Anterior Cervical Discectomy and Fusion Outcomes in Patients With and Without Bariatric Surgery—Weight Loss Does Make a Difference

Joo, Peter; Zhu, Justin R; Wilhelm, Christopher; Tang, Kevin; Day, Wesley; Moran, Jay; Grauer, Jonathan N.

doi:10.1097/brs.0000000000004580

Cited by 12 publications

(7 citation statements)

References 28 publications

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“…Tasiou et al ( 16 ) reported a superficial wound infection of 0.9% in their institutional cohort of 114 patients. More recently, Joo et al ( 17 ) utilized the Pearl Driver database to evaluate 90-day outcomes after ACDF and reported a rate of 0.3% for wound dehiscence, 1.7% for pneumonia and 0.4% for the need for transfusion. Such rates are slightly higher than those reported in the present investigation, which may be attributable to the longer follow up period (90 days) in the study by Joo et al , compared to the 30-day outcome measures evaluated in the present study.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of cervical disc arthroplasty: no difference between orthopaedic and neurologic surgeons

Chughtai,

Rajan,

Emara

et al. 2023

J Spine Surg

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Background Given differences in residency training background, there has been increasing interest in characterizing differential outcomes between orthopaedic surgeons (OS) and neurosurgeons (NS) with regards to outcomes after cervical disc arthroplasty (CDA). This study aimed to assess if there were differences in perioperative outcomes of CDA between OS and NS. Methods Patients who underwent a single-level CDA between 2012 and 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using current procedural terminology codes. The patients were subsequently stratified into those who underwent CDA with OS versus NS, and propensity score-matched to adjust for differences in patient characteristics. Differences were assessed in medical and surgical complications, as well as operative time and healthcare utilization parameters [reoperations, readmissions, and lengths-of-stay (LOS)]. Results A total of 2,148 patients were identified (NS: n=1,395; OS: n=753). After 1:1 propensity score matching (n=741 each), there were no differences in characteristics between patients who underwent CDA by OS versus NS (P>0.05). There were no significant differences in any of the medical or surgical complications between the two groups (P>0.05 for each). There was a significant difference in the operative time between NS and OS (103.7±36.18 vs. 98.75±36.69 minutes; P=0.009). There were no significant differences in readmissions, reoperations, or LOS between the two groups (P>0.05 for each). Conclusions There were no differences in medical or surgical complications, as well as in reoperations, readmissions, and LOS in patients who underwent a single-level CDA between OS and NS. There was a statistically significant shorter operative time of four minutes for OS as compared to NS, which is unlikely to have clinical relevance.

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Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of cervical disc arthroplasty: no difference between orthopaedic and neurologic surgeons

Chughtai,

Rajan,

Emara

et al. 2023

J Spine Surg

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“…Ninety-day incidence of adverse events was identified using methods previously described. 20 , 22 , 33 34 35 36 37 Severe adverse events (SAEs) were defined as at least one occurrence of the following: sepsis, cardiac events, surgical site infection (SSI), deep vein thrombosis (DVT), or pulmonary embolism (PE). Minor adverse events (MAEs) were defined as at least one occurrence of the following: transfusion, acute kidney injury (AKI), wound dehiscence, urinary tract infection (UTI), pneumonia, or hematoma.…”

Section: Methodsmentioning

confidence: 99%

Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty

Sanchez,

Rancu,

Diatta

et al. 2024

JAAOS Glob Res Rev

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Introduction: Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized. Methods: Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test. Results: Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P < 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P < 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups. Discussion: This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.

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“…Morbid Obesity as Class III (>/= 40 kg/M2: MO World Health Organization) [ Table 1 ]. [ 2 , 3 , 6 , 9 , 12 , 13 , 16 , 22 ]…”

Section: Introductionmentioning

confidence: 99%

“…Utilizing the PearlDiver Database, two studies showed that performing bariatric surgery in MO patients prior to ACDF decreased their postoperative AE/morbidity/mortality rates [ Table 1 ]. [ 9 , 13 ] With the PearlDiver Database (2007-2013) and 100% Standard Analytic Files (SAF 100), Malik et al ., (2021) compared the 90-day postoperative outcomes for 411 MO patients in Group I (BMI >/= 35 kg/M2) who had BS surgery within two years of ACDF vs. Group 2 patients (BMI >/= 35 kg/M2) undergoing ACDF without prior BS surgery. [ 13 ] MO patients with prior BS had fewer AE following ACDF (i.e., pulmonary embolism, coronary disease, renal disease, and 90-day readmission rates) vs. MO patients without BS.…”

Section: Introductionmentioning

confidence: 99%

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Anterior cervical surgery for morbidly obese patients should be performed in-hospitals

Epstein,

Agulnick

2024

Surgical Neurology International

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Background: Morbid obesity (MO) is defined by the World Health Organization (WHO) as Class II (i.e. Body Mass Index (BMI) >/= 35 kg/M2 + 2 comorbidities) or Class III (i.e. BMI >/= 40 kg/M2). Here, we reviewed the rates for adverse event/s (AE)/morbidity/mortality for MO patients undergoing anterior cervical surgery as inpatients/in-hospitals, and asked whether this should be considered the standard of care? Methods: We reviewed multiple studies to document the AE/morbidity/mortality rates for performing anterior cervical surgery (i.e., largely ACDF) for MO patients as inpatients/in-hospitals. Results: MO patients undergoing anterior cervical surgery may develop perioperative/postoperative AE, including postoperative epidural hematomas (PEH), that can lead to acute/delayed cardiorespiratory arrests. MO patients in-hospitals have 24/7 availability of anesthesiologists (i.e. to intubate/run codes) and surgeons (i.e. to evacuate anterior acute hematomas) who can best handle typically witnessed cardiorespiratory arrests. Alternatively, after average 4-7.5 hr. postoperative care unit (PACU) observation, Ambulatory Surgical Center (ASC) patients are sent to unmonitored floors for the remainder of their 23-hour stays, while those in Outpatient SurgiCenters (OSC) are discharged home. Either for ASC or OSC patients, cardiorespiratory arrests are usually unwitnessed, and, therefore, are more likely to lead to greater morbidity/mortality. Conclusion: Anterior cervical surgery for MO patients is best/most safely performed as inpatients/in-hospitals where significant postoperative AE, including cardiorespiratory arrests, are most likely to be witnessed events, and appropriately emergently treated with better outcomes. Alternatively, MO patients undergoing anterior cervical procedures in ASC/OSC will more probably have unwitnessed AE/cardiorespiratory arrests, resulting in poorer outcomes with higher mortality rates. Given these findings, isn't it safest for MO patients to undergo anterior cervical surgery as inpatients/in-hospitals, and shouldn't this be considered the standard of care?

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Anterior Cervical Discectomy and Fusion Outcomes in Patients With and Without Bariatric Surgery—Weight Loss Does Make a Difference

Cited by 12 publications

References 28 publications

Perioperative outcomes of cervical disc arthroplasty: no difference between orthopaedic and neurologic surgeons

Perioperative outcomes of cervical disc arthroplasty: no difference between orthopaedic and neurologic surgeons

Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty

Anterior cervical surgery for morbidly obese patients should be performed in-hospitals

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