Editorial: Large Database Studies—What They Can Do, What They Cannot Do, and Which Ones We Will Publish

Grauer, Jonathan N.; Leopold, Seth S.

doi:10.1007/s11999-015-4223-z

Cited by 43 publications

(29 citation statements)

References 12 publications

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“…Presently, there are not enough data in the literature to assess the accuracy of coding in NIS for uncommon complications such as ION and RAO. 27 Both over- and under-coding are possible. Also, it is not possible to rule out if changes in coding frequency of ION or of the spinal fusion procedure codes are involved in the incidence data results.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Visual Loss in Spine Fusion Surgery

et al. 2016

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Background Perioperative ischemic optic neuropathy (ION) causes visual loss in spinal fusion. Previous case–control studies are limited by study size and lack of a random sample. The purpose of this study was to study trends in ION incidence in spinal fusion and risk factors in a large nationwide administrative hospital database. Methods In the Nationwide Inpatient Sample for 1998 to 2012, procedure codes for posterior thoracic, lumbar, or sacral spine fusion and diagnostic codes for ION were identified. ION was studied over five 3-yr periods (1998 to 2000, 2001 to 2003, 2004 to 2006, 2007 to 2009, and 2010 to 2012). National estimates were obtained using trend weights in a statistical survey procedure. Univariate and Poisson logistic regression assessed trends and risk factors. Results The nationally estimated volume of thoracic, lumbar, and sacral spinal fusion from 1998 to 2012 was 2,511,073. ION was estimated to develop in 257 patients (1.02/10,000). The incidence rate ratio (IRR) for ION significantly decreased between 1998 and 2012 (IRR, 0.72 per 3 yr; 95% CI, 0.58 to 0.88; P = 0.002). There was no significant change in the incidence of retinal artery occlusion. Factors significantly associated with ION were age (IRR, 1.24 per 10 yr of age; 95% CI, 1.05 to 1.45; P = 0.009), transfusion (IRR, 2.72; 95% CI, 1.38 to 5.37; P = 0.004), and obesity (IRR, 2.49; 95% CI, 1.09 to 5.66; P = 0.030). Female sex was protective (IRR, 0.30; 95% CI, 0.16 to 0.56; P = 0.0002). Conclusions Perioperative ION in spinal fusion significantly decreased from 1998 to 2012 by about 2.7-fold. Aging, male sex, transfusion, and obesity significantly increased the risk.

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Section: Discussionmentioning

confidence: 99%

Perioperative Visual Loss in Spine Fusion Surgery

et al. 2016

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“…Furthermore, separating clinically and statistically significant differences may limit the number of differences seen within the cohorts evaluated herein, but concomitantly, it, most likely, led to decrease in type 1 errors that could be made based on such a large sample size. 15…”

Section: Limitationsmentioning

confidence: 99%

A History of Past Prostate Cancer Still Carries Risk After Total Knee Arthroplasty

et al. 2019

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Prostate cancer (PCa) is one of the most prevalent diseases in the North American elderly population. Moreover, many patients undergo prostate resection without further treatment and are often considered cured. As such, it is expected that many undergo total knee arthroplasty (TKA) for osteoarthritis while having a history of PCa. Nonetheless, limited research is available on this topic, and without it, surgeons may not be aware of increased complication rates. Therefore, the purpose of this study was to evaluate whether patients at a national level with a history of PCa are at increased risk for complications after TKA. A retrospective case–control, comorbidity matched paired analysis was performed. Patients were identified based on International Classification of Diseases, Ninth Revision codes and matched 1:1 ratio to age, smoker status, chronic kidney disease, diabetes, chronic lung disease, smoking status, and obesity. Patients with active disease were excluded. The 90-day outcomes of TKA were compared through univariate regressions (odds ratios [ORs] and 95% confidence intervals). A total of 2,381,706 TKA patients were identified, and after matching, each comprised 113,365 patients with the same prevalence of the matched comorbidities and demographic characteristics. A significant increase in thromboembolic events that was clinically relevant was found in pulmonary embolisms (PEs) (1.44 vs. 0.4%, OR: 3.04, p < 0.001), Moreover, an increased rate of deep vein thromboses was also seen but was found to be not clinically significant (2.55 vs. 2.85%, OR: 1.19). Although length of stay and other complications were similar, average reimbursements were higher for those with a history of PCa. In conclusion, a history of prior PCa carries significant risk as these patients continue to develop increased PE rates during the 90-day postoperative period which appears to lead to greater economic expenditure. Surgeons and payers should include this comorbidity in risk and patient-specific payment models.

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“…It has a focus more geared to oncology than to general orthopaedics. It is particularly suited to assess early quality measures [3]. Complications such as fracture, neuropathy, thromboembolic complications, among others, and oncologic outcome will be accessible to participating centers with approved research questions.…”

Section: How Do We Get There?mentioning

confidence: 99%

CORR Insights®: Freezing Nitrogen Ethanol Composite May be a Viable Approach for Cryotherapy of Human Giant Cell Tumor of Bone

Healey

2017

Clinical Orthopaedics &Amp; Related Research

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Editorial: Large Database Studies—What They Can Do, What They Cannot Do, and Which Ones We Will Publish

Cited by 43 publications

References 12 publications

Perioperative Visual Loss in Spine Fusion Surgery

Perioperative Visual Loss in Spine Fusion Surgery

A History of Past Prostate Cancer Still Carries Risk After Total Knee Arthroplasty

CORR Insights®: Freezing Nitrogen Ethanol Composite May be a Viable Approach for Cryotherapy of Human Giant Cell Tumor of Bone

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