Letter to Editor on “Infection Recurrence in Instrumented Spinal Fusion in Children” by Carlos A. Moyano et al

Study Design: Level 4 retrospective case series. Objectives: Surgical site infection (SSI) is one of the main complications of instrumented spinal fusion. The aim of our study was to evaluate infection recurrence (same bacteria) or reinfection (different bacteria) in posterior spinal fusion in children. Methods: A retrospective study was conducted to evaluate patients who were successfully treated for SSI after instrumented spinal fusion due to deformity, with irrigation and debridement (I&D) procedures, followed by antibiotic therapy, with a follow-up of at least 2 years. Results: Overall, 29 patients with a mean age of 14 + 3 years were evaluated. Preoperative diagnosis was nonidiopathic scoliosis in 23, idiopathic scoliosis in 5, and Scheuermann’s disease in 1 patient. The etiology was Gram-positive cocci (40.9%), Gram-negative bacilli (27.2%), and polymicrobial infection (31.8%). A mean of 1.5 (1-3) I&D procedures were performed. Intravenous antibiotic treatment was given for a mean of 15.8 (4-86) days, followed by oral treatment for a mean of 335.1 (0-1095) days. Mean follow-up was 5 + 2 years (2 to 14 + 7 years) during which 28 patients were cured (96.6%) and 1 patient developed reinfection (3.4%). This reinfection was treated with oral clindamycin for 6 months. After the infection persisted, the decision was to remove the implants. Conclusions: In this series of 29 pediatric patients who underwent instrumented spinal fusion due to deformity, we reported one case of reinfection (3.4%). Given that 96.6% of infections were resolved, we suggest treatment with I&D procedures with retention of implants to treat acute SSI.

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Low Confidence in Spinal Fusion Not Likely to Affect Coverage

Family Practice News ◽

10.1016/s0300-7073(07)70192-5 ◽

2007 ◽

Vol 37 (3) ◽

pp. 57

Author(s):

ALICIA AULT

Keyword(s):

Spinal Fusion

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Accelerated Discharge Protocol for Posterior Spinal Fusion (PSF) in Adolescent Idiopathic Scoliosis (AIS) Decreased Hospital Charges 21% without Increasing Post-Operative Complications

10.1542/peds.140.1_meetingabstract.104 ◽

2017 ◽

Author(s):

Austin E. Sanders ◽

Lindsay Andras ◽

Ted Sousa ◽

David L. Skaggs

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Hospital Charges ◽

Operative Complications ◽

Discharge Protocol ◽

Post Operative Complications

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Treatment of Neuromuscular Scoliosis with Posterior Spinal Fusion Using the Galveston Technique: A Retrospective Review and Results of 62 Patients

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.v13.i6.10 ◽

2003 ◽

Vol 13 (6) ◽

pp. 8 ◽

Cited By ~ 8

Author(s):

Bryan T. Edwards ◽

Robert D. Zura ◽

Styles Bertrand ◽

Sharon Leonard ◽

Jonathan Pellett

Keyword(s):

Spinal Fusion ◽

Retrospective Review ◽

Posterior Spinal Fusion ◽

Neuromuscular Scoliosis ◽

Galveston Technique

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The effect of hospital characteristics on pediatric neuromuscular scoliosis fusion cost

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19194 ◽

2019 ◽

Vol 24 (6) ◽

pp. 713-721

Author(s):

Jonathan Dallas ◽

Chevis N. Shannon ◽

Christopher M. Bonfield

Keyword(s):

Spinal Fusion ◽

Economies Of Scale ◽

Hospital Costs ◽

Neuromuscular Scoliosis ◽

Teaching Hospitals ◽

Inclusion Criteria ◽

Cost Information ◽

Nonprofit Hospitals ◽

Disease Etiology ◽

Hospital Characteristics

OBJECTIVESpinal fusion is used in the treatment of pediatric neuromuscular scoliosis (NMS) to improve spine alignment and delay disease progression. However, patients with NMS are often medically complex and require a higher level of care than those with other types of scoliosis, leading to higher treatment costs. The purpose of this study was to 1) characterize the cost of pediatric NMS fusion in the US and 2) determine hospital characteristics associated with changes in overall cost.METHODSPatients were identified from the National Inpatient Sample (2012 to the first 3 quarters of 2015). Inclusion criteria selected for patients with NMS, spinal fusion of at least 4 vertebral levels, and elective hospitalization. Patients with no cost information were excluded. Sociodemographics, treating hospital characteristics, disease etiology/severity, comorbidities, length of stay, and hospital costs were collected. Univariable analysis and multivariable gamma log-link regression were used to determine hospital characteristics associated with changes in cost.RESULTSA total of 1780 weighted patients met inclusion criteria. The median cost was $68,815. Following multivariable regression, both small (+$11,580, p < 0.001) and medium (+$6329, p < 0.001) hospitals had higher costs than large hospitals. Rural hospitals had higher costs than urban teaching hospitals (+$32,438, p < 0.001). Nonprofit hospitals were more expensive than both government (–$4518, p = 0.030) and investor-owned (–$10,240, p = 0.001) hospitals. There was significant variability by US census division; compared with the South Atlantic, all other divisions except for the Middle Atlantic had significantly higher costs, most notably the West North Central (+$15,203, p < 0.001) and the Pacific (+$22,235, p < 0.001). Hospital fusion volume was not associated with total cost.CONCLUSIONSA number of hospital factors were associated with changes in fusion cost. Larger hospitals may be able to achieve decreased costs due to economies of scale. Regional differences could reflect uncontrolled-for variability in underlying patient populations or systems-level and policy differences. Overall, this analysis identified multiple systemic patterns that could be targets of further cost-related interventions.

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Effects of preoperative obesity and psychiatric comorbidities on minimum clinically important differences for lumbar fusion in grade 1 degenerative spondylolisthesis: analysis from the prospective Quality Outcomes Database registry

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine20296 ◽

2020 ◽

Vol 33 (5) ◽

pp. 635-642

Author(s):

Joseph Laratta ◽

Leah Y. Carreon ◽

Avery L. Buchholz ◽

Andrew Y. Yew ◽

Erica F. Bisson ◽

...

Keyword(s):

Spinal Fusion ◽

Preoperative Diagnosis ◽

Rating Scale ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Leg Pain ◽

Quality Outcomes ◽

Medical Comorbidities ◽

Fusion Procedure ◽

Patient Reported

OBJECTIVEMedical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.METHODSThe Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.RESULTSOf 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.CONCLUSIONSMCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

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