Ninety-day complication, revision, and readmission rates for current-generation robot-assisted thoracolumbar spinal fusion surgery: results of a multicenter case series

2021 ◽  
pp. 1-8
Author(s):  
Jason I. Liounakos ◽  
Asham Khan ◽  
Karen Eliahu ◽  
Jennifer Z. Mao ◽  
Christopher R. Good ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Revision Surgery ◽  
Readmission Rate ◽  
Revision Rate ◽  
Case Series ◽  
Pedicle Screws ◽  
Robot Assisted ◽  
Readmission Rates ◽  
Current Generation ◽  
Guidance Systems

OBJECTIVE Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems. METHODS An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days. RESULTS In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases. CONCLUSIONS The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

scholarly journals Initial academic experience and learning curve with robotic spine instrumentation

2017 ◽  
Vol 42 (5) ◽  
pp. E4 ◽  
Author(s):  
Timur M. Urakov ◽  
Ken Hsuan-kan Chang ◽  
S. Shelby Burks ◽  
Michael Y. Wang
Keyword(s):  
Pedicle Screw ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Academic Experience ◽  
Robot Assisted ◽  
Spine Instrumentation ◽  
Significant Difference

OBJECTIVESpine surgery is complex and involves various steps. Current robotic technology is mostly aimed at assisting with pedicle screw insertion. This report evaluates the feasibility of robot-assisted pedicle instrumentation in an academic environment with the involvement of residents and fellows.METHODSThe Renaissance Guidance System was used to plan and execute pedicle screw placement in open and percutaneous consecutive cases performed in the period of December 2015 to December 2016. The database was reviewed to assess the usability of the robot by neurosurgical trainees. Outcome measures included time per screw, fluoroscopy time, breached screws, and other complications. Screw placement was assessed in patients with postoperative CT studies. The speed of screw placement and fluoroscopy time were collected at the time of surgery by personnel affiliated with the robot’s manufacturer. Complication and imaging data were reviewed retrospectively.RESULTSA total of 306 pedicle screws were inserted in 30 patients with robot guidance. The average time for junior residents was 4.4 min/screw and for senior residents and fellows, 4.02 min/screw (p = 0.61). Among the residents dedicated to spine surgery, the average speed was 3.84 min/screw, while nondedicated residents took 4.5 min/screw (p = 0.41). Evaluation of breached screws revealed some of the pitfalls in using the robot.CONCLUSIONSNo significant difference regarding the speed of pedicle instrumentation was detected between the operators’ years of experience or dedication to spine surgery, although more participants are required to investigate this completely. On the other hand, there was a trend toward improved efficiency with more cases performed. To the authors’ knowledge, this is the first reported academic experience with robot-assisted spine instrumentation.

Sports and Recreation Activity of Varus and Valgus Ankle Osteoarthritis before and after Realignment Surgery

2008 ◽  
Vol 29 (10) ◽  
pp. 985-993 ◽  
Author(s):  
Geert Pagenstert ◽  
André Leumann ◽  
Beat Hintermann ◽  
Victor Valderrabano
Keyword(s):  
Revision Surgery ◽  
Revision Rate ◽  
Distal Tibia ◽  
Case Series ◽  
Joint Surface ◽  
Ankle Pain ◽  
Ankle Osteoarthritis ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Sports Activity

Background: Realignment-surgery to unload ankle osteoarthritis (OA) has been proposed as treatment alternative for varus and valgus ankle OA. Sports activity after this procedure has not been analyzed. Realignment-surgery increases sports activity. Sports activity correlates with ankle pain, function, and alignment, but does not influence revision rate. Materials and Methods: Prospective case series of 35 consecutive patients with post-traumatic varus or valgus ankle OA limited to half tibiotalar joint surface were treated by OA unloading realignment-surgery. Distal tibia osteotomy was used in all cases; additional osteotomies, tendon, ligament procedures in 92% of cases. Main Outcome Measurements: Pain (visual-analogue-scale; VAS), ankle range-of-motion (ROM); function (American-Orthopaedic-Foot-and-Ankle-Society (AOFAS) ankle-score; Swiss-symptom-related-Ankle-Activity-Scale (SAAS); Sports-Frequency-Score (SFS), OA and tibiotalar-alignment-grade (Takakura-Score), and revision surgery. Mean followup was 5 years. Results: Mean values from preoperative to followup: VAS decreased ( p = 0.0001) 4 points; ankle ROM increased ( p = 0.001) 5 degrees; AOFAS-Score increased ( p = 0.0001) 46 points; SAAS increased ( p = 0.0001) 42 points; SFS increased ( p = 0.02) 0.5 grades; Takakura-score decreased ( p = 0.0001) 1.0 grades. Revision surgery was performed in 10 cases (29%). Three of these were revised to ankle arthroplasty. At follow-up, SAAS correlated with VAS, AOFAS score, Takakura score, and not with ROM or SFS. SFS did not correlate with other variables. Patients needing revision surgery had a higher ( p = 0.003) SFS than patients who needed no revision. Conclusion: Realignment-surgery increased sports activity of ankle OA patients. Improved ankle pain and function correlated with ability to perform activity without symptoms; however, sports frequency had no correlation to patients' symptoms but showed higher revision rate. Level of Evidence: II, Prospective Comparative Study

scholarly journals Percutaneous Pedicle Screws Positioning by means of the “Scotty Dog” Imaging Monitoring Technique in Spine Surgery: A Case Series

2016 ◽  
Vol 35 (01) ◽  
pp. 031-038
Author(s):  
José Galvão ◽  
Piero Scarparo ◽  
Humberto Bortolo Neto ◽  
Pil Choi ◽  
Adriano Garcia
Keyword(s):  
Spine Surgery ◽  
Case Series ◽  
Pedicle Screws ◽  
Monitoring Technique

Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets

2013 ◽  
Vol 18 (2) ◽  
pp. 134-138 ◽  
Author(s):  
Beejal Y. Amin ◽  
Tsung-Hsi Tu ◽  
William W. Schairer ◽  
Lumine Na ◽  
Steven Takemoto ◽  
...  
Keyword(s):  
Direct Cost ◽  
Administrative Data ◽  
Spine Surgery ◽  
Readmission Rate ◽  
Chart Review ◽  
Medical Center ◽  
Data Sets ◽  
Readmission Rates ◽  
Staged Surgery ◽  
The University

Object Administrative databases are increasingly being used to establish benchmarks for quality of care and to compare performance across peer hospitals. As proposals for accountable care organizations are being developed, readmission rates will be increasingly scrutinized. The purpose of the present study was to assess whether the all-cause readmissions rate appropriately reflects the University of California, San Francisco (UCSF) Medical Center hospital's clinically relevant readmission rate for spine surgery patients and to identify predictors of readmission. Methods Data for 5780 consecutive patient encounters managed by 10 spine surgeons at UCSF Medical Center from October 2007 to June 2011 were abstracted from the University HealthSystem Consortium (UHC) using the Clinical Data Base/Resource Manager. Of these 5780 patient encounters, 281 patients (4.9%) were rehospitalized within 30 days of the previous discharge date. The authors performed an independent chart review to determine clinically relevant reasons for readmission and extracted hospital administrative data to calculate direct costs. Univariate logistic regression analysis was used to evaluate possible predictors of readmission. The two-sample t-test was used to examine the difference in direct cost between readmission and nonreadmission cases. Results The main reasons for readmission were infection (39.8%), nonoperative management (13.4%), and planned staged surgery (12.4%). The current all-cause readmission algorithm resulted in an artificially high readmission rate from the clinician's point of view. Based on the authors' manual chart review, 69 cases (25% of the 281 total readmissions) should be excluded because 39 cases (13.9%) were planned staged procedures; 16 cases (5.7%) were unrelated to spine surgery; and 14 surgical cases (5.0%) were cancelled or rescheduled at index admission due to unpredictable reasons. When these 69 cases are excluded, the direct cost of readmission is reduced by 29%. The cost variance is in excess of $3 million. Predictors of readmission were admission status (p < 0.0001), length of stay (p = 0.0001), risk of death (p < 0.0001), and age (p = 0.021). Conclusions The authors' findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission. When this is implemented in the calculation method, the readmission rate will be more accurate. Current tools overestimate the clinically relevant readmission rate and cost.

scholarly journals The Value of Cement Augmentation in Patients With Diminished Bone Quality Undergoing Thoracolumbar Fusion Surgery: A Review

2021 ◽  
Vol 11 (1_suppl) ◽  
pp. 37S-44S
Author(s):  
Joshua M. Kolz ◽  
Brett A. Freedman ◽  
Ahmad N. Nassr
Keyword(s):  
Bone Quality ◽  
Revision Surgery ◽  
Revision Rate ◽  
Pedicle Screws ◽  
Cost Effective ◽  
Cement Augmentation ◽  
Fusion Surgery ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Study Design: Systematic review. Objectives: Osteoporosis predisposes patients undergoing thoracolumbar (TL) fusion to complications and revision surgery. Cement augmentation (CA) improves fixation of pedicle screws to reduce these complications. The goal of this study was to determine the value and cost-effectiveness of CA in TL fusion surgery. Methods: A systematic literature review was performed using an electronic database search to identify articles discussing the cost or value of CA. As limited information was available, the review was expanded to determine the mean cost of primary TL fusion, revision TL fusion, and the prevalence of revision TL fusion to determine the decrease of revision surgery necessary to make CA cost-effective. Results: Two studies were identified discussing the cost and value of CA. The mean cost of CA for two vertebral levels was $10 508, while primary TL fusion was $87 346 and revision TL fusion was $76 825. Using a mean revision rate of 15.4%, the use of CA for TL fusion would need to decrease revision rates by 13.7% to be cost-effective. Comparison studies showed a decreased revision rate of 11.3% with CA, which approaches this value. Conclusion: CA for TL fusion surgery improves biomechanical fixation of pedicle screws and decreases complications and revision surgery in patients with diminished bone quality. The costs of CA are substantial and reported decreases in revision rates approach but do not reach the calculated value to be a cost-effective technique. Future studies will need to focus on the optimal CA technique to decrease complications, revisions, and costs.

scholarly journals Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

2019 ◽  
Vol 14 (4) ◽  
pp. 567-572 ◽  
Author(s):  
Arnold B. Vardiman ◽  
David J. Wallace ◽  
Grant A. Booher ◽  
Neil R. Crawford ◽  
Jessica R. Riggleman ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Left And Right ◽  
Spine Surgeon

Abstract Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side (researchers were blinded). A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy, with grade A or B considered accurate. There were 630 consecutive lumbosacral pedicle screws placed. Thirty screws (5 patients) were placed without the robot due to surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively. Based on the GRS CT-based grading of pedicle breach, 98.67% (296/300) of left-side screws were graded A or B, 1.3% (4/300) were graded C, and 0% (0/300) were graded D. For the right-side screws, 97.67% (293/300) were graded A or B, 1.67% (5/300) were graded C, and 0.66% (2/300) were graded D. This study demonstrated a high level of accuracy (based on GRS) with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use of navigated, robot-assisted surgery.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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