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Ruggiero N, Soliman MAR, Kuo CC, Aguirre AO, Quiceno E, Saleh J, Yeung K, Khan A, Hess RM, Lim J, Smolar DE, Pollina J, Mullin JP. The Effect of Diabetes on Complications after Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 185:e976-e994. [PMID: 38460815 DOI: 10.1016/j.wneu.2024.03.008] [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: 02/24/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Spinal fusion procedures are used to treat a wide variety of spinal pathologies. Diabetes mellitus (DM) has been shown to be a significant risk factor for several complications following these procedures in previous studies. To the authors' knowledge, this is the first systematic review and meta-analysis elucidating the relationship between DM and complications occurring after spinal fusion procedures. METHODS Systematic literature searches of PubMed and EMBASE were performed from their inception to October 1, 2022, to identify studies that directly compared postfusion complications in patients with and without DM. Studies met the prespecified inclusion criteria if they reported the following data for patients with and without DM: (1) demographics; (2) postspinal fusion complication rates; and (3) postoperative clinical outcomes. The included studies were then pooled and analyzed. RESULTS Twenty-eight studies, with a cumulative total of 18,853 patients (2695 diabetic patients), were identified that met the inclusion criteria. Analysis showed that diabetic patients had significantly higher rates of total number of postoperative complications (odds ratio [OR] = 1.33; 95% confidence interval [CI] = 1.12-1.58; P = 0.001), postoperative pulmonary complications (OR=2.01; 95%CI=1.31-3.08; P = 0.001), postoperative renal complications (OR=2.20; 95%CI=1.27-3.80; P = 0.005), surgical site infection (OR=2.65; 95%CI=2.19-3.20; P < 0.001), and prolonged hospital stay (OR=1.67; 95%CI=1.47-1.90; P < 0.001). CONCLUSIONS Patients with DM had a significantly higher risk of developing complications after spinal fusion, particularly pulmonary and renal complications, in addition to surgical site infections and had a longer length of stay. These findings are important for informed discussions of surgical risks with patients and families before surgery.
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Affiliation(s)
- Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Julian Saleh
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | | | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - David E Smolar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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Partha Sarathi CI, Sinha A, Rafati Fard A, Bhatti F, Rujeedawa T, Ahmed S, Akhbari M, Bhatti A, Nouri A, Kotter MR, Davies BM, Mowforth OD. The significance of metabolic disease in degenerative cervical myelopathy: a systematic review. Front Neurol 2024; 15:1301003. [PMID: 38375465 PMCID: PMC10876002 DOI: 10.3389/fneur.2024.1301003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is a form of chronic spinal cord injury, with a natural history of potential for progression over time. Whilst driven by mechanical stress on the spinal cord from degenerative and congenital pathology, the neurological phenotype of DCM is likely to be modified by multiple systemic factors. The role of metabolic factors is therefore of interest, particularly given that ischaemia is considered a key pathological mechanism of spinal cord injury. The objective was therefore to synthesise current evidence on the effect of metabolism on DCM susceptibility, severity, and surgical outcomes. Methods A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English, with a focus on DCM and metabolism, including diabetes, cardiovascular disease, anaemia, and lipid profile, were eligible for inclusion. Risk of methodological bias was assessed using the Joanna Briggs Institute (JBI) critical assessment tools. Quality assessments were performed using the GRADE assessment tool. Patient demographics, metabolic factors and the relationships between metabolism and spinal cord disease, spinal column disease and post-operative outcomes were assessed. Results In total, 8,523 papers were identified, of which 57 met criteria for inclusion in the final analysis. A total of 91% (52/57) of included papers assessed the effects of diabetes in relation to DCM, of which 85% (44/52) reported an association with poor surgical outcomes; 42% of papers (24/57) discussed the association between cardiovascular health and DCM, of which 88% (21/24) reported a significant association. Overall, DCM patients with diabetes or cardiovascular disease experienced greater perioperative morbidity and poorer neurological recovery. They were also more likely to have comorbidities such as obesity and hyperlipidaemia. Conclusion Metabolic factors appear to be associated with surgical outcomes in DCM. However, evidence for a more specific role in DCM susceptibility and severity is uncertain. The pathophysiology and natural history of DCM are critical research priorities; the role of metabolism is therefore a key area for future research focus. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021268814.
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Affiliation(s)
- Celine Iswarya Partha Sarathi
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amil Sinha
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amir Rafati Fard
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Faheem Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Tanzil Rujeedawa
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shahzaib Ahmed
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Melika Akhbari
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aniqah Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Mark R. Kotter
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M. Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Oliver D. Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
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The impact of diabetes on postoperative outcomes following spine surgery: A meta-analysis of 40 cohort studies with 2.9 million participants. Int J Surg 2022; 104:106789. [PMID: 35918006 DOI: 10.1016/j.ijsu.2022.106789] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
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Roth SG, Chanbour H, Gupta R, O'Brien A, Davidson C, Archer KR, Pennings JS, Devin CJ, Stephens BF, Abtahi AM, Zuckerman SL. Optimal hemoglobin A1C target in diabetics undergoing elective cervical spine surgery. Spine J 2022; 22:1149-1159. [PMID: 35257839 DOI: 10.1016/j.spinee.2022.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Diabetes mellitus (DM) is a well-established risk factor for suboptimal outcomes following cervical spine surgery. Hemoglobin A1C (HbA1c), a surrogate for long-term glycemic control, is a valuable assessment tool in diabetic patients. PURPOSE In patients undergoing elective cervical spine surgery, we sought to identify optimal HbA1c levels to: (1) maximize 1-year postoperative patient-reported outcomes (PROs), and (2) predict the occurrence of medical and surgical complications. STUDY DESIGN/SETTING A retrospective cohort study using prospectively collected data was performed in a single academic center. PATIENT SAMPLE Diabetic patients undergoing elective anterior cervical fusion and posterior cervical laminectomy and fusion (PCLF) between October 2010-March 2021 were included. OUTCOME MEASURES Primary outcomes included Numeric Rating Scale (NRS)-Neck pain, NRS-Arm pain, and Neck Disability Index (NDI). Secondary outcomes included surgical site infection (SSI), complications, readmissions, and reoperations within 90-days postoperatively. METHODS HbA1c, demographic, comorbidity, and perioperative variables were gathered in diabetic patients only. PROs were analyzed as continuous variables and minimum clinically difference (MCID) was set at 30% improvement from baseline. RESULTS Of 1992 registry patients undergoing cervical surgery, 408 diabetic patients underwent cervical fusion surgery. Anterior: A total of 259 diabetic patients underwent anterior cervical fusion, 141 of which had an available HbA1c level within one year prior to surgery. Mean age was 55.8±10.1, and mean HbA1c value was 7.2±1.4. HbA1c levels above 6.1 were associated with failure to achieve MCID for NDI (AUC=0.77, 95%CI 0.70-0.84, p<.001), and HbA1c levels above 6.8 may be associated with increased odds of reoperation (AUC=0.61, 95%CI 0.52-0.69, p=.078). Posterior: A total of 149 diabetic patients underwent PCLF, 65 of which had an available HbA1c level within 1 year. Mean age was 63.6±9.2, and mean HbA1c value was 7.2±1.5. Despite a low AUC for NRS-Arm pain and readmission, HbA1c levels above 6.8 may be associated with failure to achieve MCID for NRS-Arm pain (AUC=0.61, 95%CI 0.49-0.73, p=.094), and HbA1c levels above 7.6 may be associated with higher readmission rate (AUC=0.63, 95%CI 0.50-0.75, p=.185). CONCLUSIONS In a cohort of diabetic patients undergoing elective cervical spine surgery, HbA1c levels above 6.1 were associated with decreased odds of achieving MCID for NDI in anterior cervical fusion surgery. Though only moderate associations were seen for the select outcomes of reoperation (6.8), readmission (7.6), and MCID for NRS-Arm pain (6.8), preoperative optimization of HbA1c using these levels as benchmarks should be considered to reduce the risk of complications and maximize PROs for patients undergoing elective cervical spine surgery.
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Affiliation(s)
- Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rishabh Gupta
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex O'Brien
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopedic Surgery, Steamboat Orthopedics and Spine Institute, Steamboat Springs, CO, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Surgical Apgar Score and Controlling Nutritional Status Score are significant predictors of major complications after cervical spine surgery. Sci Rep 2022; 12:6605. [PMID: 35459762 PMCID: PMC9033867 DOI: 10.1038/s41598-022-10674-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/04/2022] [Indexed: 12/02/2022] Open
Abstract
Nutritional screening scores, including Controlling Nutritional Status (CONUT) Score and Surgical Apgar Score (SAS), which reflect intraoperative hemodynamics, have been reported to be useful for predicting major postoperative complications in various kinds of surgery. We assessed independent risk factors for major complications after cervical spine surgery using those scoring measurements. We retrospectively reviewed medical records of patients who underwent cervical spine surgery at our institution from 2014 to 2019. Baseline clinical information, including the CONUT Score, and surgical factors, including the SAS, were assessed as risk factors for major postoperative complications. We analyzed 261 patients. Major postoperative complications occurred in 40 cases (15.3%). In the multivariate analysis, SAS (odds ratio [OR], 0.42; P < 0.01), CONUT (OR, 1.39; P < 0.01), and operative time (OR, 1.42; P < 0.01) were significant independent risk factors of major complications. The area under the SAS curve was 0.852 in the receiver operating characteristic curve analysis. Postoperative hospitalization duration was significantly longer in major complications group. Evaluating preoperative nutritional condition and intraoperative hemodynamics with CONUT score and SAS was useful for predicting major postoperative complications of cervical spine surgery. In addition, both scoring measurements are easily calculated, objective evaluations. Perioperative management utilizing those scoring measurements may help prevent them.
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Varshneya K, Bhattacharjya A, Sharma J, Stienen MN, Medress ZA, Ratliff JK, Veeravagu A. Outcome Measures of Medicare Patients With Diabetes Mellitus Undergoing Thoracolumbar Deformity Surgery. Clin Spine Surg 2022; 35:E31-E35. [PMID: 34183547 DOI: 10.1097/bsd.0000000000001229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The objective of this study was to identify the impact of diabetes on postoperative outcomes in Medicare patients undergoing adult spinal deformity (ASD) surgery. METHODS We queried the MarketScan Medicare database to identify patients who underwent ASD surgery from 2007 to 2016. Patients were then stratified based on diabetes status at the time of the index operation. Patients not enrolled in the Medicare dataset and those with any prior history of trauma or tumor were excluded from this study. RESULTS A total of 2564 patients met the inclusion criteria of this study, of which n=746 (29.1.%) were diabetic. Patients with diabetes had a higher rate of postoperative infection than nondiabetic patients (3.1% vs. 1.7%, P<0.05) within 90 days. Renal complications were also more elevated in the diabetic cohort (3.2% vs. 1.3%, P<0.05). Readmission rates were significantly higher in the diabetes cohort through of 60 days (15.2% vs. 11.8%, P<0.05) and 90 days (17.0% vs. 13.4%, P<0.05). When looking specifically at the outpatient payments, patients with diabetes did have a higher financial burden at 60 days ($8147 vs. $6956, P<0.05) and 90 days ($10,126 vs. $8376, P<0.05). CONCLUSIONS In this study, diabetic patients who underwent ASD surgery had elevated rates of postoperative infection, outpatient costs, and rates of readmissions within 90 days. Further research should investigate the role of poor glycemic control on spine surgery outcomes.
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Affiliation(s)
- Kunal Varshneya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Anika Bhattacharjya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Jigyasa Sharma
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Martin N Stienen
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
- Department of Neurosurgery, University Hospital Zurich
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Zachary A Medress
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - John K Ratliff
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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Long A, Xie Z, Wang X, Zhang Y, Han D. The impact of perioperative glucose variability on outcomes after hip fracture. Medicine (Baltimore) 2022; 101:e28728. [PMID: 35089246 PMCID: PMC8797594 DOI: 10.1097/md.0000000000028728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023] Open
Abstract
Diabetes is considered an independent risk factor for hip fracture. In the present study, we evaluated whether perioperative glucose variability (GV) was a significant predictor of the outcomes of patients with diabetes after hip fracture.We analyzed the characteristics and outcomes of all patients with hip fractures admitted to our hospital between September 2008 and December 2012. Patients with diabetes were grouped into tertiles for GV, and multivariate survival analysis included age, sex, fracture type, mean fasting plasma glucose, and GV.Among the 1099 patients included in this study, 239 (21.7%) had diabetes. Patients with diabetes were more likely to develop infectious complications (5.4% vs 2.8%, P = .045), and experience mortality postoperatively (1 month: 5.5% vs 2.7%, P = .052; 12 months: 15.1% vs 8.7%, P = .006). The postoperative mortality rate was increased across the GV tertiles, and GV was an independent predictor of 1- and 12-month mortality after surgery.Patients with diabetes had poor prognoses after hip fracture. Perioperative GV is an independent predictor of mortality in patients with diabetes. Therefore, GV might be considered a valid additional parameter to consider in the management of these patients.
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Affiliation(s)
- Anhua Long
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Zongyan Xie
- Department of Clinical Pharmacology, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Xuefei Wang
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Yakui Zhang
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Dacheng Han
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
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Zhang X, Hou A, Cao J, Liu Y, Lou J, Li H, Ma Y, Song Y, Mi W, Liu J. Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review. Front Endocrinol (Lausanne) 2022; 13:841256. [PMID: 35721703 PMCID: PMC9204286 DOI: 10.3389/fendo.2022.841256] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although a variety of data showing that diabetes mellitus (DM) (Type 1 or Type 2) is associated with postoperative complication, there is still a lack of detailed studies that go through the specific diabetic subgroups. The goal of this meta-analysis is to assess the relationship between DM and various complications after non-cardiac surgery. METHODS We searched articles published in three mainstream electronic databases (PubMed, EMBASE, Web of science) before November, 2020. A random effects model was conducted since heterogeneity always exist when comparing results between different types of surgery. RESULTS This paper included 125 studies with a total sample size of 3,208,776 participants. DM was a risk factor for any postoperative complication (Odds ratio (OR)=1.653 [1.487, 1.839]). The risk of insulin-dependent DM (OR=1.895 [1.331, 2.698]) was higher than that of non-insulin-dependent DM (OR=1.554 [1.061, 2.277]) for any postoperative complication. DM had a higher risk of infections (OR=1.537 [1.322, 1.787]), wound healing disorders (OR=2.010 [1.326, 3.046]), hematoma (OR=1.369 [1.120, 1.673]), renal insufficiency (OR=1.987 [1.311, 3.013]), myocardial infarction (OR=1.372 [0.574, 3.278]). Meanwhile, DM was a risk factor for postoperative reoperation (OR=1.568 [1.124, 2.188]), readmission (OR=1.404 [1.274, 1.548]) and death (OR=1.606 [1.178, 2.191]). CONCLUSIONS DM is a risk factor for any postoperative complications, hospitalization and death after non-cardiac surgery. These findings underscore the importance of preoperative risk factor assessment of DM for the safe outcome of surgical patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Weidong Mi
- *Correspondence: Jing Liu, ; Weidong Mi,
| | - Jing Liu
- *Correspondence: Jing Liu, ; Weidong Mi,
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Tanaka T, Bradford T, Litofsky NS. Severity of Preoperative HbA1c and Predicting Postoperative Complications in Spine Surgery. World Neurosurg 2021; 155:e770-e777. [PMID: 34520868 DOI: 10.1016/j.wneu.2021.08.133] [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: 06/14/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with a greater incidence of perioperative complications. The measurement of hemoglobin A1c (HbA1c) has not been routinely used in the preoperative assessment for spine surgeries. METHODS In the present single-institution, prospective study, HbA1c testing was included in the preoperative laboratory examination of patients undergoing spinal surgery from 2016 through 2018. The HbA1c levels were categorized using the American Diabetes Association guidelines as normal (HbA1c <5.7%), pre-DM (HbA1c 5.7%-6.4%), and diabetes (HbA1c >6.5%). Those with a HbA1c of ≥8% were separated as having poorly controlled DM for analysis. Perioperative complication and comorbidity data were collected to assess for associations with DM using logistic regression models. Odds ratios (ORs) and 95% confidence intervals were computed. RESULTS A total of 440 patients (238 men, mean age, 56.43 ± 13.28 years; mean body mass index, 30.80 ± 6.65 kg/m2) met the study criteria. The HbA1c was <5.7% in 206 patients (46.8%), 5.7%-6.4% in 148 (33.6%), 6.5%-7.9% in 64 (14.5%), and ≥8.0% in 23 patients (5.22%). Bivariate logistic modeling showed that patients with poorly controlled DM had a higher risk of complications (OR, 2.92) than did the patients with DM (OR, 2.13). Malignancy (OR, 2.62) and hypertension (OR, 1.86) were also significant risk factors for complications. However, smoking (OR, 0.83) was not significant. Poorly controlled DM remained associated with complications in multivariable logistic regression modeling (OR, 2.72). CONCLUSIONS Poorly control DM defined by the preoperative HbA1c was significantly associated with postoperative complications. Smoking, however, was not so associated. Preoperative HbA1c can be used to assess the risk of postoperative spine surgery complications.
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Affiliation(s)
- Tomoko Tanaka
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, Arkansas, USA; Division of Pediatric Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA; Division of Neurosurgery, University of Missouri School of Medicine, Columbia, Missouri, USA.
| | - Toby Bradford
- Department of Internal Medicine, Alameda Health System, Oakland, California, USA; Medical School, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - N Scott Litofsky
- Division of Neurosurgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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Narain AS, Parrish JM, Jenkins NW, Haws BE, Khechen B, Yom KH, Kudaravalli KT, Guntin JA, Singh K. Risk Factors for Medical and Surgical Complications After Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion. Int J Spine Surg 2020; 14:125-132. [PMID: 32355616 DOI: 10.14444/7018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The prevention of perioperative and postoperative complications is necessary to avoid poor postoperative outcomes and increased costs. Previous investigations have identified risk factors for complications after various spine procedures, but no such study exists in a population solely undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The purpose of this study is to determine risk factors for the development of complications up to 2 years after MIS TLIF procedures. Methods Patients who underwent primary, single-level MIS TLIF from 2007 to 2016 were retrospectively reviewed. The incidence of medical and surgical complications up to 2 years postoperatively was determined. Patients were categorized according to demographic, comorbidity, and procedural characteristics. Bivariate Poisson regression with robust error variance was used to determine if an association existed between patient characteristics and complication incidence. A final multivariate model including all patient characteristics as controls was created using backwards, stepwise regression until only those variables with P < .05 remained. Results 390 patients were analyzed. Upon bivariate analysis, age >50 years (P = .025), diabetes mellitus (P = .001), and operative duration >105 minutes (P = .016) were associated with increased medical complication rates. Regarding surgical complications, age ≤50 years (P < .001), obesity (P = .012), and diabetes mellitus (P = .042) were identified as risk factors on bivariate analysis. Upon final multivariate analysis, operative time >105 minutes (P = .009) and diabetes mellitus (P = .001) were independent risk factors for medical complications. Independent risk factors for surgical complications on multivariate analysis included age ≤50 years (P < .001), diabetes mellitus (P = .002), and obesity (P = .030). Conclusions Diabetic patients and those who underwent longer operations were at increased risk of medical complications, while younger patients, obese patients and those also with diabetes mellitus were at increased risk of surgical complications up to 2 years after MIS TLIF. Practitioners can use this information to identify patients who require preventative care before their procedure or increased postoperative vigilance and monitoring after single-level MIS TLIF. Level of Evidence 3.
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Affiliation(s)
- Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brittany E Haws
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Benjamin Khechen
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kelly H Yom
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Krishna T Kudaravalli
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jordan A Guntin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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11
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Does Gender Influence Postoperative Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion? Clin Spine Surg 2019; 32:E107-E111. [PMID: 30407263 DOI: 10.1097/bsd.0000000000000735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The objective of this study was to determine if an association exists between gender and postoperative improvements in patient-reported outcomes (PRO) measures following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA Current spine literature presents conflicting findings regarding the influence of gender on clinical outcomes. METHODS Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. PRO measures including Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) back and leg pain scores were collected preoperatively and 6-week, 12-week, and 6-month postoperatively. Rates of minimum clinically important difference (MCID) achievement were determined at 6-months postoperative. Statistical analysis was performed using Pearson χ analysis or Student t test. RESULTS In total, 169 patients, 40.83% females and 59.17% males, were included. Females experienced greater inpatient pain scores than males (POD 0: 5.30 vs. 4.69, P=0.041; POD 1: 4.80 vs. 4.13, P=0.019). Females demonstrated significantly greater ODI (43.77 vs. 36.22; P=0.002) and VAS leg (6.20 vs. 5.27; P=0.039) scores than males. No differences in postoperative improvements in ODI, VAS back or VAS leg pain scores were identified between genders, with exception to females demonstrating greater improvement in VAS leg pain at 6 months postoperatively (female: -4.40 vs. male: -3.32; P=0.033). Furthermore, no differences in MCID achievement for PROs were identified between cohorts. CONCLUSIONS Females demonstrated greater preoperative pain and disability as well as inpatient VAS pain scores compared to males. Furthermore, gender was not associated with differences in length of stay, perioperative complication rates, or narcotics consumption. Improvements in pain and disability, as well as rates of MCID achievement were similar between genders. These findings suggest that gender is not associated with surgical or clinical outcomes and should not be used as a predictor of outcomes following MIS TLIF. LEVEL OF EVIDENCE Level III.
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12
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Perioperative Catheter Use as a Risk Factor for Surgical Site Infection After Cervical Surgery: An Analysis of 39,893 Patients. Spine (Phila Pa 1976) 2019; 44:E157-E161. [PMID: 30005050 DOI: 10.1097/brs.0000000000002790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To demonstrate the relationship between perioperative use of catheters and the incidence of surgical site infection (SSI) after cervical spine surgery, after adjusting for patient's age, severity of comorbidity, surgical approach, and use of instrumentation. SUMMARY OF BACKGROUND DATA Although the association between SSI and the use of arterial catheters (ACs) or central venous catheters (CVCs) is established in cardiac surgery, the relation in the cervical spine was not well elucidated. METHODS A private insurance database was analyzed. The incidence of SSI within 1 month postoperatively and the crude odds ratio (cOR) and 95% confidence interval (95% CI) were calculated based on the use of catheters. Subsequently, logistic regression analysis was performed to identify independent factors for SSI. Independent variables of the regression analysis included Charlson comorbidity index with the score of age, the use of CVC, the use of AC, surgical approach (anterior or posterior), and instrumentation (fusion or decompression alone). RESULTS A total of 39,893 patients received cervical surgery between 2007 and 2015. Of these, 1.6% patients experienced an SSI. The incidence of SSI in patients treated with and without AC was 3.2% and 1.3%, respectively (cOR 2.44, 95% CI: 2.05-2.99, P < 0.001). Likewise, incidence of SSI in patients with and without CVC was 5.8% and 1.5%, respectively (cOR 2.61, 95% CI: 2.97-5.55, P < 0.001). Multivariate logistic regression analysis demonstrated that the adjusted OR was 1.66 in CVC use (95% CI: 1.08-2.46, P = 0.016), whereas the AC use was not significant variable (P = 0.086). CONCLUSION The use of CVC can be a potential risk factor for SSI regardless of age, severity of comorbidity, surgical approach, or presence of instrumentation. Although the essential benefits of catheters are undisputed, our data can bring up the surgeon's attention to appropriate management of the CVC. LEVEL OF EVIDENCE 3.
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13
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Luo W, Sun RX, Jiang H, Ma XL. The effect of diabetes on perioperative complications following spinal surgery: a meta-analysis. Ther Clin Risk Manag 2018; 14:2415-2423. [PMID: 30587998 PMCID: PMC6296189 DOI: 10.2147/tcrm.s185221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Degenerative spinal diseases and diabetes mellitus (DM) have increasingly become a social and economic burden. The effect of DM on spinal surgery complications reported by previous studies remains controversial. Methods We searched MEDLINE, Cochrane CENTRAL, ScienceDirect, EMBASE, and Google Scholar to identify studies reporting the relationship between DM and spinal surgery complications. Two independent reviewers performed independent data abstraction. The I2 statistic was used to assess heterogeneity. A fixed-effects or random-effects model was used for the meta-analysis. Results Twenty-four studies met the inclusion criteria. Surgical site infection and the incidence of deep venous thrombosis after spinal surgery were significantly higher in patients with than in patients without diabetes, and the length of hospital stay was significantly longer in patients with diabetes (P<0.05). No significant differences were observed in the risk of reoperation, blood loss, and operation time between patients with and those without diabetes (P.0.05). Conclusion Patients with diabetes have a higher risk when undergoing spinal surgery than patients without diabetes. Diabetes increases the risks of postoperative mortality, surgical site infection, deep venous thrombosis, and a prolonged hospitalization time after spinal surgery.
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Affiliation(s)
- Wei Luo
- Department of Orthopedics, Tianjin Hospital, Tianjin 300211, People's Republic of China,
| | - Ru-Xin Sun
- Department of Gynaecology and Obstetrics, Tianjin Hongqiao Hospital, Tianjin 300131, People's Republic of China
| | - Han Jiang
- Department of Orthopedics, Tianjin Third Central Hospital, Tianjin 300170, People's Republic of China
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Hospital, Tianjin 300211, People's Republic of China,
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14
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Poorer Fusion Outcomes in Diabetic Cervical Spondylotic Myelopathy Patients Undergoing Single-level Anterior Cervical Discectomy and Fusion Does Not Compromise Functional Outcomes and Quality of Life. Spine (Phila Pa 1976) 2018; 43:477-483. [PMID: 28858183 DOI: 10.1097/brs.0000000000002395] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective matched pair cohort study using prospectively collected registry data. OBJECTIVES The aim of this study was to determine whether patients with DM have poorer patient-reported outcomes and poorer fusion rates after undergoing a single-level anterior cervical discectomy and fusion (ACDF) for cervical myelopathy. SUMMARY OF BACKGROUND DATA ACDF remains the most common procedure in the treatment of cervical spondylotic myelopathy (CSM); however, there is a paucity of literature with regards to patient-reported outcome measures (PROMs), health-related quality-of-life (HRQOL) scores, and fusion rates post-ACDF in diabetic patients with CSM. METHODS From 2002 to 2012, 29 diabetic patients were matched with 29 nondiabetic controls. Patient demographics, perioperative data, and validated spine-specific scores including the Numerical Pain Rating Scale on Neck Pain and Upper Limb Pain, American Academy of Orthopaedic Surgeons (AAOS) neck pain and disability scores, AAOS Neurogenic Symptoms Score, Neck Disability Index, Japanese Orthopaedic Association Cervical Myelopathy Score, and Short Form 36 Physical/Mental Component Summaries were recorded. Fusion rates based on Bridwell grading were assessed at 2 years. RESULTS After matching, there were no significant preoperative differences in patient demographics, clinical outcomes, PROMs or HRQoL measures between the DM and control group (P > 0.05). There was no difference in either length of hospital stay (P = 0.92) or length of surgery (P = 0.92) between the two groups. At 2 years postoperatively, there were no significant differences between validated spine-specific scores, PROMs, HRQoL scores, satisfaction rates, or fulfilment of expectations between the two groups. Significant poorer Bridwell fusion grades were noted in the DM group at 2 years postoperatively (P < 0.05). Subgroup analysis within the DM group demonstrated that glycated hemoglobin levels had no impact on functional outcomes, fulfilment of expectations, or patient satisfaction at 2 years (P > 0.05). CONCLUSION Despite poorer fusion outcomes following single-level ACDF for symptomatic CSM, there was no significant difference in validated spine outcome scores, PROMs, HRQoL measures, or satisfaction levels when compared to nondiabetic controls at short-term follow-up. LEVEL OF EVIDENCE 3.
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15
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Shin JI, Kim JS, Steinberger J, DiCapua J, Cho SK. Patient Factors Contributing to Prolonged Postoperative Length of Stay and Increased Rate of Readmission After Elective Posterior Cervical Fusion. Clin Spine Surg 2018; 31:E55-E61. [PMID: 28234774 DOI: 10.1097/bsd.0000000000000512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
STUDY DESIGN This is retrospective study of prospectively collected data. OBJECTIVE To identify patient factors that are independently associated with prolonged length of stay (LOS) and readmission after posterior cervical fusion (PCF) utilizing a large national database. SUMMARY OF BACKGROUND DATA A number of studies have investigated the morbidity and mortality after PCF; however, little is known about the factors that are associated with prolonged LOS and readmission, both of which incur increased costs for patients and hospitals. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2014. Current Procedural Terminology code 22600 was used to identify patients who underwent PCF. All patient factors were assessed for association with LOS and readmission rate using bivariate and multivariate logistic regressions. RESULTS A total of 2667 patients who underwent PCF met the inclusion criteria for LOS analysis. Average (±SD) LOS was 3.92 (±3.24) days, and median LOS was 3 days (interquartile range, 2-5 d). On multivariate analysis, increased LOS was found to be significantly associated with dependent functional status (P<0.001), diabetes mellitus (P=0.021), preoperative anemia (P=0.001), American Society of Anesthesiologists class 3 or 4 (P<0.001), and number of fused levels (P<0.001). A total of 2591 patients met criteria (LOS≤11 d) for analysis of readmission. Readmission rate among these patients was 7.1%. Average (±SD) LOS of the patients not readmitted within 30 days of operation was 3.89 (±3.25), whereas the average (±SD) LOS of the patients readmitted was 4.24 (±3.08). On multivariate analysis, readmission was found to be significantly associated with only dependent functional status (P=0.019) and increased number of fused levels (P=0.032). CONCLUSIONS The current study provides valuable information on patient factors that are associated with prolonged LOS and readmission, which would be useful in enhanced informed consent before surgery, surgical planning, discharge planning, and optimizing postoperative care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- John I Shin
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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16
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Passias PG, Jalai CM, Worley N, Vira S, Hasan S, Horn SR, Segreto FA, Bortz CA, White AP, Gerling M, LaFage V, Errico T. Predictors of Hospital Length of Stay and 30-Day Readmission in Cervical Spondylotic Myelopathy Patients: An Analysis of 3057 Patients Using the ACS-NSQIP Database. World Neurosurg 2018; 110:e450-e458. [DOI: 10.1016/j.wneu.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
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17
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Stricsek G, Gillick J, Rymarczuk G, Harrop JS. Managing the Complex Patient with Degenerative Cervical Myelopathy: How to Handle the Aging Spine, the Obese Patient, and Individuals with Medical Comorbidities. Neurosurg Clin N Am 2017; 29:177-184. [PMID: 29173431 DOI: 10.1016/j.nec.2017.09.014] [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] [Indexed: 11/18/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord injury worldwide. Even relatively mild impairment in functional scores can significantly impact daily activities. Surgery is an effective treatment for DCM, but outcomes are dependent on more than technique and preoperative neurologic deficits.
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Affiliation(s)
- Geoffrey Stricsek
- Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - John Gillick
- Spine Division, Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - George Rymarczuk
- Spine Division, Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - James S Harrop
- Division of Spine and Peripheral Nerve Surgery, Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
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18
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Tamai K, Terai H, Suzuki A, Nakamura H, Yamashita M, Eguchi Y, Imagama S, Ando K, Kobayashi K, Matsumoto M, Ishii K, Hikata T, Seki S, Aramomi M, Ishikawa T, Kimura A, Inoue H, Inoue G, Miyagi M, Saito W, Yamada K, Hongo M, Endo K, Suzuki H, Nakano A, Watanabe K, Ohya J, Chikuda H, Aoki Y, Shimizu M, Futatsugi T, Mukaiyama K, Hasegawa M, Kiyasu K, Iizuka H, Nishida K, Kakutani K, Nakajima H, Murakami H, Demura S, Kato S, Yoshioka K, Namikawa T, Watanabe K, Nakanishi K, Nakagawa Y, Yoshimoto M, Fujiwara H, Nishida N, Sakane M, Yamazaki M, Kaito T, Furuya T, Orita S, Ohtori S. Risk factors of cervical surgery related complications in patients older than 80 years. Spine Surg Relat Res 2017; 1:179-184. [PMID: 31440631 PMCID: PMC6698567 DOI: 10.22603/ssrr.1.2017-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/16/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction With an aging population, the proportion of patients aged ≥80 years requiring cervical surgery is increasing. Surgeons are concerned with the high incidence of complications in this population, because “age” itself has been reported as a strong risk factor for complications. However, it is still unknown which factors represent higher risk among these elderly patients. Therefore, this study was conducted to identify the risk factors related to surgical complications specific to elderly patients by analyzing the registry data of patients aged ≥80 years who underwent cervical surgery. Methods We retrospectively studied multicenter collected registry data using multivariate analysis. Sixty-six patients aged ≥80 years who underwent cervical surgery and were followed up for more than one year were included in this study. Preoperative patient demographic data, including comorbidities and postoperative complications, were collected from multicenter registry data. Complications were considered as major if they required invasive intervention, caused prolonged morbidity, or resulted in prolongation of hospital stay. Logistic regression analysis was performed to analyze the risk factors for complications. A p-value of <0.05 was considered as statistically significant. Results The total number of patients with complications was 21 (31.8%), with seven major (10.6%) and 14 minor (21.2%) complications. Multivariate logistic regression analysis, after adjusting for age, revealed two significant risk factors: preoperative cerebrovascular disorders (OR, 6.337; p=0.043) for overall complications and cancer history (OR, 8.168; p=0.021) for major complications. Age, presence of diabetes mellitus, and diagnosis were not significant predictive factors for complications in this study. Conclusions Preoperative cerebrovascular disorders and cancer history were risk factors for complications after cervical surgery in patients over 80 years old. Surgeons should pay attention to these specific risk factors before performing cervical surgery in elderly patients.
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Affiliation(s)
- Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Masaomi Yamashita
- Department of Orthopedic Surgery, Social Insurance Funabashi Central Hospital, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu Hospital, Chiba, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University, Aichi, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University, Aichi, Japan
| | | | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Toyama University, Toyama, Japan
| | - Masaaki Aramomi
- Department of Orthopaedic Surgery, Sanmu Medical Center, Chiba, Japan
| | | | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Kanagawa, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, Kanagawa, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University, Kanagawa, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University, Fukuoka, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University, Akita, Japan
| | - Kenji Endo
- Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Nakano
- Department of Orthopaedic Surgery, Osaka Medical College, Osaka, Japan
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Junichi Ohya
- Department of Orthopaedic Surgery, Tokyo University, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Tokyo University, Tokyo, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University, Nagano, Japan
| | | | - Keijiro Mukaiyama
- Department of Orthopaedic Surgery, Shinshu University, Nagano, Japan
| | | | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Gunma University, Gunma, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University, Hyogo, Japan
| | | | - Hideaki Nakajima
- Department of Orthopaedic Surgery, Fukui University, Fukui, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, Japan
| | | | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University, Niigata, Japan.,Department of Orthopaedic Surgery, Sado General Hospital, Niigata, Japan
| | | | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University, Hokkaido, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, Osaka-Minami Medical Center, Osaka, Japan
| | - Norihiro Nishida
- Department of Orthopaedic Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Masataka Sakane
- Department of Orthopaedic Surgery, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, Ibaraki, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Osaka, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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19
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Impact of Glycemic Control on Morbidity and Mortality in Adult Idiopathic Scoliosis Patients Undergoing Spinal Fusion. Clin Spine Surg 2017; 30:E974-E980. [PMID: 27764054 DOI: 10.1097/bsd.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a retrospective analysis of administrative database. OBJECTIVE To elucidate the effect of glycemic control on surgical outcomes of middle-aged and elderly idiopathic scoliosis patients undergoing spinal fusion surgery. SUMMARY OF BACKGROUND DATA Diabetes mellitus (DM) is a condition thought to adversely affect outcomes of spine surgery. However, no study has stratified glycemic control levels and their impact on outcome for idiopathic scoliosis patients receiving a spinal fusion surgery. Previous studies may have reported higher than true rates of complications for controlled diabetic patients, who are the majority of diabetic patients. MATERIALS AND METHODS The Nationwide Inpatient Sample was queried from years 2002 to 2011. We extracted idiopathic scoliosis patients older than 45 years of age that received spinal fusion and analyzed complications and outcomes variables among 3 cohorts: nondiabetic patients, controlled diabetics, and uncontrolled diabetics. Multivariate analyses were used to assess whether glycemic control was a risk factor for adverse postoperative outcomes. RESULTS Controlled diabetics had significantly increased rates of acute renal failure (ARF), while uncontrolled diabetics had significantly increased rates of acute postoperative hemorrhage. In multivariate analyses controlling for patient factors and comorbidities, controlled DM was found to be an independent predictor of ARF [odds ratio (OR), 1.863; 95% confidence interval (CI), 1.346-2.579; P=0.0002), and uncontrolled DM was found to be a significant risk factor for acute postoperative hemorrhage (OR, 2.182; 95% CI, 1.192-3.997; P=0.0115), ARF (OR, 4.839; 95% CI, 1.748-13.392; P=0.0024), deep vein thrombosis (OR, 5.825; 95% CI, 1.329-25.522, P=0.0194) and in-patient mortality (OR, 8.889; 95% CI, 1.001-78.945; P=0.0499). CONCLUSIONS Controlled DM was found to be a risk factor for ARF in adult idiopathic scoliosis patients undergoing spinal fusion surgery, while uncontrolled DM was shown to be a risk factor for postoperative hemorrhage, ARF, deep vein thrombosis, and mortality. The present study provides valuable data for better informed consent for patients with diabetes considering surgery for idiopathic scoliosis. LEVEL OF EVIDENCE Level III.
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20
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Marion TE, Rivers CS, Kurban D, Cheng CL, Fallah N, Batke J, Dvorak MF, Fisher CG, Kwon BK, Noonan VK, Street JT. Previously Identified Common Post-Injury Adverse Events in Traumatic Spinal Cord Injury-Validation of Existing Literature and Relation to Selected Potentially Modifiable Comorbidities: A Prospective Canadian Cohort Study. J Neurotrauma 2017; 34:2883-2891. [PMID: 28562167 PMCID: PMC5653096 DOI: 10.1089/neu.2016.4933] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adverse events (AEs) are common during care in patients with traumatic spinal cord injury (tSCI). Increased risk of AEs is linked to patient factors including pre-existing comorbidities. Our aim was to examine the relationships between patient factors and common post-injury AEs, and identify potentially modifiable comorbidities. Adults with tSCI admitted to a Level I acute specialized spine center between 2006 and 2014 who were enrolled in the Rick Hansen SCI Registry (RHSCIR) and had AE data collected using the Spine Adverse Events Severity system were included. Patient demographic, neurological injury, and comorbidities data were obtained from RHSCIR. Potentially modifiable comorbidities were grouped into health-related conditions, substance use/withdrawal, and psychiatric conditions. Negative binomial regression and multiple logistic regression were used to model the impact of patient factors on the number of AEs experienced and the occurrence of the five previously identified common AEs, respectively. Of the 444 patients included in the study, 24.8% reported a health-related condition, 15.3% had a substance use/withdrawal condition, 8% reported having a psychiatric condition; and 79.3% experienced one or more AEs. Older age (p = 0.004) and more severe injuries (p < 0.001) were nonmodifiable independent variables significantly associated with increased AEs. The AEs experienced by patients were urinary tract infections (42.8%), pneumonia (39.2%), neuropathic pain (31.5%), delirium (18.2%), and pressure ulcers (11.0%). Risk of delirium increased in those with substance use/withdrawal; and pneumonia risk increased with psychiatric comorbidities. Opportunity exists to develop clinical algorithms that include these types of risk factors to reduce the incidence and impact of AEs.
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Affiliation(s)
- Travis E Marion
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Carly S Rivers
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Dilnur Kurban
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Juliet Batke
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Brian K Kwon
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | | | - John T Street
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
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21
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Sharif S, Afsar A. Diabetes: Is It the Troublemaker in Anterior Cervical Discectomy and Fusion? World Neurosurg 2017; 103:914-916. [PMID: 28408256 DOI: 10.1016/j.wneu.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Salman Sharif
- Liaquat National Hospital & Medical College Karachi, Sind, Pakistan.
| | - Afifa Afsar
- Liaquat National Hospital & Medical College Karachi, Sind, Pakistan
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22
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Abstract
STUDY DESIGN A retrospective cohort. OBJECTIVE The objective of the study was to determine what effect, if any, diabetes has on surgical outcomes in patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Diabetes is known to impair healing and has been shown to affect outcomes in lumbar surgery, but few studies have assessed outcomes in cervical surgery, and cervical myelopathy in particular. METHODS The records of 113 patients operated on by one surgeon were reviewed. Inclusion criteria were a diagnosis of CSM with a Nurick score, surgical interventions, and minimum 2 years follow-up. Patients were divided into two groups according to diabetes status (33 diabetic patients vs. 80 controls) and diabetic patients were further categorized by degree of perioperative glucose control. Simple and multiple regression analyses were done to compare outcomes as recorded by the Nurick score, controlling for age, gender, duration of symptoms, alcohol use, cocaine use, surgical approach, prior surgery, and signal change on preoperative magnetic resonance imaging. RESULTS There was no relationship between diabetes status and preoperative Nurick score. However, diabetes status was associated with impaired improvement in Nurick score. Average perioperative glucose in diabetic individuals was linearly associated with impaired improvement in Nurick score. CONCLUSION We conclude that hyperglycemia may impair postoperative healing of the spinal cord in patients with CSM. LEVEL OF EVIDENCE 3.
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Tetreault L, Tan G, Kopjar B, Côté P, Arnold P, Nugaeva N, Barbagallo G, Fehlings MG. Clinical and Surgical Predictors of Complications Following Surgery for the Treatment of Cervical Spondylotic Myelopathy. Neurosurgery 2016; 79:33-44. [DOI: 10.1227/neu.0000000000001151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Abstract
Diabetes is associated with a number of lower extremity orthopedic conditions and complications including fractures, Charcot neuroarthropathy, plantar ulcers, and infection. These complications are of significant clinical concern in terms of morbidity, mortality, and socioeconomic costs. A review of each condition is discussed, with particular emphasis on the clinical importance, diagnostic considerations, and orthopedic treatment recommendations. The goal of the article is to provide a clinical picture of the challenges that orthopedic surgeons confront, and highlight the need for specific clinical guidelines in diabetic patients.
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Affiliation(s)
- Daniel J Gehling
- Department of Orthopaedic Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States.
| | - Beata Lecka-Czernik
- Department of Orthopaedic Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States; Department of Physiology and Pharmacology, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States; Center for Diabetes and Endocrine Research, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States
| | - Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States
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Tetreault L, Ibrahim A, Côté P, Singh A, Fehlings MG. A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy. J Neurosurg Spine 2015; 24:77-99. [PMID: 26407090 DOI: 10.3171/2015.3.spine14971] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%-38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying "at-risk" patients would improve surgeons' ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.
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Affiliation(s)
| | - Ahmed Ibrahim
- Toronto Western Hospital, University Health Network; and
| | - Pierre Côté
- University of Ontario Institute of Technology (UOIT), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - Anoushka Singh
- Toronto Western Hospital, University Health Network; and
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Tetreault L, Nouri A, Singh A, Fawcett M, Nater A, Fehlings MG. An Assessment of the Key Predictors of Perioperative Complications in Patients with Cervical Spondylotic Myelopathy Undergoing Surgical Treatment: Results from a Survey of 916 AOSpine International Members. World Neurosurg 2015; 83:679-90. [DOI: 10.1016/j.wneu.2015.01.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Wukich DK. Diabetes and its negative impact on outcomes in orthopaedic surgery. World J Orthop 2015; 6:331-339. [PMID: 25893176 PMCID: PMC4390895 DOI: 10.5312/wjo.v6.i3.331] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/21/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.
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Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA. Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study. J Physiother 2014; 60:217-23. [PMID: 25443651 DOI: 10.1016/j.jphys.2014.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/12/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022] Open
Abstract
QUESTION In the 6 months after total knee arthroplasty (TKA), what is the pattern of pain resolution and functional recovery in people without diabetes, with diabetes that does not impact on routine activities, and with diabetes that does impact on routine activities? Is diabetes that impacts on routine activities an independent predictor of slower resolution of pain and functional recovery after TKA? DESIGN Community-based prospective observational study. PARTICIPANTS A consecutive cohort of 405 people undergoing primary TKA, of whom 60 (15%) had diabetes. PARTICIPANTS with diabetes were also asked preoperatively whether diabetes impacted on their routine activities. PARTICIPANTS were categorised into three groups: no diabetes (n=345), diabetes with no impact on activities (n=41), and diabetes that impacted activities (n=19). OUTCOME MEASURES Pain and function were measured using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within the month before surgery and 1, 3 and 6 months after surgery. Demographic, medical and surgical factors were also measured, along with depression, social support and health-related quality of life. RESULTS No baseline differences in pain and function were seen among the three groups (p > 0.05). Adjusting for age, gender and contralateral joint involvement across the 6 postoperative months, participants with diabetes that impacted on routine activities had pain scores that were 8.3 points higher (indicating greater pain) and function scores that were 5.4 points higher (indicating lower function) than participants without diabetes. PARTICIPANTS with diabetes that doesn't impact on routine activities had similar recovery to those without diabetes. CONCLUSION People undergoing TKA who report preoperatively that diabetes impacts on their routine activities have less recovery over 6 months than those without diabetes or those with diabetes that does not impact on routine activities. Physiotherapists could institute closer monitoring within the hospital and community settings for people undergoing TKA who perceive that diabetes impacts on their routine activities. [Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA (2014) Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study.Journal of Physiotherapy60: 217-223].
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Affiliation(s)
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta; Orthopedic Research, Capital Health
| | | | - Sheri L Pohar
- Canadian Agency for Drugs and Technologies in Health, Ottawa
| | - Scot Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Sharon Warren
- Faculty of Rehabilitation Medicine, University of Alberta
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta
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Yeh CC, Liao CC, Chang YC, Jeng LB, Yang HR, Shih CC, Chen TL. Adverse outcomes after noncardiac surgery in patients with diabetes: a nationwide population-based retrospective cohort study. Diabetes Care 2013; 36:3216-21. [PMID: 23990518 PMCID: PMC3781492 DOI: 10.2337/dc13-0770] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether diabetes affects perioperative complications or mortality and to gauge its impact on medical expenditures for noncardiac surgeries. RESEARCH DESIGN AND METHODS With the use of reimbursement claims from the Taiwan National Health Insurance system, we performed a population-based cohort study of patients with and without diabetes undergoing noncardiac surgeries. Outcomes of postoperative complications, mortality, hospital stay, and medical expenditures were compared between patients with and without diabetes. RESULTS Diabetes increased 30-day postoperative mortality (odds ratio 1.84 [95% CI 1.46-2.32]), particularly among patients with type 1 diabetes or uncontrolled diabetes and patients with preoperative diabetes-related comorbidities, such as eye involvement, peripheral circulatory disorders, ketoacidosis, renal manifestations, and coma. Compared with nondiabetic control patients, coexisting medical conditions, such as renal dialysis (5.17 [3.68-7.28]), liver cirrhosis (3.59 [2.19-5.88]), stroke (2.87 [1.95-4.22]), mental disorders (2.35 [1.71-3.24]), ischemic heart disease (2.08 [1.45-2.99]), chronic obstructive pulmonary disease (1.96 [1.29-2.97]), and hyperlipidemia (1.94 [1.01-3.76]) were associated with mortality for patients with diabetes undergoing noncardiac surgery. Patients with diabetes faced a higher risk of postoperative acute renal failure (3.59 [2.88-4.48]) and acute myocardial infarction (3.65 [2.43-5.49]). Furthermore, diabetes was associated with prolonged hospital stay (2.30 [2.16-2.44]) and increased medical expenditures (1.32 [1.25-1.40]). CONCLUSIONS Diabetes increases postoperative 30-day mortality, complications, and medical expenditures in patients undergoing in-hospital noncardiac surgeries.
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Abstract
BACKGROUND The Centers for Medicare and Medicaid Services and many private health plans are encouraging patients to seek orthopedic care at hospitals designated as centers of excellence. No evaluations have been conducted to compare patient outcomes and costs at centers of excellence versus other hospitals. The objective of our study was to assess whether hospitals designated as spine surgery centers of excellence by a group of over 25 health plans provided higher quality care. METHODS Claims representing approximately 54 million commercially insured individuals were used to identify individuals aged 18-64 years with 1 of 3 types of spine surgery in 2007-2009: 1-level or 2-level cervical fusion (referred to as cervical simple fusion), 1-level or 2-level lumbar fusion (referred to as lumbar simple fusion), or lumbar discectomy and/or decompression without fusion. The primary outcomes were any complication (7 complications were captured) and 30-day readmission. The multivariate models controlled for differences in age, sex, and comorbidities between the 2 sets of hospitals. RESULTS A total of 29,295 cervical simple fusions, 27,214 lumbar simple fusions, and 28,911 lumbar discectomy/decompressions were identified, of which 42%, 42%, and 47%, respectively, were performed at a hospital designated as a spine surgery center of excellence. Designated hospitals had a larger number of beds and were more likely to be an academic center. Across the 3 types of spine surgery (cervical fusions, lumbar fusions, or lumbar discectomies/decompressions), there was no difference in the composite complication rate [OR 0.90 (95% CI, 0.72-1.12); OR 0.98 (95% CI, 0.85-1.13); OR 0.95 (95% CI, 0.82-1.07), respectively] or readmission rate [OR 1.03 (95% CI, 0.87-1.21); OR 1.01 (95% CI, 0.89-1.13); OR 0.91 (95%, CI 0.79-1.04), respectively] at designated hospitals compared with other hospitals. CONCLUSIONS On average, spine surgery centers of excellence had similar complication rates and readmission rates compared with other hospitals. These results highlight the importance of empirical evaluations of centers of excellence programs.
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Sharma A, Muir R, Johnston R, Carter E, Bowden G, Wilson-MacDonald J. Diabetes is predictive of longer hospital stay and increased rate of complications in spinal surgery in the UK. Ann R Coll Surg Engl 2013; 95:275-9. [PMID: 23676813 PMCID: PMC4132503 DOI: 10.1308/003588413x13511609958299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Diabetes is a common co-morbidity of patients undergoing spinal surgery in the UK but there are no published studies from the UK, particularly with respect to length of hospital stay and complications. The aims of this study were to identify complications and length of hospital stay in patients with diabetes undergoing spinal surgery. METHODS Data were collected retrospectively for 111 consecutive patients with diabetes (and 97 age and sex matched control patients, identified using computer records) who underwent spinal surgery between 2004 and 2010 in a single centre. The data collected included operative time, blood loss, details of surgery, Clavien complications and length of hospital stay. RESULTS No significant differences were found by group in operative time, blood loss, instrumentation, use of graft or revision surgery. Overall complication rates were higher in the patients with diabetes than in the controls (28.8% vs 15.5%). The mean hospital stay was significantly longer for patients with diabetes than for control patients (4.6 vs 3.2 days, p<0.001). CONCLUSIONS This study identified a significantly higher Clavien grade I complication rate and length of hospital stay in patients with diabetes undergoing spinal surgery than control patients (p=0.02). This has resulted in a predictive model being generated. Of note, no infections were seen in patients with diabetes, suggesting that infection rates in this particular group of patients undergoing spinal surgery might not be as high as considered previously.
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Affiliation(s)
- A Sharma
- Oxford University Hospitals NHS Trust, UK.
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Comparison of spinal deformity surgery in patients with non-insulin-dependent diabetes mellitus (NIDDM) versus controls. Spine (Phila Pa 1976) 2012; 37:E978-84. [PMID: 22343274 DOI: 10.1097/brs.0b013e31824edf42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review. OBJECTIVE To quantify the exact impact of non-insulin-dependent diabetes mellitus (NIDDM) on operative complications and additional surgeries associated with spinal deformity surgery. SUMMARY OF BACKGROUND DATA There are many references supporting diabetes mellitus (DM) as one of the major risk factors for perioperative complications in spinal surgery. However, the results vary depending on the type of DM, suggesting that insulin-dependent DM causes more complications than NIDDM, which is far more prevalent in the adult population with spinal deformity. METHODS Among 5119 adult patients (older than 40 yr) with deformities, 23 patients with NIDDM and 23 control (group C) patients with a minimum 2-year follow-up were selected. Both groups were matched for age at surgery, sex, body mass index, number of comorbidities, smoking history, current and prior fusion levels, estimated blood loss, and the amount of transfusion. Pre- and final Scoliosis Research Society (SRS) scores and Oswestry Disability Index (ODI), number of perioperative complications, and additional surgeries were compared. Within the group with NIDDM, patients with (+) or without (-) complications were compared in terms of postoperative glucose control. RESULTS There were no significant differences in the number of major or minor complications or additional surgeries between the 2 groups. There was no significant difference in postoperative glucose control with the NIDDM group (+) and (-). Group C reported significantly improved scores at final follow-up in all SRS domains and ODI. The group with NIDDM reported improvement in all domains except for the mental health and pain domains. However, there were no significant differences between the group with NIDDM and group C in terms of SRS and ODI scores preoperatively and postoperatively. CONCLUSION Contrary to traditional thinking, properly selected NIDDM was not a significant risk factor for perioperative complications or additional surgeries in adult patients with spinal deformities.
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Wu JC, Chen YC, Liu L, Chen TJ, Huang WC, Thien PF, Cheng H, Lo SS. The risk of stroke after spinal fusion surgery: a national cohort study. Spine J 2012; 12:492-9. [PMID: 22703754 DOI: 10.1016/j.spinee.2012.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/03/2011] [Accepted: 05/17/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative stroke is a rare complication of spinal fusion surgery, but its relevant risk and incidence remain unclear. PURPOSE To investigate the incidence and risk of stroke after spinal fusion surgery. STUDY DESIGN Cohort study. PATIENT SAMPLE All study subjects were extracted from a nationwide representative cohort of one million people from 2000 to 2005. OUTCOME MEASURES Stroke, including hemorrhagic and ischemic, during the study period. METHODS An exposure group of 2,249 subjects who received spinal fusion surgery during the study period was compared with 2,203 control subjects matched by age, sex, and propensity score. All were followed up for 3 years for all kinds of stroke. Demographics, comorbidities, and nonmeasurable covariates were matched between the two groups. Kaplan-Meier analyses were performed, with adjustments by Cox regression model. RESULTS There were 4,452 subjects, including 2,249 spinal fusion patients and 2,203 controls, who were followed up for 12,967 person-years. The incidence rates of any, hemorrhagic, and ischemic strokes were 9.95, 1.21, and 8.86, respectively, per 1,000 person-years in the spinal fusion group and 11.5, 1.69, and 9.93, respectively, in the comparison group. Patients who received spinal fusion surgery were less likely to have any stroke (crude hazard ratio [HR]=0.87, p=.393), hemorrhagic stroke (HR=0.72, p=.473), and ischemic stroke (HR=0.89, p=.582) than the comparison group but without statistical significance. After adjusting for demographics, comorbidities, and medications, there were still no significant differences for risks of any, hemorrhagic, and ischemic strokes (adjusted HR=0.89, 1.36, and 0.87; p=.522, .553, and .477, respectively) in the spinal fusion group. CONCLUSIONS Patients receiving spinal fusion surgery have similar incidence rates of having a stroke within 3 years postoperation as those without surgery. Risks of any postoperative stroke are similar or insignificantly lower in the spinal fusion group.
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Affiliation(s)
- Jau-Ching Wu
- Institute of Pharmacology, National Yang-Ming University, 2F, No. 322, Shih-Pai Rd, Sec. 2, Peitou, Taipei 11217, Taiwan
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Li H, Dai LY. A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine J 2011; 11:1049-57. [PMID: 22015235 DOI: 10.1016/j.spinee.2011.09.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 07/25/2011] [Accepted: 09/07/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical management of ossification of the posterior longitudinal ligament (OPLL) is associated with complications. However, surgical complications for OPLL have not been clearly documented. PURPOSE To review and summarize the incidence of surgical complications of OPLL in the cervical spine and evaluate the impact of surgical approach (anterior or posterior), year of study publication, follow-up duration, and the surgical outcome on complication incidence. STUDY DESIGN Systematic review. METHODS An English literature review was conducted especially on surgical complications of cervical OPLL. The incidence of complications was statistically summarized, with its correlation to surgical approaches, year of study publications, follow-up duration, and the surgical outcome was statistically evaluated. RESULTS Twenty-seven retrospective studies, including a total of 1,558 patients, were reviewed. The overall incidence of surgical complications of cervical OPLL was 21.8%. Neurologic deficit (8.3%, overall rate), cerebrospinal fluid leakage (CFL) (5.1%), axial pain (3.5%), and implant complications (3.5%) were relatively common. The incidence of complications for posterior approach was not statistically different from those for anterior procedures. However, with regard to individual complication, C5 palsy and axial pain occurred more frequently in patients approached posteriorly, whereas CFL, implant complications, hoarseness, dysphagia, and dyspnea appeared more common in anterior cases. CONCLUSIONS There is a relatively high incidence of surgical complications for cervical OPLL compared with other cervical degeneration diseases. It is, therefore, necessary for surgeons to take into consideration the risk of surgical complications when communicating with patients for decision making and to alert complications during or after surgical procedures.
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Affiliation(s)
- Hai Li
- Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Rd, Shanghai 200092, China
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Strengths and limitations of International Classification of Disease Ninth Revision Clinical Modification codes in defining cervical spine surgery. Spine (Phila Pa 1976) 2011; 36:E38-44. [PMID: 20975624 DOI: 10.1097/brs.0b013e3181d273f6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To evaluate the sensitivity and specificity of International Classification of Disease Ninth Revision Clinical Modification (ICD9-CM) hospital discharge codes to define degenerative cervical spine surgery in comparison to patient operative notes in the medical record. SUMMARY OF BACKGROUND DATA Population-based studies of spine surgery have often relied on administrative databases as a primary information source, but little is known about the validity of using ICD9-CM codes to identify these operations. METHODS We performed a retrospective study comparing ICD9-CM billing codes to patient operative notes, the gold standard, for patients undergoing spine surgery in 2006 at a single academic center. RESULTS We identified 1090 procedures of which 265 were categorized as cervical spine surgery for degenerative indications based on the operative notes. Compared to operative notes, our ICD9-CM algorithm had high sensitivity and specificity for selecting surgery at the cervical spine level and cervical spine surgery for degenerative indications. Categorization of cases by procedure had high sensitivity and specificity for fusion and surgical approach (>95%). Categorization of cases by primary diagnosis was generally less accurate. Cervical spondylosis with myelopathy was the most sensitive primary diagnosis. Categorization of cases by procedure had high sensitivity and specificity for fusion and surgical approach (≥96%). However, diagnoses such as herniated disc and procedures such as laminectomy had low sensitivity but high specificity. CONCLUSION The use of our ICD9-CM algorithm to define spine surgery at the cervical spine level, and degenerative cervical spine surgery is highly accurate. Although specific diagnoses codes are mostly insensitive, an ICD9-CM algorithm can be used to study these procedures with reasonable precision.
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Complications in spinal deformity surgery: issues unrelated directly to intraoperative technical skills. Spine (Phila Pa 1976) 2010; 35:2215-23. [PMID: 21102296 DOI: 10.1097/brs.0b013e3181fd591f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature review of complications unrelated directly to surgical skills involved in spinal deformity surgery. OBJECTIVE Highlight complications associated with perioperative issues. SUMMARY OF BACKGROUND DATA Complications can arise from mundane events that arise during the operative experience, but are not directly related to surgical skills. METHODS Literature reviews that touches on the more common potential complication events that do not involve direct surgical expertise. RESULTS The topics of positioning, nutrition, blood loss, comorbidities, OR time, and pulmonary and GI concerns are discussed as basics that could derail a surgical outcome even with an otherwise uneventful surgical technique. The need for vigilance is stressed and the nuances of understanding these are discussed. CONCLUSION Mundane events can derail a perfectly executed surgical undertaking. Attention to detail, team work, close monitoring, and checklist type focus will help to improve, focus, and avoid these preventable complications that have nothing to do with direct surgical skills.
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Zampini JM, White AP, McGuire KJ. Comparison of 5766 vertebral compression fractures treated with or without kyphoplasty. Clin Orthop Relat Res 2010; 468:1773-80. [PMID: 20177836 PMCID: PMC2882011 DOI: 10.1007/s11999-010-1279-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources. QUESTIONS/PURPOSES We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database. METHODS We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type. RESULTS Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112). CONCLUSIONS Kyphoplasty for treatment of VCF in well-selected patients may accelerate the return of independent patient function as indicated by improved measures of hospital discharge. The initially higher cost of treatment may be offset by the reduced use of posthospital medical resources. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jay M Zampini
- Department of Orthopaedic Surgery, Hahnemann University Hospital, Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA, 19102, USA.
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE To define the term "complications" from the spine surgery literature and contrast this with definitions from other federal institutions, to summarize the incidence of adverse events in cervical, thoracic, and lumbar spine surgery, to include the factors that contribute to these events, and to determine the relationship between complications and patient centered outcomes. SUMMARY OF BACKGROUND DATA Efforts to understand and reduce complications in medicine, and spine surgery in particular have been hampered as a result of the lack of a meaningful and universally acceptable definition. The complex field of spine surgery has been a particularly challenging area for the development of a consensus to constructively describe these "undesirable/unanticipated developments arising during or out of the delivery of health care." Furthermore, an overall understanding of expected complication rates after major spine surgery is lacking. METHODS A systematic review of the English literature was undertaken for articles published between 1990 and December 2008. Electronic and federal databases and reference lists of key articles were searched to identify articles defining complications and reporting rates of spine surgical complications. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria and disagreements were resolved by consensus. RESULTS.: The definitions for complications in the spine literature and federal agencies are inconsistent and at times conflicting. Mortality rates for cervical spine and lumbar spine surgery are <1%. For thoracic spine surgery, rates range from 0.3% to 7%. Complication rates range from 5% to 19%, 7% to 18%, and 4% to 14% after cervical, thoracic, and lumbar spine surgery, respectively. Findings from a single study indicate that major complications may have an impact on 1-year self-perceived general health. However, minor complications may not. CONCLUSION We define a complication as an unintended and undesirable diagnostic or therapeutic event that may impact the patient's care. Complications should be recorded and analyzed relative to disease severity, patient comorbidities, and ultimately their effect on patient outcomes. Further work needs to be done to develop a complication risk impact index that has the ability to help us assess and communicate the interaction of patient comorbidities and complication severity on patient centered outcomes.
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Woodworth GF, Baird CJ, Garces-Ambrossi G, Tonascia J, Tamargo RJ. Inaccuracy of the administrative database: comparative analysis of two databases for the diagnosis and treatment of intracranial aneurysms. Neurosurgery 2009; 65:251-6; discussion 256-7. [PMID: 19625902 DOI: 10.1227/01.neu.0000347003.35690.7a] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Administrative databases of hospital admissions are increasingly being used, mostly without validation, for epidemiological and clinical outcomes studies. Although it has been difficult to assess the true accuracy of administrative databases, we have identified an opportunity to directly compare the State of Maryland administrative database against a prospectively maintained departmental database at The Johns Hopkins Hospital. METHODS Data for patients with the diagnosis of an intracranial aneurysm treated at The Johns Hopkins Hospital over a 17-year period were compared in the State of Maryland administrative database and the neurosurgery departmental database. Discrepancies were clarified by review of the original medical records. The sensitivity, specificity, and positive predictive value of each database were calculated. RESULTS The administrative database missed 16% of all cases and was significantly inaccurate in 10 of 12 categories. It had particularly low values in the specificity regarding surgical treatment (67%), the sensitivity regarding endovascular treatment (48%), and the positive predictive value regarding endovascular treatment (30%). By contrast, the lowest score of the departmental database in any category was 97%. CONCLUSION We show that this representative administrative database is significantly flawed. Given the exponentially increasing number of research studies based on administrative databases, the pitfalls of research based solely on these need to be recognized. Strong criteria requiring accurate data validation are critical to justify the conclusions of these studies, regardless of their large numbers and complex statistics.
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Affiliation(s)
- Graeme F Woodworth
- The Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287, USA
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Guo JJ, Yang H, Xu Y, Wang G, Huang L, Tang T. Results after immediate operations of closed ankle fractures in patients with preoperatively neglected type 2 diabetes. Injury 2009; 40:894-6. [PMID: 19524237 DOI: 10.1016/j.injury.2009.01.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/19/2009] [Indexed: 02/02/2023]
Abstract
Many studies suggest diabetes influences ankle fracture surgical outcomes, but results after immediate surgical treatment of closed ankle fractures (CAFs) in patients with preoperatively neglected type 2 diabetes (PND2) have not been documented. We contrasted the results of the immediate operation on CAF in 36 PND2 patients with those of a matched group of non-diabetic patients, using a case-controlled study. Outcomes were complications and ankle scores during the first 12 months of treatment. Compared with non-diabetic patients, immediate surgical fixation of the CAF in PND2 patients showed similar ankle scores. Immediate surgery in PND2 patient with CAF may increase the risk of postoperative infection compared to non-diabetic controls, but the difference was not statistically significant and did not worsen the final prognosis. These findings suggest that immediate surgical intervention is appropriate in CAF patients with type 2 diabetes.
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Affiliation(s)
- Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China.
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