Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index

Ondeck, Nathaniel T.; Bohl, Daniel D.; Bovonratwet, Patawut; McLynn, Ryan P.; Cui, Jonathan J.; Shultz, Blake N.; Lukasiewicz, Adam M.; Grauer, Jonathan N.

doi:10.1016/j.spinee.2017.05.028

Cited by 99 publications

(58 citation statements)

References 35 publications

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“…Lakomkin et al [17] retrospectively reviewed 6121 patients undergoing revision THA using the ACS-NSQIP database and found a positive but weak association between CCI and adverse events (OR, 1.12; 95% CI, 1.05-1.20). Ondeck et al [18] retrospectively reviewed 16,495 patients undergoing posterior lumbar fusion using the ACS-NSQIP database. Compared to CCI, the authors found the ASA classification system to be a slightly superior predictor for postoperative adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Risk stratification in primary total joint arthroplasty: the current state of knowledge

et al. 2019

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Background As we transition to value-based care delivery models, risk stratification in total joint arthroplasty is more important than ever. The purpose of this study was to identify patients who would likely require higher level of care and may not be suitable for inclusion in bundled payment models. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent primary total joint arthroplasty between 2011 and 2012. Five types of adverse events were assessed: medical complications, surgical complications, readmission, reoperation, and mortality. Univariate and multivariate logistic regression analyses were performed using a large number of demographic and morbidity variables. Results A total of 14,185 patients were identified. The 30-day medical complication, surgical complication, readmission, reoperation, and mortality rates were 2.0%, 3.2%, 4.0%, 1.5%, and 0.2%, respectively. Among the different variables assessed, only the American Society of Anesthesiologists (ASA) physical classification system was a significant risk factor for most outcomes assessed. Peripheral vascular disease was the most significant risk factor for medical complications and reoperation (odds ratio, 2.73 and 3.23, respectively). Bleeding disorders were the most significant risk factor for readmission and mortality (odds ratio, 2.03 and 5.86, respectively). Conclusions ASA score is a more reliable risk stratification tool than Charlson Comorbidity Index, but it is not sufficient by itself. Patients with higher ASA scores combined with peripheral vascular disease and/or bleeding disorders are at especially high risk of developing postsurgical adverse events and may not be suitable for inclusion in bundled payment models. These data can be used to develop better risk stratification models that are critically needed.

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Section: Discussionmentioning

confidence: 99%

“…Patient outcomes are tracked for 30 days after discharge. The data are internally audited to ensure accuracy with reported discrepancy typically around 2% [14] .…”

Section: Methodsmentioning

confidence: 99%

Risk stratification in primary total joint arthroplasty: the current state of knowledge

et al. 2019

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“…The modified frailty index has been applied to patients undergoing lumbar fusion to predict complications, length of stay, readmission, reoperation, and other adverse events. 82,108,153 Disease-specific predictive tools have been developed to assess patients and inform decision-making, including spine surgery. 99,120 As more data become available, these predictive tools will become more precise, informative, and useful.…”

Section: Predictive Analyticsmentioning

confidence: 99%

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Reid¹,

Morr²,

Kaiser³

2019

Journal of Neurosurgery: Spine

121

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Lumbar fusion is an accepted and effective technique for the treatment of lumbar degenerative disease. The practice has evolved continually since Albee and Hibbs independently reported the first cases in 1913, and advancements in both technique and patient selection continue through the present day. Clinical and radiological indications for surgery have been tested in trials, and other diagnostic modalities have developed and been studied. Fusion practices have also advanced; instrumentation, surgical approaches, biologics, and more recently, operative planning, have undergone stark changes at a seemingly increasing pace over the last decade. As the general population ages, treatment of degenerative lumbar disease will become a more prevalent—and costlier—issue for surgeons as well as the healthcare system overall. This review will cover the evolution of indications and techniques for fusion in degenerative lumbar disease, with emphasis on the evidence for current practices.

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“…We were also unable to control for surgical choice on a particular case and therefore acknowledge the potential for selection bias. We have used age and ASA as proxy indicators for patient comorbidities with the rationale that these are the best indices in recent research [13]. All-cause revision rates do not capture patients too unwell to undergo revision surgery or for whom the joint replacement may be functioning poorly.…”

Section: Discussionmentioning

confidence: 99%

How do cemented short Exeter stems perform compared with standard-length Exeter stems? The experience of the New Zealand National Joint Registry

et al. 2020

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a b s t r a c tBackground: The standard Exeter (Stryker) cemented stem is 150 mm long with standard offsets ranging from 37.5 mm to 56 mm. Exeter short stems of 125 mm are also available in the offsets of 37.5 mm, 44 mm, and 50 mm. In addition, smaller (125 mm or shorter) Exeter cemented stems with offsets of 35.5 mm or less are available. The aim of this study was to examine the New Zealand Joint Registry (NZJR) comparing medium-term survival rates and functional outcomes of standard-length stems with Exeter short stems of various offsets in patients undergoing primary total hip replacement. Methods: Using the NZJR, we compared the results of 3 separate groups of patients with Exeter stems. Patients with standard 150 mm length Exeter stems (Standard) were compared with patients with Exeter 125 mm stems with regular 37.5 mm, 44 mm, and 50 mm offsets (Short 37þ) and Exeter 125 mm stems with offsets of 35.5 mm and below (Short 37À). Demographic data, preoperative diagnosis, patient-reported outcome measures, and reasons for revision were compared between groups. Kaplan-Meier survival analysis and Cox multivariate regression analysis were used to examine implant survival and the influence of stem group on revision rates adjusting for gender, age, diagnosis, and surgical approach. Short 37 þ groups compared with the Standard group (Standard BMI, 28.71; SD 5.72; Short 37þ BMI, 29.69; SD, 6.67; Short 37À BMI, 29.09; SD 7.07; P < .001). The all-cause revision rate for standard stems was 0.55/100 component years (cy) (95% CI: 0.52 to 0.58). The Short 37À group had a higher rate of revision compared with the Standard group (hazard ratio 1.6; 95% CI: 1.3 to 1.98; P < .001), while the Short 37þ group had a hazard ratio of 0.84 (95% CI: 0.38 to 1.88; P ¼ .674) compared with the Standard group. Cox regression analysis controlling for age, gender, diagnosis of OA, and surgical approach did not affect these findings. However, no clinically meaningful difference between Oxford hip scores was observed. Conclusions: There was a significant difference in revision rates for aseptic loosening with standard-length Exeter stems having a lower revision rate than short Exeter stems with offsets 35.5 mm or less. The Short 37þ groups, despite comprising relatively small numbers, performed similarly to the Standard stem group.

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Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index

Cited by 99 publications

References 35 publications

Risk stratification in primary total joint arthroplasty: the current state of knowledge

Risk stratification in primary total joint arthroplasty: the current state of knowledge

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

How do cemented short Exeter stems perform compared with standard-length Exeter stems? The experience of the New Zealand National Joint Registry

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