166 Predictive Modeling of Length of Hospital Stay Following Adult Spinal Deformity Correction

Abstract Study Design: Retrospective case series.Objectives: This study aimed to determine the prevalence and risk factors for orthostatic hypotension (OH) in adolescents undergoing posterior spinal fusion for spinal deformity correction.Methods: The data of 312 consecutive adolescents who underwent posterior spinal fusion for spinal deformity correction in our center over 12 months were retrieved. Patient characteristics, including whether laminectomy or osteotomy was performed during the surgery, the occurrence of postoperative nausea and vomiting (PONV), perioperative hemoglobin albumin changes, perioperative blood transfusion, length of bed rest, willingness to ambulate, length of postoperative exercises of the lower limbs, and length of hospital stay, were collected and compared statistically between patients who did and did not develop postoperative OH.Results: Of 312 patients, 225 (72.1%) developed OH postoperatively, and all cases completely resolved 5 days after the first out-of-bed exercises. Significant differences in BMI, the incidence of PONV, the willingness to ambulate and the length of postoperative exercises of the lower limbs were observed. The mean length of hospital stay of the patients with OH was longer than that of the patients without OH.Conclusion: Our study suggests that temporary OH is a common manifestation following posterior spinal fusion for spinal deformity correction in adolescents. Postoperative OH may increase the length of hospital stay in these patients. Patients with PONV, who are not willing to ambulate and who perform postoperative lower limb exercises for a shorter time are more likely to have OH.

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Predicting Extended Length of Hospital Stay in an Adult Spinal Deformity Surgical Population

Spine ◽

10.1097/brs.0000000000001391 ◽

2016 ◽

Vol 41 (13) ◽

pp. E798-E805 ◽

Cited By ~ 21

Author(s):

Eric O. Klineberg ◽

Peter G. Passias ◽

Cyrus M. Jalai ◽

Nancy Worley ◽

Daniel M. Sciubba ◽

...

Keyword(s):

Hospital Stay ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Length Of Hospital Stay ◽

Extended Length

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Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04931-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ying Yang ◽

Yaping Chen ◽

Bingdu Tong ◽

Xue Tian ◽

Chunjie Yu ◽

...

Keyword(s):

Risk Factors ◽

Orthostatic Hypotension ◽

Hospital Stay ◽

Spinal Fusion ◽

Spinal Deformity ◽

Case Series ◽

Deformity Correction ◽

Length Of Hospital Stay ◽

Posterior Spinal Fusion ◽

Lower Limbs

Abstract Study design Retrospective case series. Objectives This study aimed to determine the prevalence and risk factors for orthostatic hypotension (OH) in adolescents undergoing posterior spinal fusion for spinal deformity correction. Methods The data of 282 consecutive adolescents who underwent posterior spinal fusion for spinal deformity correction in our center over 12 months were retrieved. Patient characteristics, including whether laminectomy or osteotomy was performed during the surgery, the occurrence of postoperative nausea and vomiting (PONV), perioperative hemoglobin albumin changes, perioperative blood transfusion, length of bed rest, willingness to ambulate, length of postoperative exercises of the lower limbs, and length of hospital stay, were collected and compared statistically between patients who did and did not develop postoperative OH. Results Of 282 patients, 197 (69.86%) developed OH postoperatively, and all cases completely resolved 5 days after the first out-of-bed exercises. Significant differences in the incidence of PONV, the willingness to ambulate and the length of postoperative exercises of the lower limbs were observed. The mean length of hospital stay of the patients with OH was longer than that of the patients without OH. Conclusion Our study suggests that temporary OH is a common manifestation following posterior spinal fusion for spinal deformity correction in adolescents. Postoperative OH may increase the length of hospital stay in these patients. Patients with PONV, who are not willing to ambulate and who perform postoperative lower limb exercises for a shorter time are more likely to have OH.

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Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

Journal of Neurosurgery Spine ◽

10.3171/2018.11.spine18927 ◽

2019 ◽

Vol 30 (6) ◽

pp. 822-832

Author(s):

Cecilia L. Dalle Ore ◽

Christopher P. Ames ◽

Vedat Deviren ◽

Darryl Lau

Keyword(s):

Rheumatoid Arthritis ◽

Spinal Deformity ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Vena Cava ◽

Deformity Correction ◽

Perioperative Outcomes ◽

Medical Complications ◽

Filter Placement ◽

Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

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Instrumentation techniques to prevent proximal junctional kyphosis and proximal junctional failure in adult spinal deformity correction—a systematic review of biomechanical studies

The Spine Journal ◽

10.1016/j.spinee.2021.01.011 ◽

2021 ◽

Author(s):

Remco J.P. Doodkorte ◽

Timon F.G. Vercoulen ◽

Alex K. Roth ◽

Rob A. de Bie ◽

Paul C. Willems

Keyword(s):

Systematic Review ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Proximal Junctional Kyphosis ◽

Proximal Junctional Failure ◽

Junctional Kyphosis

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Fluctuations in Spinal Cord Perfusion During Adult Spinal Deformity Correction Identify Neurologic Changes: Proof of Concept

World Neurosurgery ◽

10.1016/j.wneu.2015.08.067 ◽

2016 ◽

Vol 85 ◽

pp. 365.e1-365.e6 ◽

Cited By ~ 5

Author(s):

Jay D. Turner ◽

Robert K. Eastlack ◽

Zaman Mirzadeh ◽

Stacie Nguyen ◽

Jeff Pawelek ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Proof Of Concept

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Strategies for prevention of rod fracture in adult spinal deformity: cobalt chrome rod, accessory rod technique, and lateral lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2020.8.spine201037 ◽

2021 ◽

pp. 1-10

Author(s):

Ki Young Lee ◽

Jung-Hee Lee ◽

Kyung-Chung Kang ◽

Sang-Kyu Im ◽

Hae Seong Lim ◽

...

Keyword(s):

Spinal Deformity ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Lumbar Interbody Fusion ◽

Patient Factors ◽

Rod Fracture ◽

Cobalt Chrome

OBJECTIVERestoring the proper sagittal alignment in adult spinal deformity (ASD) can improve radiological and clinical outcomes, but pseudarthrosis including rod fracture (RF) is a common problematic complication. The purpose of this study was to analyze the methods for reducing the incidence of RF in deformity correction of ASD.METHODSThe authors retrospectively selected 178 consecutive patients (mean age 70.8 years) with lumbar degenerative kyphosis (LDK) who underwent deformity correction with a minimum 2-year follow-up. Patients were classified into the non-RF group (n = 131) and the RF group (n = 47). For predicting the crucial factors of RF, patient factors, radiographic parameters, and surgical factors were analyzed.RESULTSThe overall incidence of RF was 26% (47/178 cases), occurring in 42% (42/100 cases) of pedicle subtraction osteotomy (PSO), 7% (5/67 cases) of lateral lumbar interbody fusion (LLIF) with posterior column osteotomy, 18% (23/129 cases) of cobalt chrome rods, 49% (24/49 cases) of titanium alloy rods, 6% (2/36 cases) placed with the accessory rod technique, and 32% (45/142 cases) placed with the 2-rod technique. There were no significant differences in the incidence of RF regarding patient factors between two groups. While both groups showed severe sagittal imbalance before operation, lumbar lordosis (LL) was more kyphotic and pelvic incidence (PI) minus LL (PI-LL) mismatch was greater in the RF group (p < 0.05). Postoperatively, while LL and PI-LL did not show significant differences between the two groups, LL and sagittal vertical axis correction were greater in the RF group (p < 0.05). Nonetheless, at the last follow-up, the two groups did not show significant differences in radiographic parameters except thoracolumbar junctional angles. As for surgical factors, use of the cobalt chrome rod and the accessory rod technique was significantly greater in the non-RF group (p < 0.05). As for the correction method, PSO was associated with more RFs than the other correction methods, including LLIF (p < 0.05). By logistic regression analysis, PSO, preoperative PI-LL mismatch, and the accessory rod technique were crucial factors for RF.CONCLUSIONSGreater preoperative sagittal spinopelvic malalignment including preoperative PI-LL mismatch was the crucial risk factor for RF in LDK patients 65 years or older. For restoring and maintaining sagittal alignment, use of the cobalt chrome rod, accessory rod technique, or LLIF was shown to be effective for reducing RF in ASD surgery.

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