Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

OBJECT In the treatment of cervical spondylotic myelopathy (CSM), anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) are effective decompressive techniques. It remains to be determined whether ACCF and ACDF offer equivalent outcomes for multilevel CSM. In this study, the authors compared perioperative, radiographic, and clinical outcomes between 2-level ACCF and 3-level ACDF. METHODS Between 2006 and 2012, all patients at the authors' hospital who underwent 2-level ACCF or 3-level ACDF performed by 1 of 2 surgeons were identified. Primary outcomes of interest were sagittal Cobb angle, adjacent-segment disease (ASD) requiring surgery, neck pain measured by visual analog scale (VAS), and Nurick score. Secondary outcomes of interest included estimated blood loss (EBL), length of stay, perioperative complications, and radiographic pseudarthrosis rate. Chi-square tests and 2-tailed Student t-tests were used to compare the 2 groups. A subgroup analysis of patients without posterior spinal fusion (PSF) was also performed. RESULTS Twenty patients underwent 2-level ACCF, and 35 patients underwent 3-level ACDF during a 6-year period. Preoperative Nurick scores were higher in the ACCF group (2.1 vs 1.1, p = 0.014), and more patients underwent PSF in the 2-level ACCF group compared with patients in the 3-level ACDF group (60.0% vs 17.1%, p = 0.001). Otherwise there were no significant differences in demographics, comorbidities, and baseline clinical parameters between the 2 groups. Two-level ACCF was associated with significantly higher EBL compared with 3-level ACDF for the anterior stage of surgery (382.2 ml vs 117.9 ml, p < 0.001). Two-level ACCF was also associated with a longer hospital stay compared with 3-level ACDF (7.2 days vs 4.9 days, p = 0.048), but a subgroup comparison of patients without PSF showed no significant difference in length of stay (3.1 days vs 4.4 days for 2-level ACCF vs 3-level ACDF, respectively; p = 0.267). Similarly, there was a trend toward more complications in the 2-level ACCF group (20.0%) than the 3-level ACDF group (5.7%; p = 0.102), but a subgroup analysis that excluded those who had second-stage PSF no longer showed the same trend (2-level ACCF, 0.0% vs 3-level ACDF, 3.4%; p = 0.594). There were no significant differences between the ACCF group and the ACDF group in terms of postoperative sagittal Cobb angle (7.2° vs 12.1°, p = 0.173), operative ASD (6.3% vs 3.6%, p = 0.682), and radiographic pseudarthrosis rate (6.3% vs 7.1%, p = 0.909). Both groups had similar improvement in mean VAS neck pain scores (3.4 vs 3.2 for ACCF vs ACDF, respectively; p = 0.860) and Nurick scores (0.8 vs 0.7, p = 0.925). CONCLUSIONS Two-level ACCF was associated with greater EBL and longer hospital stays when patients underwent a second-stage PSF. However, the length of stay was similar when patients underwent anterior-only decompression with either 2-level ACCF or 3-level ACDF. Furthermore, perioperative complication rates were similar in the 2 groups when patients underwent anterior decompression without PSF. Both groups obtained similar postoperative cervical lordosis, operative ASD rates, radiographic pseudarthrosis rates, neurological improvement, and pain relief.

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Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽

10.1093/neuros/nyw072 ◽

2017 ◽

Vol 80 (3) ◽

pp. 489-497 ◽

Cited By ~ 18

Author(s):

Juan S. Uribe ◽

Joshua Beckman ◽

Praveen V. Mummaneni ◽

David Okonkwo ◽

Pierce Nunley ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Clinical Outcomes ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Radiographic Parameters ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

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Clinical outcomes of a false positive antenatal diagnosis of placenta accreta spectrum

American Journal of Perinatology ◽

10.1055/a-1673-5103 ◽

2021 ◽

Author(s):

Bahram Salmanian ◽

Amir A. Shamshirsaz ◽

Karin Fox ◽

nazlisadat meshinchi asl ◽

Hadi Erfani ◽

...

Keyword(s):

Clinical Outcomes ◽

Resource Utilization ◽

False Positive ◽

Maternal Morbidity ◽

Placenta Accreta ◽

Antenatal Diagnosis ◽

Estimated Blood Loss ◽

Management Protocol ◽

Significant Difference ◽

Placenta Accreta Spectrum

Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is critical to reduce maternal morbidity. While clinical outcomes of women with PAS have been extensively described, little information is available regarding the women who undergo cesarean delivery with a presumptive PAS diagnosis which is not confirmed by histopathologic examination. We sought to examine resource utilization and clinical outcomes of this group of women with a false-positive diagnosis of PAS. Study design: Retrospective analysis of patients with prenatally diagnosed PAS cared for between 2015 and 2020 by our multidisciplinary PAS team. Maternal outcomes were examined. Univariate analysis was performed and a multivariate model was employed to compare outcomes between women with and without histopathologically confirmed PAS. Results: A total of 162 patients delivered with the pre-operative diagnosis of PAS. Of these, 146 (90%) underwent hysterectomy and had histopathologic confirmation of PAS. Thirteen women did not undergo the planned hysterectomy. Three women underwent hysterectomy but pathologic examination did not confirm PAS. In comparing women with and without pathologic confirmation of PAS, the false positive PAS group delivered later in pregnancy (34 vs. 33 weeks of gestation, P=0.015) and had more planned surgery (88% vs. 47%, P = 0.002). There was no difference in skin incision type or hysterotomy placement for delivery. No significant difference in either the estimated blood loss or blood components transfused was noted between groups. Conclusion: Careful intraoperative evaluation of women with pre-operatively presumed PAS resulted in a 3/149 (2%) retrospectively unnecessary hysterectomy. Management of women with PAS in experienced centers benefits patients both in terms of resource utilization and avoidance of unnecessary maternal morbidity, understanding that our results are produced in a center of excellence for PAS. We also propose a management protocol to assist in the avoidance of unnecessary hysterectomy in women with the pre-operative diagnosis of PAS.

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Outcome Differences of Remnant- Preserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

Knee Surgery and Related Research ◽

10.1186/s43019-019-0017-z ◽

2020 ◽

Vol 32 (1) ◽

Cited By ~ 2

Author(s):

Sung Hun Won ◽

Byung-Il Lee ◽

Su Yeon Park ◽

Kyung-Dae Min ◽

Jun-Bum Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Acl Reconstruction ◽

Subgroup Analysis ◽

Observational Studies ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Lachman Test ◽

Significant Difference ◽

Anterior Cruciate

Abstract Purpose To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. Methods International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A meta-analysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. Results Five RCTs and six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. Conclusions This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. Results of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

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Surgery Delay Increases Length of Stay in Thoracolumbar Trauma

Neurosurgery ◽

10.1093/neuros/nyz310_446 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Lawrence Zeldin ◽

Sean N Neifert ◽

Robert J Rothrock ◽

Ian T McNeill ◽

Jonathan S Gal ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Injury ◽

Specific Effect ◽

Spinal Trauma ◽

Spine Injury ◽

Complication Rates ◽

Improvement Program ◽

Delayed Surgery ◽

Significant Difference ◽

Surgery Timing

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.

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Nonendoscopic, minimally invasive calvarial vault remodeling without postoperative helmeting for sagittal synostosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.12.peds11306 ◽

2012 ◽

Vol 9 (3) ◽

pp. 222-227 ◽

Cited By ~ 18

Author(s):

Ian S. Mutchnick ◽

Todd A. Maugans

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Intraoperative Complications ◽

Cohort Analysis ◽

Sagittal Synostosis ◽

Estimated Blood Loss ◽

Significant Difference ◽

Significant Correction ◽

The Mean

Object Multiple surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. Minimally invasive techniques have been recently emphasized, but these techniques necessitate the use of an endoscope and postoperative helmeting. The authors assert that a safe and effective, more “minimalistic” approach is possible, avoiding the use of endoscopic visualization and routine postoperative application of a cranial orthosis. Methods A single-institution cohort analysis was performed on 18 cases involving infants treated for isolated nonsyndromic sagittal synostosis between 2008 and 2010 using a nonendoscopic, minimally invasive calvarial vault remodeling (CVR) procedure without postoperative helmeting. The surgical technique is described. Variables analyzed were: age at time of surgery, sex, estimated blood loss (EBL), operative time, intraoperative complications, postoperative complications, length of stay, pre- and postoperative cephalic index (CI), clinical impressions, and results of a 5-question nonstandardized questionnaire administered to patient caregivers regarding outcome. Results Eleven male and 7 female infants (mean age 2.3 months) were included in the study. The mean duration of follow-up was 16.4 months (range 6–38 months). The mean procedural time was 111 minutes (range 44–161 minutes). The mean length of stay was 2.3 days (range 2–3 days). The mean EBL in all 18 patients was 101.4 ml (range 30–475 ml). One patient had significant bone bleeding resulting in an EBL of 475 ml. Excluding this patient, the mean EBL was 79.4 ml (range 30–150 ml). There were no deaths or intraoperative complications; one patient had a superficial wound infection. The mean CI was 69 preoperatively versus 79 postoperatively, a statistically significant difference (p < 0.0001). Two patients were offered helmeting for suboptimal surgical outcome; one family declined and the single helmeted patient showed improvement at 2 months. No patient has undergone further surgery for correction of primary deformity, secondary deformities, or bony irregularities. Complete questionnaire data were available for 14 (78%) of the 18 patients; 86% of the respondents were pleased with the cosmetic outcome, 92% were happy to have avoided helmeting, 72% were doubtful that helmeting would have provided more significant correction, and 86% were doubtful that further surgery would be necessary. Small, palpable, aesthetically insignificant skull irregularities were reported by family members in 6 cases (43%). Conclusions The authors present a nonendoscopic, minimally invasive CVR procedure without postoperative helmeting. Their small series demonstrates this to be a safe and efficacious procedure for isolated nonsyndromic sagittal synostosis, with improvements in CI at a mean follow-up of 16.1 months, commensurate with other techniques, and with overall high family satisfaction. Use of a CVR cranial orthosis in a delayed fashion can be effective for the infrequent patient in whom this approach results in suboptimal correction.

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EMERGENCY LAPAROTOMIES UNDER SPINAL ANESTHESIA: A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY, IN KABUL, AFGHANISTAN

International Journal of Advanced Research ◽

10.21474/ijar01/13072 ◽

2021 ◽

Vol 9 (06) ◽

pp. 751-756

Author(s):

Wais Farda ◽

◽

Ahmad Bashir Nawazish ◽

Keyword(s):

Length Of Stay ◽

Observational Study ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Average Length ◽

Emergency Laparotomy ◽

Complication Rates ◽

Abdominal Incision ◽

Significant Difference ◽

The Mean

Background: Laparotomy is most commonly performed under general anesthesia, but spinal anesthesia (SA) is considered an alternative to in the context of limited resources. The safety and efficacy of using SA as substitute for general anesthesia(GA) has not been explored in Afghanistan. Methodology: We conductedan observational study in the general surgery department of Isteqlal hospital in Kabul, Afghanistan on 196 adult patients undergoing emergency laparotomy under spinal anesthesia betweenApril 2018-April 2020. Results: The mean age of patients was 41.5 years (SD=19.4), the ratio of males to females was 1.9:1 and almost half (44.4%) had comorbidities. 21% were classified as ASA grade III and IV with a similar pattern among males and females. A total of 11 (5.6%) cases were converted to GA. Conversion pattern to GA was similar amongmales and females(P=0.71), ASA grade (P=0.432) and age group (P=0.642). The mean length of stay after operation was 6.5 days (SD=4.1). 32 (16.3%) patients suffered SA complications with no significant difference in terms of sex (P=0.134). Hypotension and headache accounted for 97% of complications. Complication rates were similar in terms of intervertebral level (P=0.349), type of abdominal incision (P>0.1) and average length of stay (P=0.156). 18 patients (9.2%) died due to MOF, sepsis, respiratory failure, thromboembolism and cardiogenic shock. Conclusion: Spinal anesthesia is considered a safe and effective anesthesia for emergency laparotomies, even for those with comorbidities. Based on our findings we would recommend spinal anesthesia as an alternative to general anesthesiain emergency laparotomy in Afghanistan.

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931 Deep Inferior Epigastric Perforator (DIEP) Flap: Impact of Early Drain Removal on Seroma Formation Rate and Duration of Inpatient Stay

British Journal of Surgery ◽

10.1093/bjs/znab259.706 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Grigg ◽

R Clancy ◽

C Lewis ◽

P Jackson

Keyword(s):

Length Of Stay ◽

Enhanced Recovery ◽

Formation Rate ◽

Seroma Formation ◽

Diep Flap ◽

Complication Rates ◽

Post Surgery ◽

Drain Removal ◽

Significant Difference ◽

The Mean

Abstract Aim Donor site seroma can follow deep inferior epigastric flap (DIEP) harvest. Post-surgery gradient technology (GTC) garments are worn by DIEP patients postoperatively following drain removal to reduce seroma formation. Early drain removal was considered a contributing factor to increased seroma formation rate. From June 2018 drain removal regardless of output was instigated at day two post-surgery. Prior to this, drains were removed when less than 30mls over 24 hours. We aim to assess the seroma rate post DIEP harvest with early drain removal. Method Retrospective review of prospectively managed database between June 2018 to May 2020. Surgical complications and length of stay in hospital were recorded. Results 200 patients underwent DIEP flap breast reconstruction. The mean age of patients was 52 years (range 28-73). There was no significant difference in seroma complication rate between those who had drains removed on day 3 compared with day 2 ((1.02% (1/98) vs. (0.98% (1/102); p = 1). The mean length of stay in hospital for the 1st cohort was 3.86 days and for the 2nd cohort was 3.23 days. There were no complications related to drain removal. Conclusions Our data suggests that drain removal after 2 days postoperatively with DIEP reconstruction does not affect seroma complication rates. Moreover, it leads to a shorter hospital stay. These conclusions are in keeping with enhanced recovery protocols and an early drain removal surgical process could be advised.

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Perioperative complication rates following neoadjuvant therapy in pancreatic adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.688 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 688-688

Author(s):

Christopher R. Deig ◽

Blake Beneville ◽

Amy Liu ◽

Aasheesh Kanwar ◽

Alison Grossblatt-Wait ◽

...

Keyword(s):

Length Of Stay ◽

Neoadjuvant Therapy ◽

Pancreatic Adenocarcinoma ◽

Locally Advanced ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Significant Difference ◽

Perioperative Complication ◽

The Impact

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.

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Abstract 249: The Costs and Acute Outcomes Following Pulmonary Vein Isolation for Atrial Fibrillation in Elderly Patients a Comparison Between Cryoballoon and Radiofrequency Ablation

Circulation ◽

10.1161/circ.140.suppl_2.249 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Chao-Feng Chen

Keyword(s):

Atrial Fibrillation ◽

Length Of Stay ◽

Elderly Patients ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Dwell Time ◽

Complication Rates ◽

Rf Ablation ◽

Significant Difference

Backgroup: Limited comparative data exist regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) ablation versus radiofrequency (RF) ablation in elderly patients (>75 years ). This study aims to compare the costs and periprocedural outcomes in elderly patients using these two strategies. Methods: Elderly patients (>75years) with symptomatic drug-refractory AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients by CB or RF. The costs and periprocedural outcomes of the two strategies are compared using SPSS 22. Results: 324 elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF received PVI using RF (n=176) and CB-2 (n=148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure duration and left atrial dwell time (128.9±18.3 vs. 152.8±18.9 minutes, P<0.001; 89.4±18.4 vs. 101.9± 22.2minutes, P <0.001), but greater fluoroscopy utilization (24.3±10.9 vs. 19.2±7.5 minutes, P <0.001). Periprocedural complications occurred in 3.4% (CB-2) and 9.1% (RF) of patients (P=0.037). There was no significant difference between 2 groups for AF/atrial tachycardia (AT) recurrence until discharge (16.2 vs. 18.7%, P = 0.552). The length of stay after ablation was shorter, but the costs were greater in the CB-2 group ( P <0.001). Conclusions: Both CB-2 and RF ablation appear to be safe and effective for AF in elderly patients (>75 years). In addition, CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower complication rates, but its costs and fluoroscopy time are greater than those of the RF group.

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Abstract 17173: Association of Acute Gout Flares and Colchicine Use With Clinical Outcomes During Admission for Acute Decompensated Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.17173 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Melissa E Chinn ◽

Mary E Roth ◽

Steven P Dunn ◽

Kenneth C Bilchick ◽

Sula Mazimba

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Hospital Discharge ◽

Readmission Rate ◽

Acute Gout ◽

Significant Difference ◽

The Impact ◽

Gout Flare

Introduction: Gout is a common comorbidity in heart failure (HF) patients, and is often exacerbated by diuretic use. The impact of gout or the treatment of gout on HF outcomes is unknown. The purpose of this study was to assess clinical outcomes in patients being treated for an acute HF exacerbation and receiving colchicine for an acute gout flare. Methods: This was a single center, retrospective cohort study of patients treated for an acute HF exacerbation from March 2011 to February 2020. The gout group included patients receiving colchicine for an acute gout flare during admission. The control group included those who did not receive colchicine for an acute gout flare. The primary outcome was 30-day readmission rate. Secondary outcomes included in-hospital mortality and length of stay. Results: In the cohort of 1,047 patients (68.8 +/- 13.7 years, 38% female), 237 patients received colchicine for acute gout during admission. Length of stay was significantly greater (9.93 days vs. 7.96 days, p < 0.0001) and in-hospital mortality was significantly lower (2.2% vs. 6.6%, p = 0.009) in patients with versus without gout. In a multivariate logistic regression model, in-hospital colchicine given for a gout flare was significantly associated with reduced in-hospital mortality (OR 0.322, 95% CI 0.105-0.779, p = 0.02) after adjustment for home beta blocker use, inotrope use, age, and diabetes mellitus (p < 0.05 for all in the model). The association between colchicine and survival to hospital discharge was only observed in patients who received colchicine during the hospitalization, as opposed to home use only. There was no significant difference in 30-day readmission rate based on gout status for patients surviving to hospital discharge (21.5% vs. 19.5%, p = 0.495). Conclusions: Among patients with an acute HF exacerbation, patients treated for an acute gout flare with colchicine had a greater length of stay and lower in-hospital mortality compared with those not having gout. Future analyses are warranted to identify the relationship between colchicine use and HF outcomes.

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