National Databases in Pediatric Orthopaedic Surgery: A Comparison of Demographics, Procedures, and Outcomes

Gutman, Ilya; Niemeier, Thomas E; Gilbert, Shawn R.

doi:10.1097/bpo.0000000000001204

Cited by 8 publications

(5 citation statements)

References 2 publications

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“…Therefore, it is possible that patients may have been improperly included or excluded due to potential errors within the ACS-NSQIP database. While the NSQIP database is frequently utilized, 44,45 there was no obvious way to correct for this. Furthermore, the NSQIP database does not provide information with regard to the specialty of the treating physician; it is possible that the outcomes of augmentation procedures conducted by interventional radiologists differ from those performed by surgeons or other subspecialists.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Gupta

Cha

Schwab

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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Introduction Studies have shown that osteoporotic patients are more likely to have medical or surgical complications postoperatively. In this study, we determine the predictive value of various comorbidities on the likelihood of postoperative complications, mortality, and 30-day readmission following cement augmentation for osteoporotic vertebral compression fractures (OVCFs). Methods A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database from 2007 to 2014 identified 1979 patients who met inclusion criteria. A multivariate logistic regression analysis was utilized to determine the relationship between various comorbidities and perioperative mortality, postoperative complications, and 30-day readmission rates. Results A history of cerebrovascular accident (CVA), coagulopathy, diminished preoperative functional status, and/or an American Society of Anesthesiologists (ASA) class > 2 were statistical predictors of postoperative complications. CVA generated the highest odds ratio among these comorbidities (OR = 5.36, p = 0.02 for minor complications; OR = 4.60 p = 0.05 for major complications). Among the 15 comorbidities considered, steroid use (OR =1.81; p = 0.03) and an ASA class > 2 (OR = 14.65; p = 0.01) were the only ones that were correlated with mortality; an ASA class > 2 had a particularly strong effect on the likelihood of mortality (OR = 14.65). Chronic obstructive pulmonary disorder (COPD), obesity, significant weight loss, and an ASA class > 2 were correlated with 30-day readmissions. Congestive heart failure (CHF), diabetes, dialysis, hypertension, or smoking was not correlated with adverse postoperative outcomes. Conclusions Of the 15 comorbidities considered in this study, four were statistically associated with increased rates of postoperative complications, two were associated with increased mortality, and four were associated with increased rates of readmission at 30 days. The presence of CHF, diabetes mellitus (DM), hypertension, ascites, renal failure, or smoking were not associated with the adverse outcomes studied. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Gupta

Cha

Schwab

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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“…These conditions may require consultations from other departments. 6 7 22 23 Moreover, it is occasionally difficult to differentiate between the normal physiologic changes and pathologic presentations in children. This is because their musculoskeletal characteristics change continuously.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Tertiary Hospital Utilization in Pediatric Orthopaedics: a Study Using Nationwide Sample Data from Korea

Bae

Park

et al. 2021

J Korean Med Sci

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Background In the Korean medical system, the severity classification for a specific disease depends primarily on its nationwide admission rate in tertiary hospitals. Inversely, one of the important designation criteria for a tertiary hospital is the hospital's treatment ratio of patients classified as having a specific severe disease. Most diseases requiring pediatric orthopaedic surgery (POS) are not currently classified as high severity in terms of disease severity. We investigated the admission rates for the representative POS diseases in tertiary hospitals and compared these rates with those for adult orthopaedic surgery (AOS) diseases. Methods Seven POS diagnoses and three AOS diagnoses were selected based on frequency of admission. Nationwide sample data were used to investigate the admission rates for these representative diagnoses from 2008 to 2017. Results Six of the seven frequent POS diagnoses presented high admission rates in tertiary hospitals (62.5–92.3%). In contrast, all frequent AOS diagnoses presented low admission rates in tertiary hospitals. Conclusion The admission rates of frequent POS diagnoses in tertiary hospitals are high. Considering that these rates are the most important factors for the classification of disease severity, POS diseases seem to be underestimated in terms of severity. This may lead to a tendency for tertiary hospitals to intentionally reduce the admission of children with POS diseases. As a result, these children may not receive appropriate professional care. Therefore, for the disease severity, POS diseases should be classified differently from general AOS diseases by using different criteria reflecting the patient's age.

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“…To this end, it is possible that patients may have been improperly included or excluded due to potential errors within the ACS-NSQIP database. While the NSQIP database is highly regarded and frequently referenced, 27,28 there was no obvious way to correct for this. Another challenge with the NSQIP database is its use of the term “null” instead of “no” when identifying patients with CNS tumors.…”

Section: Discussionmentioning

confidence: 99%

Age Is Just a Number: Patient Age Does Not Affect Outcome Following Surgery for Osteoporotic Vertebral Compression Fractures

Gupta

Cha

Schwab

et al. 2020

Global Spine Journal

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Study Design: Retrospective study. Objective: Multiple studies have shown that osteoporotic patients are at an increased risk for medical and surgical complications, making optimal management of these patients challenging. The purpose of this study was to determine the relationship between patient age and the likelihood of surgical complications, mortality, and 30-day readmission rates following surgery for osteoporotic vertebral compression fractures (OVCFs). Methods: A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database from 2007 to 2014 identified 1979 patients who met inclusion criteria. A multivariate logistic regression analysis was conducted to calculate odds ratios (OR), with corresponding P values and 95% confidence intervals, of the relationship between age (treated as a continuous variable) and perioperative mortality, surgical complications, and 30-day readmission rates. Results: Younger patients were statistically more likely to endure a minor (OR = 0.98; P = .002) or major complication (OR = 0.97; P = .009). The older a patient was, on the other hand, the higher the likelihood that patient would be readmitted within 30 days of surgery (OR =1.02; P = .004). Mortality within the 30-day perioperative period was not statistically correlated with age. Conclusions: The impact of age on adverse outcomes following surgery for OVCF is mixed. While younger patients are more likely to endure complications, older patients are more likely to be readmitted within 30 days following surgery. Patient age showed no correlation with mortality rates. In the setting of surgical treatment for an OVCF, a patient’s age can help determine the risk of complications and the rate of readmission following intervention.

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National Databases in Pediatric Orthopaedic Surgery: A Comparison of Demographics, Procedures, and Outcomes

Abstract: Level III, prognostic study.

Cited by 8 publications

References 2 publications

Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Analysis of Tertiary Hospital Utilization in Pediatric Orthopaedics: a Study Using Nationwide Sample Data from Korea

Age Is Just a Number: Patient Age Does Not Affect Outcome Following Surgery for Osteoporotic Vertebral Compression Fractures

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