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van Grafhorst J, van Furth W, Vleggeert-Lankamp C. Mental state as a predictor of outcome in spinal stenosis surgery: Four quadrants model integrating patient satisfaction and functional outcome. BRAIN & SPINE 2024; 4:103902. [PMID: 39309548 PMCID: PMC11416550 DOI: 10.1016/j.bas.2024.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/05/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024]
Abstract
Introduction Mental status, characterised by anxiety and depression, significantly influences physical well-being, particularly in patients with spinal stenosis symptoms. Research question The prevalence of depression and anxiety in our cohort. The correlation between psychological distress and physical outcome after surgery, including postoperative recovery and satisfaction. Materials and methods Questionnaires evaluating anxiety and depression (HADS), functionality (ODI), quality of life (EQ-5D), and perceived recovery (Likert-scale) were sent to a randomly selected cohort of 450 lumbar spinal stenosis patients, with or without spondylolisthesis, who underwent surgery between 2007 and 2013. Results are presented, dichotomised by HADS score (score ≥8 indicating psychologically impaired) and in a Four Quadrants Model integrating functional outcomes and perceived recovery separately for psychologically impaired and non-impaired cases. Results Among the 147 included patients, 32 (22%) exhibited anxiety and/or depression (impaired cases). Satisfactory outcome (perceived recovery) was reported in 29.0% of the impaired cases and 78.3% of the non-impaired cases (p < 0.001). The mean postoperative functionality score of the impaired cases was 42.46 ± 16.24, in contrast to 18.48 ± 18.25 for the non-impaired cases (p < 0.001). In the impaired group, only 12.5% achieved both a good functional outcome (ODI ≤24) and satisfactory perceived recovery, compared with 58.4% in the non-impaired group. Discussion and conclusion Patients reporting anxiety and/or depression demonstrate an inferior long-term outcome after spinal stenosis surgery compared to non-impaired patients. This clinically relevant difference underscores the importance of addressing depression and anxiety in preoperative counselling to optimize patient satisfaction and functional outcomes.
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Affiliation(s)
| | - Wouter van Furth
- University Neurosurgical Center Holland, LUMC | HMC | HAGA, the Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem, Hoofddorp, the Netherlands
| | - Carmen Vleggeert-Lankamp
- University Neurosurgical Center Holland, LUMC | HMC | HAGA, the Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem, Hoofddorp, the Netherlands
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2
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Toll BJ, Yolcu YU, Passer JZ, Yew AY, Magge SN, Ghogawala Z, Whitmore RG. Impact of Depression and Anxiety on Patient Reported Outcomes Measures after Lumbar Fusion. World Neurosurg 2024; 186:e391-e397. [PMID: 38575064 DOI: 10.1016/j.wneu.2024.03.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Depression and anxiety are common in patients undergoing spinal surgery and might negatively impact outcomes. This study investigates the possible effect of these diagnoses on patient reported outcomes following lumbar fusion. METHODS Retrospective review of a registry containing prospectively collected data of lumbar fusion procedures at a single institution was performed from May 23, 2012 to June 15, 2022. Patients with a minimum of two year follow-up were included. Demographic information, diagnoses, medications, patient-reported outcomes measures (PROMs), and complications data at preoperative, three months, six months, 1 year, and two years postoperative were collected. Statistical analysis was performed using Student's t-tests, χ2, binomial correlation, odds ratios, logistic regression, and mean clinically important difference. RESULTS A total of 156 patients were included (60 males, 96 females) with mean age 62.6 ± 11.1 years at surgery. Thirty-nine (25%) had depression and/or anxiety (DA). Baseline Oswestry Disability Index (ODI) and EuroQol Group 5D questionnaire (EQ5D) scores were significantly worse in the DA cohort compared to controls (ODI 51.1 ± 18.3 vs. 42.9 ± 15.8; P = 0.010, EQ5D 0.46 ± 0.21 vs. 0.57 ± 0.21; P = 0.005). Both cohorts experienced similar relative improvement at two years (delta ODI -18.2 ± 27.9 vs. -17.8 ± 22.1; P = 0.924, EQ5D 6.8 ± 33.8 vs. 8.1 ± 32.9; P = 0.830). Absolute outcome scores were worse in the DA cohort at all intervals. DA were not independently predictive of changes in PROMs (delta ODI mean difference 4.49, r2 = 0.36, P = 0.924). CONCLUSIONS The present study showed similar improvement in PROMs following lumbar fusion for patients with anxiety and depression compared to healthy controls. These data suggest these patients are no less likely to benefit from appropriately planned lumbar fusion.
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Affiliation(s)
- Brandon J Toll
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Yagiz U Yolcu
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joel Z Passer
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Andrew Y Yew
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Subu N Magge
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Robert G Whitmore
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
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Diltz ZR, West EJ, Colatruglio MR, Kirwan MJ, Konrade EN, Thompson KM. Perioperative Management of Comorbidities in Spine Surgery. Orthop Clin North Am 2023; 54:349-358. [PMID: 37271563 DOI: 10.1016/j.ocl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The number of spinal operations performed in the United States has significantly increased in recent years. Along with these rising numbers, there has been a corresponding increase in the number of patient comorbidities. The focus of this article is to review comorbidities in Spine surgery patients and outline strategies to optimize patients and avoid complications.
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Affiliation(s)
- Zachary R Diltz
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Eric J West
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Matthew R Colatruglio
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Mateo J Kirwan
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Elliot N Konrade
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Kirk M Thompson
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA.
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Agarwal N, Aabedi AA, Chan AK, Letchuman V, Shabani S, Bisson EF, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Haid RW, Chou D, Mummaneni PV. Leveraging machine learning to ascertain the implications of preoperative body mass index on surgical outcomes for 282 patients with preoperative obesity and lumbar spondylolisthesis in the Quality Outcomes Database. J Neurosurg Spine 2023; 38:182-191. [PMID: 36208428 DOI: 10.3171/2022.8.spine22365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior studies have revealed that a body mass index (BMI) ≥ 30 is associated with worse outcomes following surgical intervention in grade 1 lumbar spondylolisthesis. Using a machine learning approach, this study aimed to leverage the prospective Quality Outcomes Database (QOD) to identify a BMI threshold for patients undergoing surgical intervention for grade 1 lumbar spondylolisthesis and thus reliably identify optimal surgical candidates among obese patients. METHODS Patients with grade 1 lumbar spondylolisthesis and preoperative BMI ≥ 30 from the prospectively collected QOD lumbar spondylolisthesis module were included in this study. A 12-month composite outcome was generated by performing principal components analysis and k-means clustering on four validated measures of surgical outcomes in patients with spondylolisthesis. Random forests were generated to determine the most important preoperative patient characteristics in predicting the composite outcome. Recursive partitioning was used to extract a BMI threshold associated with optimal outcomes. RESULTS The average BMI was 35.7, with 282 (46.4%) of the 608 patients from the QOD data set having a BMI ≥ 30. Principal components analysis revealed that the first principal component accounted for 99.2% of the variance in the four outcome measures. Two clusters were identified corresponding to patients with suboptimal outcomes (severe back pain, increased disability, impaired quality of life, and low satisfaction) and to those with optimal outcomes. Recursive partitioning established a BMI threshold of 37.5 after pruning via cross-validation. CONCLUSIONS In this multicenter study, the authors found that a BMI ≤ 37.5 was associated with improved patient outcomes following surgical intervention. These findings may help augment predictive analytics to deliver precision medicine and improve prehabilitation strategies.
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Affiliation(s)
- Nitin Agarwal
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Alexander A Aabedi
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Vijay Letchuman
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Saman Shabani
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 5Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee
| | - Christopher I Shaffrey
- Departments of6Neurosurgery and
- 7Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 8Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 9Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 10Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 12Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Y Wang
- 13Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L Asher
- 10Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Michael S Virk
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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5
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Elsamadicy AA, Sandhu MRS, Reeves BC, Jafar T, Craft S, Sherman JJZ, Hersh AM, Koo AB, Kolb L, Lo SFL, Shin JH, Mendel E, Sciubba DM. Impact of Affective Disorders on Inpatient Opioid Consumption and Hospital Outcomes Following Open Posterior Spinal Fusion for Adult Spine Deformity. World Neurosurg 2023; 170:e223-e235. [PMID: 36332777 DOI: 10.1016/j.wneu.2022.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Affective disorders (ADs) are common and have a profound impact on surgical recovery, though few have studied the impact of ADs on inpatient narcotic consumption. The aim of this study was to assess the impact of ADs on inpatient narcotic consumption and healthcare resource utilization in patients undergoing spinal fusion for adult spinal deformity. METHODS A retrospective cohort study was performed using the 2016-2017 Premier Healthcare Database. Adults who underwent adult spinal deformity surgery were identified using International Classification of Disease, Tenth Revision, codes. Patients were grouped based on comorbid diagnosis of an AD. Demographics, comorbidities, intraoperative variables, complications, length of stay, admission costs, and nonroutine discharge rates were assessed. Increased inpatient opioid use was categorized by morphine milligram equivalents consumption greater than the 75th percentile. Multivariate regression analysis was used to identify predictors of increased healthcare recourse utilization. RESULTS Of the 1831 study patients, 674 (36.8%) had an AD. A smaller proportion of patients in the AD cohort were 65+ years of age (P = 0.001), while a greater proportion of patients in the AD cohort identified as non-Hispanic White (P < 0.001). A greater proportion of patients in the AD cohort had increased morphine milligram equivalents consumption (P < 0.001). The AD cohort also had a longer mean length of stay (P < 0.001). A greater proportion of patients in the AD cohort had nonroutine discharges (P = 0.039) and unplanned 30-day readmission (P = 0.041). On multivariate analysis, AD was significantly associated with increased cost (odds ratio: 1.61, P < 0.001) and nonroutine discharge (odds ratio: 1.36, P = 0.035). CONCLUSIONS ADs may be associated with increased inpatient opioid consumption and healthcare resource utilization.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Mani Ratnesh S Sandhu
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tamara Jafar
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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6
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Siempis T, Prassas A, Alexiou GA, Voulgaris S, Tsitsopoulos PP. A systematic review on the prevalence of preoperative and postoperative depression in lumbar fusion. J Clin Neurosci 2022; 104:91-95. [PMID: 35987119 DOI: 10.1016/j.jocn.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and Degenerative Spine Disease (DSD) frequently co-exist. Pooled prevalence estimates of depression before and after lumbar fusion surgery has not been analyzed before. The purpose of this systematic review was to estimate the pre- and post-operative prevalence of depression in patients with DSD undergoing lumbar fusion. METHODS A literature review until April 30th 2022 was performed. All studies on DSD patients undergoing lumbar spine fusion surgery with either a history of formal diagnosis of depression or a recording of depression using a validated tool were included. Patients with other psychiatric conditions or undergoing a different form of spinal surgery were excluded. Risk of bias of the included studies was evaluated using the Newcastle-Ottawa Scale. RESULTS Fifteen (15) studies with a total of 98.375 patients met the inclusion and exclusion criteria and were included in the analysis. The prevalence estimate of depression in patients before surgery was 15,35 % (95% CI: 10,56-20,86%). In the 7 studies including patients who had undergone lumbar fusion, the pooled prevalence was estimated 11,46% (95% CI: 8,11-15,30%). CONCLUSION An increased prevalence of depression in patients undergoing lumbar spine fusion was noted. Given the correlation between depression and poor surgical outcomes, strategies should be identified to prevent and treat depression in these patients.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Aristeidis Prassas
- Department of Neurosurgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - George A Alexiou
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece.
| | - Spyridon Voulgaris
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Mooney J, Michalopoulos GD, Alvi MA, Zeitouni D, Chan AK, Mummaneni PV, Bisson EF, Sherrod BA, Haid RW, Knightly JJ, Devin CJ, Pennicooke B, Asher AL, Bydon M. Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. J Neurosurg Spine 2022; 36:753-766. [PMID: 34905727 DOI: 10.3171/2021.10.spine211128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the expanding indications for and increasing popularity of minimally invasive surgery (MIS) for lumbar spinal fusion, large-scale outcomes analysis to compare MIS approaches with open procedures is warranted. METHODS The authors queried the Quality Outcomes Database for patients who underwent elective lumbar fusion for degenerative spine disease. They performed optimal matching, at a 1:2 ratio between patients who underwent MIS and those who underwent open lumbar fusion, to create two highly homogeneous groups in terms of 33 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, indications, and operative details). The outcomes of interest were overall satisfaction, decrease in Oswestry Disability Index (ODI), and back and leg pain, as well as hospital length of stay (LOS), operative time, reoperations, and incidental durotomy rate. Satisfaction was defined as a score of 1 or 2 on the North American Spine Society scale. Minimal clinically important difference (MCID) in ODI was defined as ≥ 30% decrease from baseline. Outcomes were assessed at the 3- and 12-month follow-up evaluations. RESULTS After the groups were matched, the MIS and open groups consisted of 1483 and 2966 patients, respectively. Patients who underwent MIS fusion had higher odds of satisfaction at 3 months (OR 1.4, p = 0.004); no difference was demonstrated at 12 months (OR 1.04, p = 0.67). Lumbar stenosis, single-level fusion, higher American Society of Anesthesiologists Physical Status Classification System grade, and absence of spondylolisthesis were most prominently associated with higher odds of satisfaction with MIS compared with open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference 1.61, p = 0.006; MCID OR 1.14, p = 0.0495) and 12 months (mean difference 2.35, p < 0.001; MCID OR 1.29, p < 0.001). MIS was also associated with a greater decrease in leg and back pain at both follow-up time points. The two groups did not differ in operative time and incidental durotomy rate; however, LOS was shorter for the MIS group. Revision surgery at 12 months was less likely for patients who underwent MIS (4.1% vs 5.6%, p = 0.032). CONCLUSIONS In patients who underwent lumbar fusion for degenerative spinal disease, MIS was associated with higher odds of satisfaction at 3 months postoperatively. No difference was demonstrated at the 12-month follow-up. MIS maintained a small, yet consistent, superiority in decreasing ODI and back and leg pain, and MIS was associated with a lower reoperation rate.
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Affiliation(s)
- James Mooney
- 1Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Giorgos D Michalopoulos
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 4School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew K Chan
- 5Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 5Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | | | - Clinton J Devin
- 9Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
| | - Brenton Pennicooke
- 10Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Anthony L Asher
- 11Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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8
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Elsamadicy AA, Koo AB, Sarkozy M, Reeves BC, Pennington Z, Havlik J, Sandhu MR, Hersh A, Patel S, Kolb L, Larry Lo SF, Shin JH, Mendel E, Sciubba DM. Differences in Healthcare Resource Utilization After Surgery for Metastatic Spinal Column Tumors in Patients with a Concurrent Affective Disorder in the United States. World Neurosurg 2022; 161:e252-e267. [PMID: 35123021 DOI: 10.1016/j.wneu.2022.01.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Affective disorders, such as depression and anxiety, are exceedingly common among patients with metastatic cancer. The aim of this study was to investigate the relationship between affective disorders and healthcare resource utilization in patients undergoing surgery for a spinal column metastasis. METHODS A retrospective cohort study was performed using the 2016-2018 National Inpatient Sample database. All adult patients (≥18 years) undergoing surgery for a metastatic spinal tumor were identified using the ICD-10-CM coding systems. Patients were categorized into two cohorts: No Affective Disorder (No-AD) and Affective Disorder (AD). Patient demographics, comorbidities, hospital characteristics, intraoperative variables, postoperative adverse events (AEs), LOS, discharge disposition, and total cost of hospital admission were assessed. A multivariate logistic regression analysis was used to identify independent predictors of increased cost, non-routine discharge, and prolonged LOS. RESULTS Of the 8,360 patients identified, 1,710 (20.5%) had a diagnosis of AD. While no difference was observed in the rates of postoperative AEs between the cohorts (p=0.912), the AD cohort had a significantly longer mean LOS (No-AD:10.1±8.3 days vs AD:11.6±9.8 days, p=0.012) and greater total cost (No-AD:$53,165±35,512 vs AD:$59,282±36,917, p=0.011). No significant differences in non-routine discharge were observed between the cohorts (p=0.265). On multivariate regression analysis, having an affective disorder was a significant predictor of increased costs [OR:1.45, CI(1.03,2.05), p=0.034] and non-routine discharge [OR:1.40, CI(1.06,1.85), p=0.017], but not prolonged LOS (p=0.067). CONCLUSIONS Our study found that affective disorders were significantly associated with greater hospital expenditures and non-routine discharge, but not prolonged LOS, for patients undergoing surgery for spinal metastases.
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Affiliation(s)
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Margot Sarkozy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | | | - John Havlik
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Mani R Sandhu
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Andrew Hersh
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD
| | - Saarang Patel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Daniel M Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY
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9
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Chan AK, Mummaneni PV, Burke JF, Mayer RR, Bisson EF, Rivera J, Pennicooke B, Fu KM, Park P, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Wang MY, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Chou D. Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis? J Neurosurg Spine 2022; 36:177-184. [PMID: 34534963 DOI: 10.3171/2021.3.spine202059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors' aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to -2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - John F Burke
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Rory R Mayer
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Erica F Bisson
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Joshua Rivera
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Brenton Pennicooke
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Kai-Ming Fu
- 3Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Paul Park
- 4Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Mohamad Bydon
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Knoxville, Tennessee
- 8Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Christopher I Shaffrey
- 9Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 10Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 12Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - John J Knightly
- 13Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Michael Y Wang
- 14Department of Neurological Surgery, University of Miami, Miami, Florida
| | | | - Anthony L Asher
- 12Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael S Virk
- 3Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mohammed A Alvi
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jian Guan
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Chan AK, Wozny TA, Bisson EF, Pennicooke BH, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Mummaneni PV. Classifying Patients Operated for Spondylolisthesis: A K-Means Clustering Analysis of Clinical Presentation Phenotypes. Neurosurgery 2021; 89:1033-1041. [PMID: 34634113 DOI: 10.1093/neuros/nyab355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Trials of lumbar spondylolisthesis are difficult to compare because of the heterogeneity in the populations studied. OBJECTIVE To define patterns of clinical presentation. METHODS This is a study of the prospective Quality Outcomes Database spondylolisthesis registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means clustering analysis-an unsupervised machine learning algorithm-was used to identify clinical presentation phenotypes. RESULTS Overall, 608 patients were identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (P > .05). Both clusters improved clinically (P < .001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the high-disease-burden cluster (adjusted-P < .001). However, the high-disease-burden cluster demonstrated greater 24-mo improvements for ODI, NRS-BP, and EQ-5D (adjusted-P < .05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-P = .001). High-disease-burden cluster had lower satisfaction (adjusted-P = .02). CONCLUSION We define 2 distinct phenotypes-those with high vs intermediate disease burden-operated for lumbar spondylolisthesis. Those with high disease burden were less satisfied, had a lower quality of life, and more disability, more back pain, and more leg pain than those with intermediate disease burden, but had greater magnitudes of improvement in disability, back pain, quality of life, and more often reached ODI MCID.
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Affiliation(s)
- Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Brenton H Pennicooke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin T Foley
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA.,Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Eric A Potts
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Domagoj Coric
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - John J Knightly
- Atlantic Neurosurgical Specialists, Morristown, New Jersey, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York, USA
| | | | - Anthony L Asher
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York, USA
| | | | - Mohammed A Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jian Guan
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Regis W Haid
- Atlanta Brain and Spine Care, Atlanta, Georgia, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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