Short-term outcomes following posterior cervical fusion among octogenarians with cervical spondylotic myelopathy: a NSQIP database analysis

Vonck, Caroline E.; Tanenbaum, Joseph E.; Bomberger, Thomas T.; Benzel, Edward C.; Savage, Jason W.; Kalfas, Iain H.; Mroz, Thomas E.; Steinmetz, Michael P.

doi:10.1016/j.spinee.2018.02.012

Cited by 10 publications

(5 citation statements)

References 49 publications

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“…For example, octogenarians with cervical spondylotic myelopathy undergoing posterior cervical fusion were not found to have a higher risk of readmission compared to younger geriatric patients. 28 However, there are several orthopedic arthroplasty studies that are in contrary to this study's findings of specifically no increased risk of complications in octogenarians. A study by Souza et al found an age of 80 or older to be an independent risk factor for postoperative complications following TKA.…”

Section: Discussioncontrasting

confidence: 98%

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Thirty-day morbidity and mortality following revision total shoulder arthroplasty in octogenarians

2021

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Background Octogenarians are at an increased risk of morbidity and mortality following various surgeries, but this has not yet been well explored in octogenarians undergoing revision total shoulder arthroplasty (RTSA). Thus, the purpose of this study was to analyze whether octogenarians undergoing RTSA are at an increased risk of 30-day postoperative complications, readmissions, and mortality relative to the younger geriatric population. Methods Data of patients who underwent RTSA from 2013 to 2018 were obtained from a large de-identified database. Patients were divided into two cohorts: ages 65–79 and ages 80–89. Demographic data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate and multivariate analyses were performed. Results On bivariate analyses, patients aged 80–89 were more likely to develop pulmonary embolism (p = 0.014) and extended length of stay more than 3 days (p = 0.006) compared to the cohort aged 65–79. Following adjustment on multivariate analyses, 80–89 years old patients no longer had an increased likelihood of pulmonary embolism or extended length of stay compared to the 65–79 age group. Octogenarians were not found to have higher rates of 30-day readmissions (p = 0.782), mortality (p = 0.507), reoperation (p = 0.785), pneumonia (p = 0.417), urinary tract infection (p = 0.739), or sepsis (p = 0.464) compared to the cohort aged 65–79 following RTSA. Conclusion Age greater than 80 should not be used independently as a factor for evaluating whether a geriatric patient is a proper candidate for RTSA.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Thirty-day morbidity and mortality following revision total shoulder arthroplasty in octogenarians

2021

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“…Advanced age and obesity are considered predictors of poor postoperative outcomes generally; however, this study and others suggest they are not associated with adverse outcomes following PCF. 5,16,17 Comorbidities such as CKD requiring dialysis and coronary artery disease (CAD) are commonly cited as risk factors as well. 10,18 In our multivariable model, CAD approached significance as a predictor of readmission, associated with nearly 4-fold increase in odds (OR: 3.78, P = .05, Table 2).…”

Section: Key Resultsmentioning

confidence: 99%

Smoking Is an Independent Risk Factor for 90-Day Readmission and Reoperation Following Posterior Cervical Decompression and Fusion

Badiee¹,

Chan²,

Rivera³

et al. 2021

Neurosurg.

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BACKGROUND Posterior cervical decompression and fusion (PCF) is a common procedure used to treat various cervical spine pathologies, but the 90-d outcomes following PCF surgery continue to be incompletely defined. OBJECTIVE To identify risk factors associated with 90-d readmission and reoperation following PCF surgery. METHODS Adults undergoing PCF from 2012 to 2020 were identified. Demographic and radiographic data, surgical characteristics, and 90-d outcomes were collected. Univariate analysis was performed using Student's t-test, chi square, and Fisher exact tests as appropriate. Multivariable logistic regression models with lasso penalty were used to analyze various risk factors. RESULTS A total of 259 patients were included. The 90-d readmission and reoperation rates were 9.3% and 4.6%, respectively. The most common reason for readmission was surgical site infection (SSI) (33.3%) followed by new neurological deficits (16.7%). Patients who smoked tobacco had 3-fold greater odds of readmission compared to nonsmokers (odds ratio [OR]: 3.48; 95% CI 1.87-6.67; P = .0001). Likewise, the most common reason for reoperation was SSI (33.3%) followed by seroma and implant failure (25.0% each). Smoking was also an independent risk factor for reoperation, associated with nearly 4-fold greater odds of return to the operating room (OR: 3.53; 95% CI 1.53-8.57; P = .003). CONCLUSION Smoking is a significant predictor of 90-d readmission and reoperation in patients undergoing PCF surgery. Smoking cessation should be strongly considered preoperatively in elective PCF cases to minimize the risk of 90-d readmission and reoperation.

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“…Hospitals receiving an "excellent" score in the "discharge to home" category were associated with lower mean gross charges. Medical comorbidities have been associated with both nonhome discharge status [28][29][30] and increased hospital charges [31][32][33] in patients undergoing cervical spinal fusion. It is possible that medical comorbidities, which were unaccounted for in our data set, confounded or modified the association between excellent discharge to home status and gross charges.…”

Section: Discussionmentioning

confidence: 99%

Price Transparency for Cervical Spinal Fusion Among High-Performing Spine Centers in the United States

Yoon,

Ng,

Hoffman

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: As of January 1, 2021, all US hospitals are required by the Hospital Price Transparency Final Rule (HPTFR) to publish standard charges for all items and services, yet the state of price transparency for cervical spinal fusion is unknown. Here, we assess the nationwide price transparency landscape for cervical spinal fusion among high-performing spine centers in the United States. METHODS: In this cross-sectional economic evaluation, we queried publicly available price transparency websites of 332 “high-performing” spine centers, as defined by the US News and World Report. We extracted variables including gross charges for cervical spinal fusion, payor options, price reporting methodology, and prices relevant to consumers including listed cash prices and minimum and maximum negotiated charges. RESULTS: While nearly all 332 high-performing spine surgery centers (99.4%) had an online cost estimation tool, the HPTFR compliance rate was only 8.4%. Gross charges for cervical spinal fusion were accessible for 68.1% of hospitals, discounted cash prices for 46.4% of hospitals, and minimum and maximum charges for 10.8% of hospitals. There were large IQRs for gross charges ($48 491.98-$99 293.37), discounted cash prices ($26 952.25-$66 806.63), minimum charges ($10 766.11-$21 248.36), and maximum charges ($39 280.49-$89 035.35). There was geographic variability in the gross charges of cervical spinal fusion among high-performing spine centers within and between states. There was a significant association between “excellent” discharge to home status and lower mean gross charges. CONCLUSION: Although online cost reporting has drastically increased since implementation of the HPTFR, data reported for cervical spinal fusion remain inadequate and difficult to interpret by both providers and patients.

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Short-term outcomes following posterior cervical fusion among octogenarians with cervical spondylotic myelopathy: a NSQIP database analysis

Cited by 10 publications

References 49 publications

Thirty-day morbidity and mortality following revision total shoulder arthroplasty in octogenarians

Thirty-day morbidity and mortality following revision total shoulder arthroplasty in octogenarians

Smoking Is an Independent Risk Factor for 90-Day Readmission and Reoperation Following Posterior Cervical Decompression and Fusion

Price Transparency for Cervical Spinal Fusion Among High-Performing Spine Centers in the United States

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