis. The purpose of this study was to estimate the ideal correction of lumbar lordosis (LL) required to prevent symptomatic ASDis requiring revision surgery in patients of various ages, and to determine the radiographic risk factors for ASDis.Methods 468 patients who underwent lumbar fusion between January 2014 and December 2016, were enrolled in the present study. The patients were classified into the ASDis and N-ASD group. These two matched groups were compared regarding surgery-related factors and radiographic features. Multivariate logistic regression analysis was used to evaluate the risk factors for ASDis.Results Sixty-two patients (13.25%) underwent reoperation for ASDis during a mean follow-up duration of 38.07 months. Receiver operating characteristic curve analysis showed that the postoperative LL - preoperative LL (△LL) cutoff value was 11.7°for the development of ASDis. Logistic regression analysis revealed that the risk factors for symptomatic ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10° (p < 0.05). For patients > 60 years, the incidence of ASDis was higher in patients with a LL correction of ≥ 10° and a lumbar-pelvic mismatch (PI-LL) of > 20°.Conclusions The significant predictors of the occurrence of ASD were a smaller LL angle, △LL > 12°, and PI-LL > 10°. However, in patients older than 60 years, the incidence of ASD after lumbar fusion was higher in those with a LL correction of ≥ 10° and PI-LL of > 20°. More attention should be paid to patient age and the angle of correction of LL before lumbar fusion.

Analysis of anesthesia-related prognostic indicators in neurosurgery

2019 ◽  
Author(s):  
Aihua Shu ◽  
Qiang Wang ◽  
Xiaobo Chen ◽  
Feng Zhou ◽  
Yifei Liu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Transfusion ◽  
Logistic Regression Analysis ◽  
Operation Time ◽  
Apache Ii ◽  
Prognostic Indicators ◽  
Apache Ii Score ◽  
Cardiac Events ◽  
Postoperative Fever

Abstract Background: This retrospective study was conducted to identify prognostic predictors for patients undergoing neurosurgery under general anesthesia.Methods: From April 2015 to May 2017, a total of 757 patients undergoing neurosurgery in our hospital were analyzed. Baseline and clinical data including age, gender, etiology, surgery procedures, comorbid and underlying diseases, the Glasgow coma scale (GCS), the APACHE II score, ASA score, anesthesia class, operation time, intraoperative cardiac events, intraoperative blood transfusion, and postoperative fever were collected and analyzed. The Glasgow outcome scale (GOS) was used as outcome measure. Logistic regression analysis was performed to identify the independent prognostic factors. Results: Among the 14 factors analyzed, twelve were significantly correlated to the GOS scores (P < 0.05), including age, etiology, type of surgery, hypertension, anesthesia class, APACHE II score and ASA class, intraoperative cardiac events, intraoperative blood transfusion and postoperative fever. Further logistic regression analysis showed the three parameters had prognostic values with odds ratios of 3.933, 1.812 and 2.910, respectively. On other hand, gender and operation time were not correlated to GOS.Conclusions: Anesthesia class, APACHE II score and ASA class have significant prognostic values for patients undergoing neurosurgical surgery.

scholarly journals Risk factors analysis of hyperbilirubinemia after off-pump coronary artery bypass grafting: a retrospective observational study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yingdi Gao ◽  
Dongjie Li ◽  
Honghong Dong ◽  
Yulin Guo ◽  
Yuanshu Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Transfusion ◽  
Logistic Regression Analysis ◽  
Total Bilirubin ◽  
Serum Total Bilirubin ◽  
Preoperative Serum ◽  
Independent Risk Factors ◽  
Perioperative Blood Transfusion

Abstract Background Hyperbilirubinemia is a common complication after off-pump coronary artery bypass grafting (OPCAB), but the incidence and the risk factors are unclear. This study aimed to analyze the incidence and risk factors of postoperative hyperbilirubinemia in patients undergoing OPCAB. Methods From December 2016 to March 2019, a total of 416 consecutive patients undergoing OPCAB were enrolled in this single-center retrospective study. Patients were divided into the normal serum total bilirubin group and the hyperbilirubinemia group based on the serum total bilirubin levels. Perioperative variables between the two groups were compared by univariate logistic regression analysis. Then, multivariate binary logistic regression analysis was used to analyze the independent risk factors of developing hyperbilirubinemia in patients underwent OPCAB. P < 0.05 was considered as statistically significant. Results Thirty two of 416 (7.7%) patients developed postoperative hyperbilirubinemia. Univariate regression analysis showed significant differences in gender (73.96% vs. 93.75%, P = 0.012), preoperative total bilirubin levels (11.92 ± 4.52 vs. 18.28 ± 7.57, P < 0.001), perioperative IABP implantation (22.66% vs. 43.75%, P = 0.008), perioperative blood transfusion (37.50% vs. 56.25%, P = 0.037) between the two groups. Multivariate logistic regression analysis revealed that elevated preoperative serum total bilirubin levels (OR = 1.225, 95% CI 1.145–1.310, P < 0.001), perioperative blood transfusion (OR = 4.488, 95% CI 1.876–10.737, P = 0.001) and perioperative IABP implantation (OR = 4.016, 95% CI 1.709–9.439, P = 0.001) were independent risk factors for hyperbilirubinemia after OPCAB. Conclusions Hyperbilirubinemia is also a common complication after OPCAB. Elevated preoperative serum total bilirubin levels, perioperative blood transfusion, and perioperative IABP implantation were independent risk factors for patients developing hyperbilirubinemia after OPCAB. Further studies need to be conducted to confirm the risk factors of hyperbilirubinemia after OPCAB procedure.

scholarly journals Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

2020 ◽  
Author(s):  
Shengyu Wang ◽  
Chao Liu ◽  
Rongzhi Wei ◽  
Qiuhua Zhang ◽  
Feng Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Operative Time ◽  
Blood Transfusions ◽  
Intraoperative Blood Loss ◽  
Multivariate Logistic Regression ◽  
Perioperative Blood Transfusion

Abstract Background. During surgery for thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and thus require a perioperative blood transfusion. However, the risk factors for increased intraoperative blood loss and perioperative blood transfusion have yet to be identified. The aim of this retrospective study was to determine the predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods. From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified using univariate and multivariate logistic regression analyses. Univariate and multivariate linear regressions were conducted to investigate the risk factors for intraoperative blood loss. The predictors of high levels of intraoperative blood loss were analyzed by multivariate logistic regression analysis.Results. Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean age of patients was 49.6 ± 15.5 years old (range 14-85). Our data revealed significant relationships between blood transfusions and female gender, BMI, vertebral collapse/kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent risk factors for intraoperative blood loss. Specifically, a lower BMI, decreased preoperative hemoglobin levels, four or more levels of instrumentation, a combined surgical approach and a prolonged operative time were identified as risk factors for high levels of intraoperative blood loss.Conclusions. This study identified some clinical predictors of perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to the planning of preoperative blood transfusions and help to minimize intra- or postoperative complications. Level of evidenceLevel IV, retrospective case series.

scholarly journals Pulmonary disease as a risk factor for transfusion-related acute lung injury

2021 ◽  
pp. 00039-2021
Author(s):  
Akira Yokoyama ◽  
Yukiyo Sakamoto ◽  
Taisuke Jo ◽  
Hirokazu Urushiyama ◽  
Hiroyuki Tamiya ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Acute Lung Injury ◽  
Blood Transfusion ◽  
Lung Injury ◽  
Pulmonary Disease ◽  
Conditional Logistic Regression ◽  
Blood Products ◽  
Conditional Logistic Regression Analysis

Transfusion-related acute lung injury (TRALI) is a severe condition characterised by noncardiogenic pulmonary edema that develops within 6 h after blood transfusion. Patient factors and blood products have both been implicated in the development of TRALI; however, the role of pulmonary disease has not been investigated. We aimed to determine whether pulmonary disease is a risk factor for TRALI. We conducted a nested case-control study using data from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan, between July 2010 and March 2015. Case patients who developed TRALI were 1:4-matched with control patients for sex, age, and same hospital for receipt of blood transfusion. We conducted a multivariable conditional logistic regression analysis to evaluate the associations of TRALI with various factors including comorbidities, body mass index (BMI), and plasma-containing blood products. We identified 2,019,501 hospitalised patients who received a blood transfusion. Among these patients, 72 developed TRALI. The 72 case patients had higher proportions of hematological malignancy, trauma, and interstitial lung disease (ILD) than the 288 matched control patients. The multivariable conditional logistic regression analysis showed that occurrence of TRALI was associated with ILD (odds ratio, 3.88; 95% confidence interval, 1.11–13.6), BMI ≥25.0 kg·m−2 (2.10; 1.05–4.24), and plasma-containing blood products (1.94; 1.10–3.42), but not with infectious lung disease or obstructive airway disease. In conclusion, ILD was an independent risk factor for the development of TRALI. Physicians should be aware of the increased risk of TRALI in patients with ILD.

scholarly journals Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

2020 ◽  
Author(s):  
Shan-Jin Wang ◽  
Shu-Bao Zhang ◽  
Yu-Yang Yi ◽  
Hao-Wei Xu ◽  
De-Sheng Wu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Lumbar Lordosis ◽  
Lumbar Fusion ◽  
Multivariate Logistic Regression Analysis ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
The Ideal

Abstract Background Symptomatic adjacent segment disease (ASDis) is a major complication following spinal fusion. Sagittal spinopelvic imbalance may contribute to the development of ASDis. However, the exact ideal correction of LL is unknown for different ages of people to prevent ASDis. The purpose of this study was to estimate the ideal correction of lumbar lordosis (LL) required to prevent symptomatic ASDis requiring revision surgery in patients of various ages, and to determine the radiographic risk factors for ASDis. Method 468 patients who underwent lumbar fusion between January 2014 and December 2016, were enrolled in the present study. The patients were classified into the ASDis and N-ASD group. These two matched groups were compared regarding surgery-related factors and radiographic features. Multivariate logistic regression analysis was used to evaluate the risk factors for ASDis. Results Sixty-two patients (13.25%) underwent reoperation for ASDis during a mean follow-up duration of 38.07 months. Receiver operating characteristic curve analysis showed that the postoperative LL - preoperative LL (△LL) cutoff value was 11.7°for the development of ASDis. Logistic regression analysis revealed that the risk factors for symptomatic ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10° (p < 0.05). For patients > 60 years, the incidence of ASDis was higher in patients with a LL correction of ≥ 10° and a lumbar-pelvic mismatch (PI-LL) of > 20°. Conclusions The significant predictors of the occurrence of ASD were a smaller LL angle, △LL > 12°, and PI-LL > 10°. However, in patients older than 60 years, the incidence of ASD after lumbar fusion was higher in those with a LL correction of ≥ 10° and PI-LL of > 20°. More attention should be paid to patient age and the angle of correction of LL before lumbar fusion.

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