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Study Design: Retrospective comparative cohort study using the National Surgical Quality Improvement Program. Objective: The aim of this study was to evaluate trends in the annual number of PSOs performed, describe the patient populations associated with each cohort, and compare outcomes between specialties. Summary of Background Data: Pedicle subtraction osteotomies (PSO) are complex and advanced spine deformity surgical procedures performed by neurosurgeons and orthopedic surgeons. Though both sets of surgeons can be equally qualified and credentialed to perform a PSO, it is possible that differences in training and exposure could translate into differences in patient management and outcomes. Methods: Patients that underwent lumbar PSO from 2005 to 2014 in the American College of Surgeons-National Surgical Quality Improvement Program registry were identified. Relevant demographic, preoperative comorbidity, and postoperative 30-day complications were queried and analyzed. The data was divided into 2 cohorts consisting of those patients who were treated by neurosurgeons versus orthopedic surgeons. Additional data from the Scoliosis Research Society Morbidity and Mortality database was queried and analyzed for comparison. Results: Demographic and comorbidity factors were similar between the neurosurgery and orthopedic surgery cohorts, except there were higher rates of hypertension among orthopedic surgeon-performed PSOs (65.66% vs. 48.67%, P=0.004). Except for 2012, in every year queried, orthopedic surgeons reported more PSOs than neurosurgeons. In patients who underwent lumbar fusion surgery, there was a higher rate of PSOs if the surgery was performed by an orthopedic surgeon (OR 1.7824, 95% CI: 1.4017–2.2665). The incidence of deep vein thrombosis after PSOs was higher for neurosurgery compared with orthopedic surgery (8.85% vs. 1.20%, P=0.004). However, besides deep vein thrombosis, there were no salient differences in surgical complication rates between neurosurgeon-performed PSOs and orthopedic surgeon-performed PSOs. Conclusions: The number of PSO procedures performed by neurosurgeons and orthopedic surgeons has increased annually. Differences in outcomes between neurosurgeons and orthopedic surgeons suggest an opportunity for wider assessment and alignment of adult spinal deformity surgery exposure and training across specialties.

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Introduction: COVID-19 infection causes a thrombotic state and elevation in D-dimer. This study characterizes the contour and nature of D-dimer elevation during severe COVID-19 infections. Methods: Retrospective review of 100 consecutive COVID-19 patients selected for severe infection at a tertiary medical center in New York City admitted to four COVID units and three ICU units on 04/15/2020. Admission D-dimer and serial D-dimer values during hospitalization were obtained as were demographic data, major thrombotic complications, and other significant hospital events. Data was analyzed with the Mann-Whitney U test, student’s t-test, and chi-squared test. Results: Hospital mortality was 28% among these 100 study subjects, ventilatory support 47%, ICU stay 40%, discharged in 61% and 11% remained hospitalized on 5/15/2020. Admission D-dimer elevated in 89% (mean D-dimer 3.36+/-4.84 mg/L) and 97% of hospitalized patients had elevated D-dimer (peaked mean D-dimer 7.33+/-7.34 mg/L). There was no significant difference in the admission D-dimers between patients who died versus those who survived (3.50+/-0.81 vs 3.02+/-0.55 mg/L, p=0.19), however; the contours of the subsequent D-dimers were significantly different between those who died versus survivors. Mean in hospital D-dimer remained without significant change in the survivor group but increased significantly in the deceased group (3.06+/-0.53 vs 4.62+/-0.48 mg/L, p<0.001). The final D-dimer measurement prior to a patients discharge or death was significantly higher in the deceased group vs the survivor group (5.53+/-0.86 vs 1.98+/-0.39 mg/L, p<0.001). There were 27 thrombotic complications (CVA 10, MI 4, PE 6, DVT 5, arterial thrombosis 2) diagnosed in 22 patients. Elevated peaked D-dimers were significantly associated with ICU (12.04 +/-6.96 mg/L, R 0.27-20, 95% CI 2.23) vs. no-ICU stay (5.13 +/- 6.49 mg/L, R 0.3-20, 95% CI 1.68, p<0.001), and thrombotic complications (12.60 +/- 7.62 mg/L, R 0.27-20, 95% CI 3.38) vs. no thrombotic complication (6.57 mg/L +/- 0.3-20, 95% CI 1.47, p<0.001). Conclusions: D-dimers were near universally elevated in severe COVID-19 infection but a marked upward trending of D-dimers presaged COVID-associated complications and a poor outcome.

including penetrating versus blunt mechanism (P ¼ .18), specialty performing bypass (P ¼ .98), interposition bypass (P ¼ .64), associated orthopedic injury (P ¼ .35), Injury Severity Score (P ¼ .31), or conduit type (P ¼ .34) (Table ). The composite outcome was reached in only 7 of 31 patients. Follow-up demonstrates 90% survival at 20 months (Figs 1 and 2).Conclusions: Upper extremity bypass for traumatic arterial injury has a low composite end point. While this may be an effect of sample size, it appears that these patients do well overall. These data may be useful for sample size calculations studies.