Predicting Postoperative Morbidity and Readmission for Revision Posterior Lumbar Fusion

Basques, Bryce A.; Ibe, Izuchukwu; Samuel, Andre M.; Lukasiewicz, Adam M.; Webb, Matthew L.; Bohl, Daniel D.; Grauer, Jonathan N.

doi:10.1097/bsd.0000000000000391

Cited by 41 publications

(20 citation statements)

References 29 publications

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“…Compared to instrumented posterior fusion, instrumented posterior fusion with interbody took an average of 19 minutes of additional time (P , .001). Although operative time has been associated with an increased risk of adverse events in other studies, 34,35 the differences were not associated with different perioperative morbidity in the current study. Thus, the clinical significance of these relatively small differences is thought not to be great in this setting.…”

Section: Discussioncontrasting

confidence: 52%

Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options

et al. 2019

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Background: Surgical treatment for lumbar degenerative spondylolisthesis has been shown to provide better longterm outcomes than conservative treatment. However, there is variation in surgical approaches employed by surgeons. This study investigates current surgical practice patterns and compares perioperative outcomes of 3 common surgical treatments for this pathology.Methods: A survey was administered to surgeons who attended the Lumbar Spine Research Society (LSRS) meeting in 2014. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005 to 2014 to characterize the same responses. The 2 data sets were compared. Perioperative outcomes of those in the ACS-NSQIP posterior fusion subcohorts were characterized and compared.Results: Posterior surgical approaches utilized by surgeons who responded to the LSRS survey were similar to those captured by ACS-NSQIP where 72% of those with degenerative spondylolisthesis were fused. Of those that were fused, 8% had an uninstrumented posterior fusion, 33% had an instrumented posterior fusion, and 59% had an instrumented posterior fusion with interbody. On multivariate analysis, there was no difference in risk of postoperative adverse events, readmission, or length of stay between these 3 common types of fusion.Conclusions: Practice patterns for the posterior management of lumbar degenerative spondylolisthesis were similar between LSRS survey responses and ACS-NSQIP data. The ACS-NSQIP perioperative outcome measures assessed were similar regardless of surgical technique. These findings highlight that cost-benefit considerations and longer-term outcomes have to be the measures by which surgical technique is chosen for degenerative spondylolisthesis. Lumbar Spine

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Section: Discussioncontrasting

confidence: 52%

Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options

et al. 2019

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“… 24 The impact of obesity was also overestimated by 1.23 relative risk and may be due to recent studies focusing on the effects of this modifiable risk factor. 18 , 25 Finally, the underestimated impact of preoperative anemia, although not statistically significant, may be explained by a stringent American College of Surgeons NSQIP definition for this status. 11 …”

Section: Discussionmentioning

confidence: 96%

General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons’ Perceptions and Reported Data for Rates and Risk Factors

Ondeck

Bohl

Bovonratwet

et al. 2017

Global Spine Journal

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Study Design:Survey study and retrospective review of prospective data.Objectives:To contrast surgeons’ perceptions and reported national data regarding the rates of postoperative adverse events following anterior cervical discectomy and fusion (ACDF) and to assess the accuracy of surgeons in predicting the impact of patient factors on such outcomes.Methods:A survey investigating perceived rates of perioperative complications and the perceived effect of patient risk factors on the occurrence of complications following ACDF was distributed to spine surgeons at the Cervical Spine Research Society (CSRS) 2015 Annual Meeting. The equivalent reported rates of adverse events and impacts of patient risk factors on such complications were assessed in patients undergoing elective ACDF from the National Surgical Quality Improvement Program (NSQIP).Results:There were 110 completed surveys from attending physicians at CSRS (response rate = 44%). There were 18 019 patients who met inclusion criteria in NSQIP years 2011 to 2014. The rates of 11 out of 17 (65%) postoperative adverse events were mildly overestimated by surgeons responding to the CSRS questionnaire in comparison to reported NSQIP data (overestimates ranged from 0.24% to 1.50%). The rates of 2 out of 17 (12%) postoperative adverse events were mildly underestimated by surgeons (range = 0.08% to 1.2%). The impacts of 5 out of 10 (50%) patient factors were overestimated by surgeons (range relative risk = 0.56 to 1.48).Conclusions:Surgeon estimates of risk factors for and rates of adverse events following ACDF procedures were reasonably nearer to national data. Despite an overall tendency toward overestimation, surgeons’ assessments are roughly appropriate for surgical planning, expectation setting, and quality improvement initiatives.

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“…An analysis of ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) data from 2005 to 2013 found a 30-day readmission rate of 5.8% following lumbar fusion revision surgery. 20 Another previous review of ACS-NSQIP data found that PLIF/TLIF (posterior lumbar interbody fusion/transforaminal lumbar interbody fusion) and ALIF/LLIF (anterior lumbar interbody fusion/lateral lumbar interbody fusion) revision lumbar surgery were associated with a 53% increased odds of morbidity, including bleeding events requiring transfusion. The study, however, found no significant difference between readmission rates in revision versus primary lumbar procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings correlate with previous studies examining risk factors for readmission following lumbar surgery. 20,25,26 This makes sense clinically, given diabetes' association with impaired wound healing, neuropathy, and increased risk of infection. 27 Since there are an increasing number of Americans living with diabetes, 28 it is important for surgeons to identify and medically optimize glycemic levels in patients undergoing elective revision lumbar surgery.…”

Section: Baaj Et Al Conducted An Analysis Of 86 869 Patients Who Recementioning

confidence: 99%

Ninety-Day Readmission in Elective Revision Lumbar Fusion Surgery in the Inpatient Setting

Hydrick

Rubel

Renfree

et al. 2019

Global Spine Journal

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Study Design: Retrospective review. Objectives: (1) Identify the 90-day rate of readmission following revision lumbar fusion, (2) identify independent risk factors associated with increased rates of readmission within 90 days, (3) and identify the hospital costs associated with revision lumbar fusion and subsequent readmission within 90 days. Methods: Utilizing 2014 data from the Nationwide Readmissions Database, patients undergoing elective revision lumbar fusion were identified. With this sample, multivariate logistic regression was utilized to identify independent predictors of readmission within 90 days. An analysis of total hospital costs was also conducted. Results: In 2014, an estimated 14 378 patients underwent elective revision lumbar fusion. The readmission rate at 90 days was 3.1% (n = 446). Diabetes with chronic complications was the only comorbidity found to carry significantly increased odds of readmission. Surgical complications such as deep venous thrombosis, surgical wound disruption, hematoma, and pneumonia (experienced during the index admission) were also independent predictors of readmission. Anterior approaches were associated with increased odds of readmission. The most common related diagnoses on readmission were hardware issues, postoperative infection, and disc herniation. Readmissions were associated with an average of $96 152 in increased hospital costs per patient compared with those not readmitted. Conclusion: Relevant patient comorbidities and surgical complications were associated with increased readmission within 90 days. Readmission within 90 days was associated with significant increases in hospital costs.

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Predicting Postoperative Morbidity and Readmission for Revision Posterior Lumbar Fusion

Abstract: In general, longer, more extensive procedures on sicker patients were associated with increased risk of postoperative complications and readmission.

Cited by 41 publications

References 29 publications

Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options

Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options

General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons’ Perceptions and Reported Data for Rates and Risk Factors

Ninety-Day Readmission in Elective Revision Lumbar Fusion Surgery in the Inpatient Setting

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