scholarly journals Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

2016 ◽  
Vol 24 (2) ◽  
pp. 268-274 ◽  
Author(s):  
Chueng-He Lu ◽  
Zhi-Fu Wu ◽  
Bo-Feng Lin ◽  
Meei-Shyuan Lee ◽  
Chin Lin ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Operating Room ◽  
Spine Surgery ◽  
Total Intravenous Anesthesia ◽  
Lumbar Spine Surgery ◽  
Surgical Time ◽  
Intravenous Anesthesia ◽  
Extubation Time ◽  
Surgical Suite

OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.

scholarly journals EVALUATION OF PAIN SYNDROME AND EFFICIENCY OF PAIN MANAGEMENT IN LUMBAR SPINE SURGERY

2019 ◽  
Vol 6 ◽  
pp. 29-34
Author(s):  
Mykola Lyzohub ◽  
Marine Georgiyants ◽  
Kseniia Lyzohub
Keyword(s):  
Neuropathic Pain ◽  
Lumbar Spine ◽  
Pain Management ◽  
Spinal Anesthesia ◽  
Spine Surgery ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Total Intravenous Anesthesia ◽  
Lumbar Spine Surgery ◽  
Intravenous Anesthesia

Multimodal analgesia for lumbar spine surgery is still a controversial problem, because of possible fusion problems, significant neuropathic component of pain, and influence of anesthesia type. Aim of the study was to assess the efficacy of pain management after lumbar spine surgery considering characteristics of pain, type of anesthesia and analgesic regimen. Material and methods. 254 ASA I-II patients with degenerative lumbar spine disease were enrolled into prospective study. Patients were operated either under spinal anesthesia (SA) or total intravenous anesthesia (TIVA). In postoperative period patients got either standard pain management (SPM – paracetamol±morphine) or multimodal analgesia (MMA – paracetamol+parecoxib+pregabalin±morphine). Results. We revealed neuropathic pain in 53.9 % of patients, who were elected for lumbar spine surgery. VAS pain score in patients with neuropathic pain was higher, than in patients with nociceptive pain. Total intravenous anesthesia was associated with greater opioid consumption during the first postoperative day. Multimodal analgesia based on paracetamol, parecoxib and pregabalin allowed to decrease requirements for opioids, postoperative nausea and dizziness. Pregabalin used for evening premedication had equipotential anxiolytic effect as phenazepam without postoperative cognitive disturbances. Conclusions. Multimodal analgesia is opioid-sparing technique that allows to decrease complications. Spinal anesthesia is associated to a decreased opioid consumption in the 1st postoperative day.

scholarly journals Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale

2017 ◽  
Vol 27 (4) ◽  
pp. 382-390 ◽  
Author(s):  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Silky Chotai ◽  
Deborah Pfortmiller ◽  
Jeffrey M. Sorenson ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Hospital Readmission ◽  
Inpatient Rehabilitation ◽  
Lumbar Spine Surgery ◽  
Day Hospital ◽  
Data Set ◽  
Inpatient Facility ◽  
Grading Scale

OBJECTIVEExtended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies.METHODSThe Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0–12 points), discharge to inpatient facility (0–18 points), and 90-day readmission (0–6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic).RESULTSA total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System class > III, Oswestry Disability Index score ≥ 70, diabetes, Medicare/Medicaid, nonindependent ambulation, and fusion. Increasing point totals in the Carolina-Semmes scale effectively stratified the incidence of extended LOS, discharge to facility, and readmission in a stepwise fashion in both the aggregate QOD data set and when subsequently applied to the CNSA/Semmes Murphey practice groups.CONCLUSIONSThe authors introduce the Carolina-Semmes grading scale that effectively stratifies the risk of prolonged hospital stay, need for postdischarge inpatient facility care, and 90-day hospital readmission for patients undergoing first-time elective 1- to 3-level degenerative lumbar spine surgery. This grading scale may be helpful in identifying patients who may require additional resource utilization within a global period after surgery.

scholarly journals Variations in 30-day readmissions and length of stay among spine surgeons: a national study of elective spine surgery among US Medicare beneficiaries

2018 ◽  
Vol 29 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Siddhartha Singh ◽  
Rodney Sparapani ◽  
Marjorie C. Wang
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Practice Patterns ◽  
Lumbar Spine Surgery ◽  
Medicare Beneficiaries ◽  
Readmission Rates ◽  
Underlying Assumption ◽  
The Mean ◽  
Hospital Characteristics

OBJECTIVEPay-for-performance programs are targeting hospital readmissions. These programs have an underlying assumption that readmissions are due to provider practice patterns that can be modified by a reduction in reimbursement. However, there are limited data to support the role of providers in influencing readmissions. To study this, the authors examined variations in readmission rates by spine surgeon within 30 days among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions.METHODSThe authors applied validated ICD-9-CM algorithms to 2003–2007 Medicare data to select beneficiaries undergoing elective inpatient lumbar spine surgery for degenerative conditions. Mixed models, adjusting for patient demographics, comorbidities, and surgery type, were used to estimate risk of 30-day readmission by the surgeon. Length of stay (LOS) was also studied using these same models.RESULTSA total of 39,884 beneficiaries were operated on by 3987 spine surgeons. The mean readmission rate was 7.2%. The mean LOS was 3.1 days. After adjusting for patient characteristics and surgery type, 1 surgeon had readmission rates significantly below the mean, and only 5 surgeons had readmission rates significantly above the mean. In contrast, for LOS, the patients of 288 surgeons (7.2%) had LOS significantly lower than the mean, and the patients of 397 surgeons (10.0%) had LOS significantly above the mean. These findings were robust to adjustments for surgeon characteristics and clustering by hospital. Similarly, hospital characteristics were not significantly associated with readmission rates, but LOS was associated with hospital for-profit status and size.CONCLUSIONSThe authors found almost no variations in readmission rates by surgeon. These findings suggest that surgeon practice patterns do not affect the risk of readmission. Likewise, no significant variation in readmission rates by hospital characteristics were found. Strategies to reduce readmissions would be better targeted at factors other than providers.

scholarly journals Patient-specific factors affecting hospital costs in lumbar spine surgery

2016 ◽  
Vol 24 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Ross C. Puffer ◽  
Ryan Planchard ◽  
Grant W. Mallory ◽  
Michelle J. Clarke
Keyword(s):  
Multivariate Analysis ◽  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Univariate Analysis ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Lumbar Spine Surgery ◽  
Patient Factors ◽  
Lumbar Decompression

OBJECT Health care-related costs after lumbar spine surgery vary depending on procedure type and patient characteristics. Age, body mass index (BMI), number of spinal levels, and presence of comorbidities probably have significant effects on overall costs. The present study assessed the impact of patient characteristics on hospital costs in patients undergoing elective lumbar decompressive spine surgery. METHODS This study was a retrospective review of elective lumbar decompression surgeries, with a focus on specific patient characteristics to determine which factors drive postoperative, hospital-related costs. Records between January 2010 and July 2012 were searched retrospectively. Only elective lumbar decompressions including discectomy or laminectomy were included. Cost data were obtained using a database that allows standardization of a list of hospital costs to the fiscal year 2013–2014. The relationship between cost and patient factors including age, BMI, and American Society of Anesthesiologists (ASA) Physical Status Classification System grade were analyzed using Student t-tests, ANOVA, and multivariate regression analyses. RESULTS There were 1201 patients included in the analysis, with a mean age of 61.6 years. Sixty percent of patients in the study were male. Laminectomies were performed in 557 patients (46%) and discectomies in 644 (54%). Laminectomies led to an increased hospital stay of 1.4 days (p < 0.001) and increased hospital costs by $1523 (p < 0.001) when compared with discectomies. For laminectomies, age, BMI, ASA grade, number of levels, and durotomy all led to significantly increased hospital costs and length of stay on univariate analysis, but ASA grade and presence of a durotomy did not maintain significance on multivariate analysis for hospital costs. For a laminectomy, patient age ≥ 65 years was associated with a 0.6-day increased length of stay and a $945 increase in hospital costs when compared with patient age < 65 years (p < 0.001). A durotomy during a laminectomy increased length of stay by 1.0 day and increased hospital costs by $1382 (p < 0.03). For discectomies, age, ASA grade, and durotomy were significantly associated with increased hospital costs on univariate analysis, but BMI was not. Only age and presence of a durotomy maintained significance on multivariate analysis. There was a significant increase in hospital length of stay in patients undergoing discectomy with increasing age, BMI, ASA grade, and presence of a durotomy on univariate analysis. However, only age and presence of a durotomy maintained significance on multivariate analysis. For discectomies, age ≥ 65 years was associated with a 0.7-day increased length of stay (p < 0.001) and an increase of $931 in postoperative hospital costs (p < 0.01) when compared with age < 65 years. CONCLUSIONS Patient factors such as age, BMI, and comorbidities have significant and measurable effects on the postoperative hospital costs of elective lumbar decompression spinal surgeries. Knowledge of how these factors affect costs will become important as reimbursement models change.

scholarly journals INFLUENCE OF ANESTHESIA TYPE ON INTRAOCULAR PRESSURE DURING SPINE SURGERY IN PRONE POSITION

2020 ◽  
Vol 73 (1) ◽  
pp. 104-106
Author(s):  
Mykola V. Lyzohub ◽  
Marine A. Georgiyants ◽  
Kseniia I. Lyzohub ◽  
Juliia V. Volkova ◽  
Dmytro V. Dmytriiev ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Lumbar Spine ◽  
Spinal Anesthesia ◽  
Spine Surgery ◽  
Head Rotation ◽  
Lumbar Spine Surgery ◽  
Intravenous Anesthesia ◽  
Group I ◽  
Before And After ◽  
Spinal Segments

The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) – under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) – under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.

Impact of length of stay on HCAHPS scores following lumbar spine surgery

2019 ◽  
Vol 31 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Gabriel A. Smith ◽  
Steven Chirieleison ◽  
Jay Levin ◽  
Karam Atli ◽  
Robert Winkelman ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Healthcare Providers ◽  
Primary Outcome Measure ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Lumbar Spine Surgery ◽  
Significant Difference ◽  
Hcahps Survey

OBJECTIVEHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.METHODSThe authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of “top-box” (“9–10” or “always or usually”) versus “low-box” (“1–8” and “somewhat or never”) scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher’s exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.RESULTSTwo hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.CONCLUSIONSHere, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.

Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis

2015 ◽  
Vol 15 (6) ◽  
pp. 1188-1195 ◽  
Author(s):  
Jordan A. Gruskay ◽  
Michael Fu ◽  
Daniel D. Bohl ◽  
Matthew L. Webb ◽  
Jonathan N. Grauer
Keyword(s):  
Multivariate Analysis ◽  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Factors Affecting
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