Duration of overlap during lumbar fusion does not predict outcomes

Farooqi, Ali S.; Borja, Austin J; Detchou, Donald K E; Glauser, Gregory; Strouz, Krista; McClintock, Scott D.; Malhotra, Neil R.

doi:10.1016/j.clineuro.2021.106610

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…15 Exact-matched patients were defined as those who match on every matching variable, as previously described by authors from the present work. 16,17 Matching variables included age, gender, race, median household income (MHI), insurance status, BMI, American Society of Anesthesiologists (ASA) grade, Charlson Comorbidity Index (CCI) score, and surgical history ever and within 30 d of the index operation. Binary binning was performed for race (white or nonwhite), MHI (above or below the study population's median), insurance status (privately sponsored or governmental), and surgical history (presence or absence).…”

Section: Discussionmentioning

confidence: 99%

Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity

Farooqi¹,

Borja²,

Detchou³

et al. 2021

Neurosurg.

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BACKGROUND Few studies have assessed the impact of overlapping surgery during different timepoints of neurosurgical procedures. OBJECTIVE To evaluate the impact of overlap before the critical portion of surgery on short-term patient outcomes following lumbar fusion. METHODS In total, 3799 consecutive patients who underwent single-level, posterior-only lumbar fusion over 6 yr (2013-2019) at an academic hospital system were retrospectively studied. Outcomes included 30-d emergency department (ED) visit, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. Duration of overlap that occurred before the critical portion of surgery was calculated as a percentage of total beginning operative time. Univariate logistic regression was used to assess the impact of incremental 1% increases in the duration of overlap within the whole population and patients with beginning overlap. Subsequently, univariate analysis was used to compare exact matched patients with the least (bottom 40%) and most amounts of overlap (100% beginning overlap). Coarsened exact matching was used to match patients on key demographic factors, as well as attending surgeon. Significance was set at a P-value < .05. RESULTS Increased duration of beginning overlap was associated with a decrease in 30-d ED visit (P = .03) within all patients with beginning overlap, but not within the whole population undergoing lumbar fusion. Duration of beginning overlap was not associated with any other short-term morbidity or mortality outcome in either the whole population or patients with beginning overlap. CONCLUSION Increased duration of overlap before the critical step of surgery does not predict adverse short-term outcomes after single-level, posterior-only lumbar fusion.

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Section: Discussionmentioning

confidence: 99%

Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity

Farooqi¹,

Borja²,

Detchou³

et al. 2021

Neurosurg.

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“…Patients with LACE+ scores in the bottom decile were matched with those patients with scores in the top 4 deciles to control for confounding variables. These cutoffs, which were previously used in other studies, 18 were used to evaluate the extremes of LACE+ scores and achieve adequate statistical power with a large population of patients available for exact matching. Unlike propensity score matching, which converts numerous covariates into a single composite value for matching, CEM utilizes raw covariate values for 1:1 exact matching.…”

Section: Matchingmentioning

confidence: 99%

Use of the LACE+ index to predict readmissions after single-level lumbar fusion

Borja

Glauser

Strouz

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE Spinal fusion is one of the most common neurosurgical procedures. The LACE (length of stay, acuity of admission, Charlson Comorbidity Index [CCI] score, and emergency department [ED] visits within the previous 6 months) index was developed to predict readmission but has not been tested in a large, homogeneous spinal fusion population. The present study evaluated use of the LACE+ score for outcome prediction after lumbar fusion. METHODS LACE+ scores were calculated for all patients (n = 1598) with complete information who underwent single-level, posterior-only lumbar fusion at a single university medical system. Logistic regression was performed to assess the ability of the LACE+ score as a continuous variable to predict hospital readmissions within 30 days (30D), 30–90 days (30–90D), and 90 days (90D) of the index operation. Secondary outcome measures included ED visits and reoperations. Subsequently, patients with LACE+ scores in the bottom decile were exact matched to the patients with scores in the top 4 deciles to control for sociodemographic and procedural variables. RESULTS Among all patients, increased LACE+ score significantly predicted higher rates of readmissions in the 30D (p < 0.001), 30–90D (p = 0.001), and 90D (p < 0.001) postoperative windows. LACE+ score also predicted risk of ED visits at all 3 time points and reoperations at 30–90D and 90D. When patients with LACE+ scores in the bottom decile were compared with patients with scores in the top 4 deciles, higher LACE+ score predicted higher risk of readmissions at 30D (p = 0.009) and 90D (p = 0.005). No significant difference in hospital readmissions was observed between the exact-matched cohorts. CONCLUSIONS The present results suggest that the LACE+ score demonstrates utility in predicting readmissions within 30 and 90 days after single-level lumbar fusion. Future research is warranted that utilizes the LACE+ index to identify strategies to support high-risk patients in a prospective population.

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