scholarly journals Impact of Navigation on 30-Day Outcomes for Adult Spinal Deformity Surgery

2021 ◽  
pp. 219256822110475
Author(s):  
Austen D. Katz ◽  
Jesse Galina ◽  
Junho Song ◽  
Sayyida Hasan ◽  
Dean Perfetti ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Large Scale ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Database Study ◽  
Increased Risk ◽  
Spinal Deformity Surgery

Study Design Retrospective database study. Objective Navigation has been increasingly used to treat degenerative disease, with positive radiographic and clinical outcomes and fewer adverse events and reoperations, despite increased operative time. However, short-term analysis on treating adult spinal deformity (ASD) surgery with navigation is limited, particularly using large nationally represented cohorts. This is the first large-scale database study to compare 30-day readmission, reoperation, morbidity, and value-per-operative time for navigated and conventional ASD surgery. Methods Adults were identified in the National Surgical Quality Improvement Program (NSQIP) database. Multivariate regression was used to compare outcomes between navigated and conventional surgery and to control for predictors and baseline differences. Results 3190 ASD patients were included. Navigated and conventional patients were similar. Navigated cases had greater operative time (405 vs 320 min) and mean RVUs per case (81.3 vs 69.7), and had more supplementary pelvic fixations (26.1 vs 13.4%) and osteotomies (50.3 vs 27.7%) ( P <.001). In univariate analysis, navigation had greater reoperation (9.9 vs 5.2%, P = .011), morbidity (57.8 vs 46.8%, P = .007), and transfusion (52.2 vs 41.8%, P = .010) rates. Readmission was similar (11.9 vs 8.4%). In multivariate analysis, navigation predicted reoperation (OR = 1.792, P = .048), but no longer predicted morbidity or transfusion. Most reoperations were infectious and hardware-related. Conclusions Despite controlling for patient-related and procedural factors, navigation independently predicted a 79% increased odds of reoperation but did not predict morbidity or transfusion. Readmission was similar between groups. This is explained, in part, by greater operative time and transfusion, which are risk factors for infection. Reoperation most frequently occurred for wound- and hardware-related reasons, suggesting navigation carries an increased risk of infectious-related events beyond increased operative time.

Peripheral Nerve Injury during Abdominal-Pelvic Surgery: Analysis of the National Surgical Quality Improvement Program Database

2017 ◽  
Vol 83 (11) ◽  
pp. 1214-1219 ◽  
Author(s):  
Christopher J.D. Wallis ◽  
Sarah Peltz ◽  
James Byrne ◽  
Jamie Kroft ◽  
Paul Karanicolas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Peripheral Nerve Injury ◽  
Odds Ratio ◽  
Open Surgery ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
Preventable Complication

Peripheral nerve injury (PNI) is a rare but preventable complication of surgery. We sought to assess whether the use of minimally invasive surgery (MIS) affects the occurrence of PNI. Using the American College of Surgeons National Surgical Quality Improvement Program database, we examined rates of PNI among patients undergoing appendectomy, hysterectomy, colectomy, or radical prostatectomy between 2005 and 2012. We assessed the effect of MIS, as compared with open surgery, on PNI occurrence using logistic regression. Among 297,532 patients, of whom 175,884 (59.1%) underwent MIS, the rate of PNI was 0.03 per cent. Forty-four patients treated using MIS had PNI (0.03%) as compared with 63 who underwent open surgery (0.05%; P = 0.0002). There was a significant decrease in the proportion of surgeries resulting in PNI (P < 0.0001) over time. In univariate analysis, MIS was associated with a decreased occurrence of PNI (odds ratio 0.48, 95% confidence interval 0.33–0.71), but this became nonsignificant on multivariable analysis (odds ratio 0.71, 95% confidence interval 0.47–1.09). Increased operative time and smoking status were the only factors independently associated with an increased risk of PNI on multivariable analysis. MIS techniques during common abdominal-pelvic surgeries do not appear to increase the risk of PNI. Prolonged operative time and smoking are independently associated with an increased risk of PNI. Quality improvement initiatives to increase awareness of PNI and identify patients at increased risk of this preventable complication should be considered.

scholarly journals Risk Factors for Non-Neurological Complications in Adult Spinal Deformity Surgery: An International, Large-Scale, Prospective Multicenter Study

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554345-s-0035-1554345
Author(s):  
Kenneth M. C. Cheung ◽  
Cora Bow ◽  
Dino Samartzis ◽  
Mark Dekutoski ◽  
Frank Schwab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicenter Study ◽  
Spinal Deformity ◽  
Large Scale ◽  
Adult Spinal Deformity ◽  
Neurological Complications ◽  
Prospective Multicenter Study ◽  
Spinal Deformity Surgery

scholarly journals Operative Time Is an Independent Risk Factor for Complications in Adult Spinal Deformity Surgery

2017 ◽  
Vol 17 (10) ◽  
pp. S189 ◽  
Author(s):  
Robert K. Eastlack ◽  
Justin B. Ledesma ◽  
Gregory M. Mundis ◽  
Stacie Nguyen ◽  
Eric O. Klineberg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Spinal Deformity ◽  
Independent Risk Factor ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Spinal Deformity Surgery

scholarly journals Proximal junctional failure prevention in adult spinal deformity surgery utilizing interlaminar fixation constructs

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Alan H. Daniels ◽  
Shyam A. Patel ◽  
Daniel B.C. Reid ◽  
Burke Gao ◽  
Eren O. Kuris ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Neurological Injury ◽  
Spinal Deformity Surgery ◽  
Proximal Junctional Failure ◽  
Upper Instrumented Vertebra ◽  
Tissue Trauma ◽  
Posterior Soft Tissue ◽  
Junctional Kyphosis

Proximal junctional kyphosis (PJK) is a common complication following fusion for Adult Spinal Deformity. PJK and proximal junctional failure (PJF) may lead to pain, neurological injury, reoperation, and increased healthcare costs. Efforts to prevent PJK and PJF have aimed to preserve or reconstruct the posterior spinal tension band and/or modifying instrumentation to allow for more gradual transitions in stiffness at the cranial end of long spinal constructs. We describe placement of an interlaminar fixation construct at the upper instrumented vertebra which may decrease PJK/PJF severity, and is placed with little additional operative time and minimal posterior soft tissue trauma.

scholarly journals ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients

2017 ◽  
Vol 7 (8) ◽  
pp. 719-726 ◽  
Author(s):  
Sulaiman Somani ◽  
John Di Capua ◽  
Jun S. Kim ◽  
Kevin Phan ◽  
Nathan J. Lee ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Stratification ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Wound Complications ◽  
Complication Rates ◽  
Multivariate Logistic Regression ◽  
Improvement Program ◽  
Asa Classification ◽  
Increased Risk

Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery.

scholarly journals Negative Sagittal Balance Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 8 (2) ◽  
pp. 149-155
Author(s):  
Robert K. Merrill ◽  
Jun S. Kim ◽  
Ian T. McNeill ◽  
Samuel C. Overley ◽  
James E. Dowdell ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Balance ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Deformity Correction ◽  
Sagittal Vertical Axis ◽  
Spinal Deformity Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Study Design: Retrospective cohort study. Objective: Elucidate negative sagittal balance following adult spinal deformity surgery. Methods: We conducted a retrospective review of adult spinal deformity patients who underwent long fusion (>5 levels) to the sacrum by a single surgeon at a single institution between 2011 and 2015. Patients were divided into cohorts of postoperative sagittal vertical axis (SVA) <−10 mm, between −10 and +10 mm, or >+10 mm, denoted as groups 1, 2, and 3, respectively. Univariate analysis compared preoperative factors between the groups, and a multivariable logistic regression model was used to determine independent risk factors for developing a negative sagittal balance (SVA<−10 mm) following adult spinal deformity correction. Results: We reviewed 8 patients in group 1, 9 patients in group 2, and 25 patients in group 3. The average postoperative SVA for group 1, group 2, and group 3 were −30.99, +3.67, and +55.56 mm, respectively. There was a trend toward higher upper-instrumented vertebra (UIV) in group 1 (T2) compared with group 2 (T10) and group 3 (T9) ( P = .05). A trend toward lower preoperative SVA in groups 1 and 2 compared with group 3 was also seen (+53.36 vs +71.73 vs +122.80 mm) ( P = .06). Finally, we found a trend toward lower body mass index in group 1 compared with groups 2 and 3 (24.71 vs 25.92 vs 29.33 kg/m2) ( P = .07). Based on multivariable regression, higher UIV was found to be a statistically significant independent predictor for developing a postoperative negative sagittal balance of <−10 mm ( P = .02, odds ratio = 0.67). Conclusions: Our results demonstrate that a higher UIV may predispose patients undergoing adult spinal deformity correction to have a postoperative negative sagittal balance.

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