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Aggad M, Terrier LM, Nidal Salah C, Zemmoura I, Planty-Bonjour A, Francois P, Amelot A. Are There Still Any Benefits to Drainage for Anterior Cervical Arthrodesis/Arthroplasty by Cervicotomy? Spine (Phila Pa 1976) 2024; 49:1092-1097. [PMID: 38362711 DOI: 10.1097/brs.0000000000004964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
STUDY DESIGN A retrospective single-center study between January 2019 and January 2023. OBJECTIVE The role and contribution of drainage in the anterior approach to the cervical spine (cervicotomy) is much debated, motivated primarily by the prevention of retropharyngeal hematoma, so are there still any benefits to drainage? BACKGROUND The anterior approach to the cervical spine is a widespread and common procedure performed in almost all spine surgery departments for the replacement of cervical intervertebral discs and medullar or radicular decompression. The primary endpoint was the occurrence of symptomatic postoperative cervical hematoma. PATIENTS AND METHODS Four hundred thirty-one patients who had undergone cervical spine surgery by anterior cervicotomy for cervicarthrosis or cervical disc herniation (anterior cervical discectomy and fusion and anterior cervical disc replacement) were consecutively included. Patients were separated into 2 groups: (1) Group A, 140 patients (with postoperative drainage) and (2) Group B, 291 patients (without drainage). RESULTS The mean follow-up was 2.8 months. The 2 groups were comparable on all criteria, but there was a predominance of arthroplasty ( P < 0.0001), use of anticoagulants/antiaggregants ( P < 0.0001) and a greater number of stages ( P < 0.0001) in group A. There were a total of 4/431 symptomatic postoperative hematomas (0.92%) in this study. Two hematomas occurred in group A (2/140, 1.4%) and 2 in group B (2/291, 0.68%; P < 0.0001). One patient in group A (0.71%) required surgical drainage for cavity hematoma revealed by marked dyspnea, swallowing, and neurological disorders. One case of hematoma diagnosed by dysphonia and neurological deficit was reported in group B (0.34%; P < 0.0001). CONCLUSIONS The placement of a drain during anterior cervicotomy (anterior cervical discectomy and fusion/anterior cervical disc replacement) did not limit the occurrence of symptomatic postoperative hematoma.
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Affiliation(s)
- Mourad Aggad
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | | | | | | | | | - Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, Tours, France
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Latka K, Kolodziej W, Pawus D, Bielecki M, Latka D. Performance of successful ambulatory cervical spine surgery: safety, efficacy, and early experiences of first 100 cases in Poland. Br J Neurosurg 2024:1-6. [PMID: 39007749 DOI: 10.1080/02688697.2024.2378825] [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: 03/28/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Ambulatory anterior cervical discectomy and fusion (ACDF) is a promising method, but not common in Poland. OBJECTIVE That is why the purpose of this study was to demonstrate the experience of performing ACDF in patients with degenerative spinal diseases. METHODS This study at the Spine Centre involved a single-center, multi-surgeon evaluation of 100 patients undergoing ACDF. RESULTS Outcomes assessed included pain severity, measured by the visual analogue scale, which improved from 4.28 ± 0.76 preoperatively to 1.11 ± 0.59 one month postoperatively. The Core Outcome Measures Index-neck (COMI-neck) scale also showed significant improvement: before surgery, 30% of patients scored their condition severity between 4-6, and 70% scored 7-10; 6 months postoperatively, the scores were 0-3 for 55% of patients, 4-6 for 45%, and 7-10 for none. Only 2% of patients experienced moderate, temporary complications, with no serious complications or postoperative hematomas observed. CONCLUSION The study supports the feasibility, safety, and efficacy of performing ACDF in an ambulatory setting, suggesting that with appropriate patient selection and surgical protocols, ambulatory ACDF can be more broadly implemented.
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Affiliation(s)
- Kajetan Latka
- Department of Neurosurgery, University of Opole, Opole, Poland
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery, Opole, Poland
| | - Waldemar Kolodziej
- Department of Neurosurgery, University of Opole, Opole, Poland
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery, Opole, Poland
| | - Dawid Pawus
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, Opole, Poland
| | - Mateusz Bielecki
- Department of Neurosurgery, John Paul II Western Hospital in Grodzisk Mazowiecki, Grodzisk Mazowiecki, Poland
- Department of Neurosurgery, Lazarski University, Warsaw, Poland
| | - Dariusz Latka
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery, Opole, Poland
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Opole, Poland
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Amen TB, Song J, Mai E, Rudisill SS, Bovonratwet P, Subramanian T, Kaidi AK, Maayan O, Qureshi SA, Iyer S. Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors. Spine J 2023; 23:1848-1857. [PMID: 37716549 DOI: 10.1016/j.spinee.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND CONTEXT Although outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern. PURPOSE This study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURES Hospital readmission within 30 postoperative days. METHODS Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission. RESULTS A total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all). CONCLUSION This study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA.
| | - Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Eric Mai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Samuel S Rudisill
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Austin K Kaidi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
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Ye J, Zielinski E, Richardson S, Petrone B, McCarthy MM, Boody B. Is It Safe to Perform True Outpatient Multilevel ACDFs in a Surgery Center? Clin Spine Surg 2023; 36:151-153. [PMID: 36727974 DOI: 10.1097/bsd.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jason Ye
- Indiana Spine Group, Carmel Carmel
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Bovonratwet P, Kapadia M, Chen AZ, Vaishnav AS, Song J, Sheha ED, Albert TJ, Gang CH, Qureshi SA. Opioid prescription trends after ambulatory anterior cervical discectomy and fusion. Spine J 2023; 23:448-456. [PMID: 36427653 DOI: 10.1016/j.spinee.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND CONTEXT Opioid utilization has been well studied for inpatient anterior cervical discectomy and fusion (ACDF). However, the amount and type of opioids prescribed following ambulatory ACDF and the associated risk of persistent use are largely unknown. PURPOSE To characterize opioid prescription filling following single-level ambulatory ACDF compared with inpatient procedures. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Opioid-naive patients who underwent ambulatory (no overnight stay) or inpatient single-level ACDF from 2011 to 2019 were identified from a national insurance database. OUTCOME MEASURES Rate, amount, and type of perioperative opioid prescription. METHODS Opioid-naive patients who underwent ambulatory (no overnight stay) or inpatient single-level ACDF from 2011 to 2019 were identified from a national insurance database. Perioperative opioids were defined as opioid prescriptions 30 days before and 14 days after the procedure. Rate, amount, and type of opioid prescription were characterized. Multivariable analyses controlling for any differences in demographics and comorbidities between the two treatment groups were utilized to determine any association between surgical setting and persistent opioid use (defined as the patient still filling new opioid prescriptions >90 days postoperatively). RESULTS A total of 42,521 opioid-naive patients were identified, of which 2,850 were ambulatory and 39,671 were inpatient. Ambulatory ACDF was associated with slightly increased perioperative opioid prescription filling (52.7% vs 47.3% for inpatient procedures; p<.001). Among the 20,280 patients (47.7%) who filled perioperative opioid prescriptions, the average amount of opioids prescribed (in morphine milligram equivalents) was similar between ambulatory and inpatient procedures (550 vs 540, p=.413). There was no association between surgical setting and persistent opioid use in patients who filled a perioperative opioid prescription, even after controlling for comorbidities, (adjusted odds ratio, 1.15, p=.066). CONCLUSIONS Ambulatory ACDF patients who filled perioperative opioid prescriptions were prescribed a similar amount of opioids as those undergoing inpatient procedures. Further, ambulatory ACDF does not appear to be a risk factor for persistent opioid use. These findings are important for patient counseling as well as support the safety profile of this new surgical pathway.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Milan Kapadia
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Aaron Z Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Avani S Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Junho Song
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Catherine H Gang
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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Carlson BC, Dawson JM, Beauchamp EC, Mehbod AA, Mueller B, Alcala C, Mullaney KJ, Perra JH, Pinto MR, Schwender JD, Shafa E, Transfeldt EE, Garvey TA. Choose Wisely: Surgical Selection of Candidates for Outpatient Anterior Cervical Surgery Based on Early Complications Among Inpatients. J Bone Joint Surg Am 2022; 104:1830-1840. [PMID: 35869896 DOI: 10.2106/jbjs.21.01356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are attractive targets for transition to the outpatient setting. We assessed the prevalence of rapid responses and major complications in the inpatient setting following 1 or 2-level ACDFs and CDAs. We evaluated factors that may place patients at greater risk for a rapid response or a postoperative complication. METHODS This was an institutional review board-approved, retrospective cohort study of adults undergoing 1 or 2-level ACDF or CDA at 1 hospital over a 2-year period (2018 and 2019). Data on patient demographic characteristics, surgical procedures, and comorbidities were collected. Rapid response events were identified by hospital floor staff and involved acute changes in a patient's clinical condition. Complications were events that were life-threatening, required an intervention, or led to delayed hospital discharge. RESULTS In this study, 1,040 patients were included: 888 underwent ACDF and 152 underwent CDA. Thirty-six patients (3.5%) experienced a rapid response event; 22% occurred >24 hours after extubation. Patients having a rapid response event had a significantly higher risk of developing a complication (risk ratio, 10; p < 0.01) and had a significantly longer hospital stay. Twenty-four patients (2.3%) experienced acute complications; 71% occurred >6 hours after extubation. Patients with a complication were older and more likely to be current or former smokers, have chronic obstructive pulmonary disease, have asthma, and have an American Society of Anesthesiologists (ASA) score of >2. The length of the surgical procedure was significantly longer in patients who developed a complication. All patients who developed dysphagia had a surgical procedure involving C4-C5 or more cephalad. Patients with a rapid response event or complication were more commonly undergoing revision surgical procedures. CONCLUSIONS Rapid response and complications are uncommon following 1 or 2-level ACDFs or CDAs but portend a longer hospital stay and increased morbidity. Revision surgical procedures place patients at higher risk for rapid responses and complications. Additionally, older patients, patients with chronic obstructive pulmonary disease or asthma, patients who are current or former smokers, and patients who have an ASA score of ≥3 are at increased risk for postoperative complications. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Shahi P, Vaishnav AS, Melissaridou D, Sivaganesan A, Sarmiento JM, Urakawa H, Araghi K, Shinn DJ, Song J, Dalal SS, Iyer S, Sheha ED, Dowdell JE, Qureshi SA. Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery. Spine (Phila Pa 1976) 2022; 47:1137-1144. [PMID: 35797654 DOI: 10.1097/brs.0000000000004380] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF). SUMMARY OF BACKGROUND DATA Assessing postoperative inefficiencies is vital to increase the feasibility of ALF. MATERIALS AND METHODS Patients who underwent single-level minimally invasive transforaminal lumbar interbody fusion and would have met the eligibility criteria for ALF were included. Length of stay (LOS); time in postanesthesia recovery unit (PACU); alertness and neurological examination, and pain scores at three and six hours; type of analgesia; time to physical therapy (PT) visit; reasons for PT nonclearance; time to per-oral (PO) intake; time to voiding; time to readiness for discharge were assessed. Time taken to meet each discharge criterion was calculated. Multiple regression analyses were performed to study the effect of variables on postoperative parameters influencing discharge. RESULTS Of 71 patients, 4% were discharged on the same day and 69% on postoperative day 1. PT clearance was the last-met discharge criterion in 93%. Sixty-six percent did not get PT evaluation on the day of surgery. Seventy-six percent required intravenous opioids and <60% had adequate pain control. Twenty-six percent had orthostatic intolerance. The median postoperative LOS was 26.9 hours, time in PACU was 4.2 hours, time to PO intake was 6.5 hours, time to first void was 6.3 hours, time to first PT visit was 17.7 hours, time to PT clearance was 21.8 hours, and time to discharge readiness was 21.9 hours. Regression analysis showed that time to PT clearance, time to PO intake, time to voiding, time in PACU, and pain score at three hours had a significant effect on LOS. CONCLUSIONS Unavailability of PT, surgery after 1 pm , orthostatic intolerance, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Avani S Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
| | - Jose M Sarmiento
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Hikari Urakawa
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Daniel J Shinn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Junho Song
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sidhant S Dalal
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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Sivaganesan A, Kim C, Kiran Alluri R, Vaishnav AS, Qureshi S. Advanced Technologies for Outpatient Lumbar Fusion: Barriers and Opportunities. Int J Spine Surg 2022; 16:S37-S43. [PMID: 35831061 PMCID: PMC9808792 DOI: 10.14444/8275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years, there has been increasing interest in outpatient spine surgery. Minimally invasive techniques have created an opportunity for ambulatory lumbar fusion, and these techniques increasingly involve advanced technologies such as navigation and robotics. OBJECTIVE To explore the barriers, advantages, and future predictions for such technology in the context of outpatient lumbar fusions. METHODS This is a narrative review of studies examining the advantages, limitations, and cost-effectiveness of navigation and spinal robotics in conjunction with the outcomes and costs of outpatient lumbar fusion. RESULTS Outpatient lumbar fusion is a growing trend with ample evidence of its safety, favorable patient outcomes, and cost savings. Navigation and spinal robotics are associated with improved instrumentation accuracy and fewer complications, and the long-term cost savings can make these technologies financially practical in the outpatient setting. Future capabilities with robotics will only increase their value. CONCLUSIONS Advanced technologies such as navigation and robotics are strategic long-term investments in the context of outpatient lumbar fusion. CLINICAL RELEVANCE The favorable outcomes and costs associated with navigation and robotics will be relevant to any spine surgeon interested in developing an outpatient lumbar fusion program. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Choll Kim
- Excel Spine Center, San Diego, CA, USA
| | | | | | - Sheeraz Qureshi
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA, Sheeraz Qureshi, Weill Cornell Medical College, 535 E 70th St, New York, NY 10021, USA;
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Lim S, Bazydlo M, Macki M, Haider S, Schultz L, Nerenz D, Fadel H, Pawloski J, Yeh HH, Park P, Aleem I, Khalil J, Easton R, Schwalb JM, Abdulhak M, Chang V. A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. Spine (Phila Pa 1976) 2022; 47:220-226. [PMID: 34516058 DOI: 10.1097/brs.0000000000004169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective, cohort analysis of multi-institutional database. OBJECTIVE This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries. SUMMARY OF BACKGROUND DATA After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation. RESULTS We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13-1.34; P < 0.001). There were no significant differences in other outcomes measured. CONCLUSION Our analysis demonstrated that drain use is associated with significant longer hospital stay.Level of Evidence: 3.
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Affiliation(s)
- Seokchun Lim
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Michael Bazydlo
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - Mohamed Macki
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Sameah Haider
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Lonni Schultz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - David Nerenz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Hassan Fadel
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Jacob Pawloski
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Hsueh-Han Yeh
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Ilyas Aleem
- Department of Orthopaedics, University of Michigan, Ann Arbor, MI
| | - Jad Khalil
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Richard Easton
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Jason M Schwalb
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Muwaffak Abdulhak
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Victor Chang
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
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Kamalapathy PN, Puvanesarajah V, Sequeria S, Bell J, Hassanzadeh H. Safety profile of outpatient vs inpatient ACDF: An analysis of 33,807 outpatient ACDFs. Clin Neurol Neurosurg 2021; 207:106743. [PMID: 34153778 DOI: 10.1016/j.clineuro.2021.106743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/04/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat symptomatic cervical spondylolysis. Recently, many spine surgeons have begun performing ACDF in the outpatient setting. However, as this is a relatively new trend, many studies are either outdated or have small sample populations. The aim of this study was to evaluate outcomes following elective outpatient ACDF in comparison to those performed in the inpatient setting. METHODS Patients in Mariner Claims Database (2011-2017) undergoing outpatient elective ACDF were propensity score matched using age, gender and comorbidity burden. Chronic and peri-operative complications were assigned based on medical claims codes. All outcomes of interest were analyzed using multivariate logistic regression and compared to those undergoing inpatient ACDF. Significance was defined as p < 0.05 and adjusted with Bonferroni correction. RESULTS Outpatient surgery had significantly lower risk of dysphagia within 24 h in both single (OR 0.44, p < 0.001) and multilevel ACDF (OR 0.48, p < 0.001). Patients undergoing outpatient procedures also have lower risk of 90-day minor (Single OR 0.64, p < 0.001; Multilevel OR 0.52, p < 0.001) and major (Single OR 0.48, p < 0.001; Multilevel OR 0.57, p < 0.001) medical complications. Outpatient procedures were also associated with decreased hospital resource utilization with a noted lower risk of subsequent hospital readmission (Single OR 0.71, p < 0.001; Multilevel OR 0.60, p < 0.001) and ER visits (Single OR 0.84, p < 0.001; Multilevel OR 0.87, p < 0.001). CONCLUSION Outpatient single and multilevel ACDF may be performed safely in properly selected patients. Since there are relatively low rates of readmission and significant complications within the days following outpatient ACDF, many surgeons should consider transitioning carefully selected patients to an outpatient setting.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sean Sequeria
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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Jenkins NW, Parrish JM, Nolte MT, Jadczak CN, Mohan S, Geoghegan CE, Hrynewycz NM, Podnar J, Buvanendran A, Singh K. Multimodal Analgesic Management for Cervical Spine Surgery in the Ambulatory Setting. Int J Spine Surg 2021; 15:219-227. [PMID: 33900978 DOI: 10.14444/8030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patient selection and analgesic techniques, such as the multimodal analgesic (MMA) protocol, aid in ambulatory surgical center (ASC) cervical spine surgery. The purpose of this case series is to characterize patients undergoing anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (CDR) in an ASC with an enhanced MMA protocol. METHODS A prospectively maintained registry was retrospectively reviewed for cervical surgeries between May 2013 and August 2019. Inclusion criteria included ASC patients who underwent single-level or multilevel CDR or ACDF using an MMA protocol. Baseline, intraoperative, and postoperative characteristics were recorded, including length of stay, visual analog scale pain scores, neck disability index, complications, and narcotics administered. RESULTS A total of 178 patients met inclusion criteria with 125 single-level, 52 two-level, and 1 three-level procedure. Of those patients, 127 underwent ACDF and 51 underwent CDR. The longest procedure was 95 minutes and the mean length of stay was 6.1 hours, with 2 patients requiring hospital admission. All other patients were discharged within 10 hours. One of the admitted patients experienced a postoperative seizure that was later determined to be secondary to drug use and serotonin syndrome. The second patient developed an anterior cervical hematoma 5 hours postoperatively, which was immediately evacuated. The patient was admitted for observation and discharged the next day. CONCLUSION In our study, patients experienced considerable improvement in disability scores, with a low likelihood of postoperative complications. A safe and effective MMA protocol may help facilitate anterior cervical surgery in the outpatient setting. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Transitioning anterior cervical discectomy and fusions to the ASC requires an appropriate MMA protocol. Our findings reveal that an enhanced MMA protocol will help improve disability scores while keeping the likelihood of postoperative complications low. This supports the ASC setting for cervical spine procedures in appropriate patient populations.
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Affiliation(s)
- Nathaniel W Jenkins
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
| | - Jeffrey Podnar
- Department of Anesthesiology, Midwest Anesthesia Partners LLC, Park Ridge, Illinois
| | | | - Kern Singh
- Department of Orthopaedic Surgery, , Rush University Medical Center, Chicago, Illinois
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Vaishnav AS, Gang CH, Iyer S, McAnany S, Albert T, Qureshi SA. Correlation between NDI, PROMIS and SF-12 in cervical spine surgery. Spine J 2020; 20:409-416. [PMID: 31678044 DOI: 10.1016/j.spinee.2019.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT As the focus in spine surgery has shifted from radiographic to patient-centric outcome, patient-reported outcomes measures (PROMs) are becoming increasingly important. They are linked to patient satisfaction, and are used to assess healthcare expenditure, determine compensation and evaluate cost-effectiveness. Thus, PROMs are important to various stakeholders, including patients, physicians, payers, and healthcare institutions. Thus, it is vital to establish methods to interpret and evaluate these outcome measures. PURPOSE To evaluate the correlation between Neck Disability Index (NDI), Patient Reported Outcome Measurement Information System Physical Function (PROMIS-PF) and Short Form-12 Physical Health Score (SF-12 PHS) in cervical spinal surgery in order to determine the validity of PROMIS-PF in these patients. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Consecutive patients who underwent cervical surgery for degenerative spinal pathology with a minimum of 3 months follow-up. OUTCOME MEASURES Self-reported measures that is, PROMs including NDI, PROMIS-PF, and SF-12 PHS. METHODS No funding was received for this study. The authors report no relevant conflict of interest. PROM collected preoperatively and at each follow-up were analyzed using Pearson product-moment correlation. RESULTS Of the 121 patients included, 66 underwent anterior cervical discectomy and fusion, 42 cervical disc replacement, 13 posterior cervical decompression with or without fusion. A statistically significant improvement was achieved in all PROMs by 6 weeks and maintained at 1 year. Furthermore, the percentage of patients achieving an improvement greater than minimum clinically important difference was similar for NDI and PROMIS-PF, particularly at a follow-up of 3 months or more. A statistically significant negative correlation was seen between NDI and PROMIS-PF, which was moderate preoperatively and in the early postoperative period (r=-0.565 to -0.600), and strong at 3 months or longer follow-up (r=-0.622 to -0.705). A statistically significant, negative correlation was also seen between SF-12 PHS and NDI, which was moderate preoperatively and at 6 weeks (r=-0.5551 to -0.566); and strong at all other time-points (r=-0.678 to -0.749). There was a statistically significant positive correlation between SF-12 PHS and PROMIS-PF, which was strong to very-strong at all time-points (r=0.644-0.822), except at 2 weeks (r=0.570). CONCLUSIONS Although NDI and SF-12 have been used for several years, PROMIS is a new outcome measure that is increasingly being implemented. The results of our study demonstrate the convergent and discriminant validity of PROMIS-PF, supported by the strong correlation between SF-12 PHS and PROMIS-PF at all time-points and the moderate correlation between NDI and PROMIS-PF preoperatively and in the early postoperative period, respectively. Thus, while PROMIS-PF may not be a good surrogate for disease-specific outcome measures, it may extend value as a precise and efficient general health tool.
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Affiliation(s)
| | | | - Sravisht Iyer
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Steven McAnany
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA.
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