Health Care Utilization and Associated Economic Burden of Postoperative Surgical Site Infection after Spinal Surgery with Follow-Up of 24 Months

Breaking Boundaries in Spinal Surgery: GPT-4's Quest to Revolutionize Surgical Site Infection Management

BACKGROUND

Surgical site infection (SSI) is a common and costly complication in spinal surgery. Identifying risk factors and preventive strategies is crucial for reducing SSIs. Generative Pre-trained Transformer 4 (GPT-4) has evolved from a simple text-based tool to a sophisticated multimodal data expert, invaluable for clinicians. This study explored GPT-4's applications in SSI management across various clinical scenarios.

METHODS

GPT-4 was employed in clinical scenarios related to SSIs in spinal surgery. Researchers designed specific questions for GPT-4 to generate tailored responses. Six evaluators assessed the responses for logic and accuracy using a 5-point Likert scale. Interrater consistency was measured with Fleiss' kappa, and radar charts visualized GPT-4's performance.

RESULTS

Interrater consistency, measured by Fleiss' kappa, ranged from 0.62 to 0.83. The average scores for logic and accuracy were 24.27 ± 0.4 and 24.46 ± 0.25. Radar charts indicated consistently high performance across criteria. GPT-4 demonstrated proficiency in creating personalized treatment plans, improving SSI management strategies, and identified emerging research trends.

CONCLUSIONS

GPT-4 shows a significant potential in SSI management in spinal surgery, promoting patient-centered care and precision medicine. Despite limitations in antibiotics and patient education, GPT-4's continuous learning, data privacy focus, and professional collaboration indicate its potential to revolutionize SSI management, requiring further development.

A Study of Risk Factors for Surgical Site Infections and Direct Economic Losses in Clean Orthopedic Surgery

Background: Surgical site infection (SSI) is a serious complication after clean orthopedic surgery. Patients and Methods: We retrospectively gathered data on 18,140 patients who underwent clean incision orthopedic operations at two institutions between January 2023 and April 2024. The study included 87 patients with SSIs in the case group and 80 matched controls without SSIs. Age, diabetes mellitus, and intra-operative blood transfusions were all examined using uni-variable and conditional multi-variable logistic regression to detect risk and independent risk factors for SSI. Differences in hospital charges and length of stay were also investigated. Results: Among the 18,140 surveyed patients, 87 developed SSIs, yielding an infection rate of 0.48%. Significant risk factors for SSI included hypertension (31.3% vs. 15.0%, p = 0.015), more than two surgical procedures (28.8% vs. 8.8%, p = 0.001), and durations of indwelling urinary catheters (p ＜ 0.001) and drains (p = 0.003). Independent risk factors included age ≥60 years [odds ratio (OR): 36.011, p = 0.025], more than two surgical procedures (OR: 7.001, p = 0.034), and durations of indwelling urinary catheters (OR: 2.164, p = 0.033) and drains (OR: 1.426, p = 0.004). The median hospitalization cost was $5,289.3 for patients with SSIs compared with $3,653.9 for those without infections. The cost difference was statistically significant (Z = -3.409, p = 0.001), with an additional median expense of $1,366.5 attributed to SSIs. Patients in the infection group were hospitalized for a median of 30 days, compared with 15 days in the non-infected group, a statistically significant difference (Z = -7.32, p < 0.001), resulting in 17 additional days of hospitalization. The total direct economic loss attributed to 80 SSI cases across both hospitals amounted to $162,415.8. Conclusion: The study identifies multiple risk factors for SSIs following orthopedic clean surgical procedures. Hospital-related departments should aim to mitigate these risks to decrease the incidence of SSIs and reduce the financial burden on patients.

Polypharmacy in elective lumbar spinal surgery for degenerative conditions with 24-month follow-up

We sought to identify long-term associations of medical complications and healthcare utilization related to polypharmacy following spinal surgery for degenerative lumbar pathology. The IBM MarketScan dataset was used to select patients who underwent spinal surgery for degenerative lumbar pathology with 2-year follow-up. Regression analysis compared two matched cohorts: those with and without polypharmacy. Of 118,434 surgical patients, 68.1% met criteria for polypharmacy. In the first 30 days after discharge, surgical site infection was observed in 6% of those with polypharmacy and 4% of those without polypharmacy (p < 0.0001) and at least one complication was observed in 24% for the polypharmacy group and 17% for the non-polypharmacy group (p < 0.0001). At 24 months, patients with polypharmacy were more likely to be diagnosed with pneumonia (48% vs. 37%), urinary tract infection (26% vs. 19%), and surgical site infection (12% vs. 7%), (p < 0.0001). The most prescribed medication was hydrocodone (60% of patients) and more than 95% received opioids. Two years postoperatively, the polypharmacy group had tripled overall healthcare utilization payments ($30,288 vs. $9514), (p < 0.0001). Patients taking 5 or more medications concurrently after spinal surgery for degenerative lumbar conditions were more likely to develop medical complications, higher costs, and return to the emergency department.

Effect of negative pressure wound therapy on the incidence of deep surgical site infections after orthopedic surgery: a meta-analysis and systematic review

OBJECTIVE

This meta-analysis aimed to explore the impact of prophylactic negative pressure wound therapy (NPWT) on the occurrence of deep surgical site infections (SSIs) following orthopedic surgery.

METHODS

A systematic search was conducted across Medline, Embase, Cochrane Library, and Web of Science databases for articles concerning NPWT in patients who underwent orthopedic surgery up to May 20, 2024. Using Stata 15.0, the combined odds ratios (ORs) were calculated with either a random-effects model or a fixed-effects model, depending on the heterogeneity values.

RESULTS

From a total of 440 publications, studies that utilized NPWT as the experimental group and conventional dressings as the control group were selected to analyze their impact on SSIs. Ultimately, 32 studies met the inclusion criteria. These included 12 randomized controlled trials and 20 cohort studies, involving 7454 patients, with 3533 of whom received NPWT and 3921 of whom were treated with conventional dressings. The results of the meta-analysis demonstrated that the NPWT group had a lower incidence of deep SSIs in orthopedic surgeries than did the control group [OR 0.64, 95% CI (0.52, 0.80), P = 0.0001]. Subgroup analysis indicated a notable difference for trauma surgeries [OR 0.65, 95% CI (0.50, 0.83), P = 0.001], whereas joint surgeries [OR 0.65, 95% CI (0.38, 1.12), P = 0.122] and spine surgeries [OR 0.61, 95% CI (0.27, 1.35), P = 0.221] did not show significant differences. Additionally, when examined separately according to heterogeneity, trauma surgeries exhibited a significant difference [OR 0.50, 95% CI (0.31, 0.80), P = 0.004].

CONCLUSION

The results of our study indicate that the prophylactic use of NPWT reduces the incidence of deep SSIs following orthopedic trauma surgery when compared to the use of conventional dressings. We postulate that the prophylactic application of NPWT in patients at high risk of developing complications from bone trauma may result in improved clinical outcomes and an enhanced patient prognosis.

Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis

Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention.

Impact of a severe complication two years after laparoscopic Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry

BACKGROUND

Although severe complications (SCs) after laparoscopic Roux-en-Y gastric bypass (LRYGB) are rare, they can be devastating for the affected patient.

OBJECTIVE

To access the impact of SCs (Clavien-Dindo ≥3b) 2 years after LRYGB by using a nationwide Swedish cohort of 48,201 primary cases between 2007 and June 2016.

SETTING

University hospital, Sweden.

METHODS

Patients with SC were matched 1:1 on age, sex, diabetic status, body mass index (BMI), and year of operation to patients without an SC. Weight loss, patient-scored quality of life (QoL), antidepressant use, proton pump inhibitors (PPI) and opioids, and in-hospital care were gathered from 3 national registers.

RESULTS

A total of 1411 (2.9%) patients suffered an SC and 16 (.03%) died. In total, 1403 patients with SC (mean age, 42 yr; female, 75%; with diabetes, 15.7%; mean BMI, 41.9 kg/m²) could be matched. Both groups had a total body weight loss of 32% at 2 years. A lower physical QoL was observed in SCs throughout the study period. Antidepressant, PPI and opioid use was higher among patients with SC, even 2 years after surgery. At this time point, a doubling of oral morphine equivalents (7.3 to 17.0 mg/d) was found in patients with SC compared with prior to surgery. The SC group required more in-hospital care after the initial 30 days (3.8 versus .9 d in the remaining part of the first year).

CONCLUSION

An SC resulted in higher antidepressant, PPI and opioid use as well as higher need for in-hospital care during the first 2 postoperative years. Affected patients should therefore receive special attention during follow up.