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.

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques

2017 ◽  
Vol 45 (2) ◽  
Author(s):  
Cenk Gezer ◽  
Atalay Ekin ◽  
Gokhan Goynumer ◽  
Kaan Pakay ◽  
Hicran Acar ◽  
...  
Keyword(s):  
Significant Risk ◽  
Perinatal Outcomes ◽  
Invasive Procedure ◽  
Significant Risk Factor ◽  
Adverse Outcomes ◽  
Control Group ◽  
Needle Technique ◽  
Adverse Perinatal Outcomes ◽  
Chorion Villus ◽  
The Impact

AbstractObjective:To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.Methods:In this case-control study, 412 women who underwent CVS at 11–14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.Results:The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4–2.7, P=0.008].Conclusion:The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

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 The Predictive Value of N-Terminal Probrain Natriuretic Peptide for Infection in Patients With Acute Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
YiNing Dai ◽  
XiaoLiang Wan ◽  
Can Liu ◽  
ChongYang Duan ◽  
Shuai Shao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Poor Outcomes ◽  
Cox Analysis

Background: Infections increase the risk of poor outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, predicting patients at a high risk of developing infection remains unclear. Moreover, the value of N-terminal probrain natriuretic peptide (NT-proBNP) for predicting infection is still unknown. Thus, we aimed to assess the relationship between NT-proBNP and the following development of infection, and clinical adverse outcomes in patients with STEMI undergoing PCI.Methods: STEMI patients undergoing PCI were consecutively enrolled from January 2010 to July 2016 and divided into groups according to baseline NT-proBNP levels: tertiles T1 (&lt;988 pg/mL), T2 (988–3520 pg/mL), and T3 (≥3520 pg/mL). The primary endpoint was infection during hospitalization.Results: A total of 182 (27%) patients developed in-hospital infection. The incidence of infection increased from T1 to T3 (10.5, 17.7, and 54.5%, P &lt; 0.001). NT-proBNP was an independent risk factor (adjusted odds ratio = 1.39, 95% confidence interval (CI) = 1.12–1.73, P = 0.003) and presented accurately predicting infection (area under curve = 0.774). Multivariate cox analysis showed that NT-proBNP was a significant risk factor for major adverse clinical events (MACE) at follow-up (adjusted HR = 1.92, 95% CI = 1.61–2.29, P &lt; 0.001).Conclusion: The baseline NT-proBNP level has a good predictive value for infection and MACE in STEMI patients undergoing PCI.

Glucose Levels during the First 24 Hours following Perinatal Hypoxia

2019 ◽  
Author(s):  
Mahdi Alsaleem ◽  
Lida I. Zeinali ◽  
Bobby Mathew ◽  
Vasantha H. S. Kumar
Keyword(s):  
Premature Infants ◽  
Physiological Stress ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Significant Risk Factor ◽  
Adverse Outcomes ◽  
Positive Pressure ◽  
Perinatal Brain Injury ◽  
Term Infants ◽  
Glucose Levels

Abstract Objective Hypoglycemia is a significant risk factor for perinatal brain injury and adverse outcomes, particularly in infants requiring resuscitation following hypoxic ischemic (HI) insult. We aimed to study blood glucose (BG) levels in physiologically stressed infants in the presence or absence of epinephrine (Epi) administration at resuscitation in the first 24 hours after birth. Study Design A retrospective chart review of all infants with heart rate (HR) < 100/min at 1 minute requiring positive pressure ventilation (PPV) at birth was performed. Infants were classified into two groups as follows: (1) PPV group: infants' HR improved with PPV only at resuscitation, and Epi group: infants received Epi at resuscitation for persistent bradycardia. Serial measurements of BG levels collected and glucose infusion rate (GIR) calculated at 24 hours. Results By design, infants in the Epi group had lower cord pH and higher base deficit. BG was significantly lower overtime in premature infants ≤32 weeks of gestation in the Epi group. The BG was markedly higher in near-term and term infants in the Epi group compared with the PPV group. Hypoglycemia was more common despite administration of higher GIR in premature infants ≤32 weeks of gestation. Conclusion In the presence of physiological stress, premature infants are more at risk for hypoglycemia than term infants.

scholarly journals Thirty-Day Perioperative Complications, Prolonged Length of Stay, and Readmission Following Elective Posterior Lumbar Fusion Associated With Poor Nutritional Status

2018 ◽  
Vol 9 (4) ◽  
pp. 417-423 ◽  
Author(s):  
Kevin Phan ◽  
William Ranson ◽  
Samuel J. W. White ◽  
Zoe B. Cheung ◽  
Jun Kim ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lumbar Fusion ◽  
Postoperative Mortality ◽  
Unplanned Readmission ◽  
Albumin Concentration ◽  
Improvement Program ◽  
Posterior Lumbar Fusion ◽  
Prolonged Length ◽  
Preoperative Serum ◽  
Perioperative Complication

Study Design: Retrospective study. Objective: To determine the rates of early postoperative mortality and morbidity in adults with hypoalbuminemia undergoing elective posterior lumbar fusion (PLF). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was examined from 2005 to 2012. Current Procedural Terminology (CPT) codes were used to query the database for adults (≥18 years) who underwent PLF and/or posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). Patients were divided into those with normal albumin concentration (≥3.5g/dL) and those with hypoalbuminemia (<3.5 g/dL). Both univariate and multivariate analyses were performed. Results: A total of 2410 patients were included, of whom 2251 (93.4%) were normoalbuminemic and 159 (6.6%) were hypoalbuminemic. Patients with preoperative serum albumin levels <3.5 g/dL were older with a higher American Society of Anesthesiologists (ASA) score, and more comorbidities, including anemia, diabetes, dependent functional status, and preoperative history of chronic steroid therapy. Hypoalbuminemic patients had higher rates of any 30-day perioperative complication ( P < .001), unplanned readmission ( P = .019), and prolonged length of stay (LOS) >5 days ( P < .001). However, hypoalbuminemia was not significantly associated with any specific perioperative complication. On multivariate analysis, preoperative hypoalbuminemia was found to be an independent predictor of prolonged LOS (OR 2.4, 95% CI 1.7-3.5; P < .001) and unplanned readmission (OR 2.7, 95% CI 1.1-6.3; P = .023). Conclusion: Hypoalbuminemia was found to be an important predictor of patient outcomes in this population. This study suggests that clinicians should consider nutritional screening and optimization as part of the preoperative risk assessment algorithm. Level of Evidence: III

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

Physical Illness and Suicide Risk in Rural Residents of Contemporary China

Crisis ◽  
2014 ◽  
Vol 35 (5) ◽  
pp. 330-337 ◽  
Author(s):  
Cun-Xian Jia ◽  
Lin-Lin Wang ◽  
Ai-Qiang Xu ◽  
Ai-Ying Dai ◽  
Ping Qin
Keyword(s):  
Risk Factor ◽  
Family Income ◽  
Rural China ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Health Condition ◽  
Physical Illness ◽  
Rural Residents ◽  
Increased Risk ◽  
Study Population

Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.

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