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Marx JS, Pagadala M, Carney J, Gerlach E, Swiatek P, Zabinsky JA, Sarwark J, Brickman WJ, Habiby RL. Scoliosis and Kyphosis Prevalence in Turner Syndrome: A Retrospective Review at a Pediatric Tertiary Care Medical Center. J Pediatr Orthop 2023; 43:299-302. [PMID: 36791404 DOI: 10.1097/bpo.0000000000002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND The prevalence of major coronal and sagittal spinal curves (scoliosis and kyphosis) in Turner syndrome (TS) is not well established due to limited reporting. The relationship between growth hormone (GH) therapy and its effect on TS spinal curve incidence is also not well established. METHODS A retrospective chart review of 306 TS patients from 2007 to 2021 evaluated major coronal and sagittal spinal curves, progression of the curve, and treatment with GH. Statistical significance (defined as P <0.05) between curvature rates and curve progression was compared between GH-treated patients and non-GH-treated patients using a χ 2 or Fisher exact test when appropriate. RESULTS Thirty-seven of 306 (12%) TS patients had a radiographically relevant spinal deformity. Twenty-seven of 37 (73%) had mild; 4 of 37 (11%) had moderate, and 6 of 37 (16%) had severe curves. Of those with severe, 4 underwent spinal fusion, 1 was treated with bracing, and 1 was braced before a cardiovascular-related death. Regarding GH use among TS patients, 190 of 306 (62%) used GH versus 116 of 306 (38%) who did not. Of those with a spinal curve, 24 of 37 (65%) used GH compared with 13 of 37 (35%) who did not. On univariate analysis, GH therapy was not a risk factor for the diagnosis of a major spinal curve, a more severe degree of the curve at the time of diagnosis, or spinal curve progression ( P >0.05 for all). CONCLUSIONS This is the largest single institution retrospective review of a TS cohort known to the authors assessing spinal curve prevalence and relation to GH treatment and demonstrates a TS spinal curve rate of 12% (37/306). Four of six (11%) TS patients with a severe curve underwent corrective spine fusion. There was no relationship between the use of GH and the presence of a spinal curve or curve progression. Further study is warranted to determine risk factors for curve progression. LEVEL OF EVIDENCE Level III. CLINICAL RELEVANCE This retrospective case series serves to review and address the prevalence of spinal deformity in TS patients and whether GH impacts worsening deformity.
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Affiliation(s)
- Jeremy S Marx
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Manasa Pagadala
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - John Carney
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Erik Gerlach
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Peter Swiatek
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Jennifer A Zabinsky
- Departments of Orthopaedics
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Endocrinology, UCSF Department of Pediatrics, San Francisco, CA
| | | | - Wendy J Brickman
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Reema L Habiby
- Division of Orthopaedics
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago
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Gerlach EB, Ituarte F, Plantz MA, Swiatek PR, Arpey NA, Marx JS, Fei-Zhang DJ, Divi SN, Hsu WK, Patel AA. Predictive Analysis of Healthcare Resource Utilization after Elective Spine Surgery. Spine Surg Relat Res 2022; 6:638-644. [PMID: 36561162 PMCID: PMC9747222 DOI: 10.22603/ssrr.2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction The management of degenerative spine pathology continues to be a significant source of costs to the US healthcare system. Besides surgery, utilization of healthcare resources after spine surgery drives costs. The responsibility of managing costs is gradually shifting to patients and providers. Patient-centered predictors of healthcare utilization after elective spine surgery may identify targets for cost reduction and value creation. Therefore, our study aims to quantify patterns of healthcare utilization and identify risk factors that predict high healthcare utilization after elective spine surgery. Methods A total of 623 patients who underwent elective spine surgery at a tertiary academic medical center by one of three fellowship-trained orthopedic spine surgeons between 2013 and 2018 were identified in this retrospective cohort study. Healthcare utilization was quantified including advanced spine imaging, emergency and urgent care visits, hospital readmission, reoperation, PT/OT referrals, opioid prescriptions, epidural steroid injections, and pain management referrals. Patient variables, namely, the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification system, were assessed as potential predictors for healthcare utilization. Results Among all patients, a wide range of health utilization was identified. Age, body mass index, Charlson Comorbidity Index, and American Society of Anesthesiology class were identified as positive predictors of postoperative healthcare utilization including emergency department visits, spine imaging studies, opioid and nerve blocker prescriptions, inpatient rehabilitation, any referrals, and pain management referrals. Conclusions Markers of patient health-such as CCI and ASA class-may be used to predict healthcare utilization following elective spine surgery. Identifying at-risk patients and addressing these challenges prior to surgery is an important step to deliver efficient postoperative care. Level of Evidence 3.
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Affiliation(s)
- Erik B. Gerlach
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Felipe Ituarte
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Mark A. Plantz
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Peter R. Swiatek
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Nicholas A. Arpey
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Jeremy S. Marx
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - David J. Fei-Zhang
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Wellington K. Hsu
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
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Marx JS, Plantz MA, Gerlach EB, Carney J, Swiatek PR, Cantrell CK, Tjong VK. Revision ACL reconstruction has higher incidence of 30-day hospital readmission, reoperation, and surgical complications relative to primary procedures. Knee Surg Sports Traumatol Arthrosc 2022; 30:1605-1610. [PMID: 34279703 DOI: 10.1007/s00167-021-06646-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/18/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Although there has been substantial improvement in ACL reconstructive surgery, graft failure remains a devastating complication for some patients. Revision procedures are inherently more complex and technically challenging. The purpose of this study is to determine the incidence of short-term complications after these procedures and to compare trends in operative length, relative valuation, and reimbursement after primary versus revision ACL reconstruction. METHODS Primary and revision arthroscopic ACL reconstruction cases were identified on the American College of Surgeons' NSQIP database using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes between January 1, 2012 and December 31, 2017. Demographics, patient variables, and surgical variables were compared between primary and revision groups using Chi-squared tests. Logistic regression was used to identify independent risk factors for revision ACL reconstruction. Various 30-day outcome measures were compared between the primary and revision ACL reconstruction groups. Various measures of valuation-including total relative value units (RVU) and reimbursement per minute-were calculated and compared between the two groups. RESULTS A total of 8292 patients-8135 primary and 157 revision procedures-were included in the final cohort. Higher ASA scores were associated with revision ACL reconstructions. Patients undergoing revision procedures were less likely to have an ASA score of 1 (p < 0.001) and more likely to have an ASA score of 2 (p = 0.004) or 3 (p = 0.020). Revision ACL reconstruction was associated with higher rates of poor 30-day outcome measures, including unplanned readmission (p = 0.029), reoperation (p = 0.012), return to the OR (p = 0.012), and surgical complications (p = 0.021). The total RVUs and reimbursement for revision procedures were significantly greater than those for primary procedures (p < 0.001). However, when accounting for operative time, the RVU/minute and reimbursement/minute were similar between the two groups (n.s.). CONCLUSIONS Relative to primary ACL reconstruction, revision ACL procedures are associated with worse short-term outcomes-including unplanned readmission, reoperation, return to the OR, and surgical complications. A greater ASA score was independently predictive of revision ACL surgery. The current RVU system undervalues revision ACL procedures, considering the increased operative time and complexity of such procedures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jeremy S Marx
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA.
| | - Erik B Gerlach
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA
| | - John Carney
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA
| | - Peter R Swiatek
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA
| | - Colin K Cantrell
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair St., Suite 1350, Chicago, IL, 60611, USA
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Carney J, Gerlach E, Plantz MA, Cantrell C, Swiatek PR, Marx JS, Marra G. Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis. Cureus 2021; 13:e16441. [PMID: 34422472 PMCID: PMC8367019 DOI: 10.7759/cureus.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Studies have shown that the use of total shoulder arthroplasty is increasing every year in the United Stated at a rate higher than that of total hip or total knee arthroplasty. As the population of the United States continues to age, it is becoming more important for surgeons to understand the true impact of age on outcomes and complications following procedures such a total shoulder arthroplasty. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group. Methods Data was obtained through the American College of Surgeons National Surgical Quality Improvement Program database (ACS NSQIP). Patients who had undergone total shoulder arthroplasty were identified by Current Procedural Terminology code (23472). Indication for arthroplasty was determined by ICD9/10 code (osteoarthritis, fracture, other). Each octogenarian was matched 1:1 to a non-octogenarian based on sex, BMI, ASA class, medical comorbidities, functional status, and surgical indication for arthroplasty by propensity scoring. A subgroup analysis was performed to compare outcomes between only those patients who underwent TSA for osteoarthritis.Outcomes of interest were assessed between the two groups for statistical significance using a chi-squared test or fisher exact test for expected values of less than 5. Statistical significance was set at p<0.05. Results After matching, octogenarians were found to be at higher risk of readmission (4.7% vs. 3.3%, p=0.046), non-home discharge (27.1% vs. 9.4%, p<0.001), and overall surgical (4.4% vs. 2.5%, p=0.006) and medical complications (3.7% vs. 2.4%, p=0.039). In the setting of TSA for osteoarthritis only, however, octogenarians were only at higher risk for non-home discharge (22.4% vs. 7.5%, p<0.001). Conclusions Octogenarians are at higher risk of some complications following total shoulder arthroplasty but fewer than has been previously reported, particularly in the setting of arthroplasty for the treatment of arthritis.
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Affiliation(s)
- John Carney
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Erik Gerlach
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Colin Cantrell
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Peter R Swiatek
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, USA
| | - Jeremy S Marx
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
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