Thirty-Day Perioperative Outcomes in Spinal Fusion by Specialty Within the NSQIP Database

McCutcheon, Brandon A.; Ciacci, Joseph D.; Marcus, Logan P.; Noorbakhsh, Abraham; Gonda, David; McCafferty, Randall; Taylor, William R.; Chen, Clark C.; Carter, Bob S.; Chang, David C.

doi:10.1097/brs.0000000000000599

Cited by 68 publications

(72 citation statements)

References 11 publications

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“…Moreover, this rate is clearly lower than what has previously been reported for fusion procedures [20,26]. Interestingly, the rate of unintentional durotomies was very low and there were no major complications such as nerve injury, DVT, PE, and deep-wound infections [9,16,24,27].…”

Section: Discussionmentioning

confidence: 67%

Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study

et al. 2015

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Section: Discussionmentioning

confidence: 67%

Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study

et al. 2015

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“…56 This data source has been previously used to evaluate patients undergoing neurosurgical intervention, 7,9,11,13,24,28,33,[47][48][49]52,53 including craniotomy for tumor. [1][2][3]10,14,29,54 The NSQIP database has been exempted as not human subject research by our institutional review board.…”

Section: Data Sourcementioning

confidence: 99%

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Dasenbrock

Liu

Devine

et al. 2015

FOC

146

103

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OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p < 0.001); African American (OR 1.75, 95% CI 1.44%-2.14%, p < 0.001) and Hispanic (OR 1.68, 95% CI 1.36%-2.08%) race or ethnicity; ASA class 3 (OR 1.52, 95% CI 1.34%-1.73%) or 4-5 (OR 2.18, 95% CI 1.82%-2.62%) designation; partially (OR 1.94, 95% CI 1.61%-2.35%) or totally dependent (OR 3.30, 95% CI 1.95%-5.55%) functional status; insulin-dependent diabetes mellitus (OR 1.46, 95% CI 1.16%-1.84%); hematological comorbidities (OR 1.68, 95% CI 1.25%-2.24%); and preoperative hypoalbuminemia (OR 1.78, 95% CI 1.51%-2.09%, all p ≤ 0.009). Several postoperative complications were additional independent predictors of prolonged hospitalization including pulmonary emboli (OR 13.75, 95% CI 4.73%-39.99%), pneumonia (OR 5.40, 95% CI 2.89%-10.07%), and urinary tract infections (OR 11.87, 95% CI 7.09%-19.87%, all p < 0.001). The C-statistic of the model based on preoperative characteristics was 0.79, which increased to 0.83 after the addition of postoperative complications. A length of stay after craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p < 0.001). Extended hospital stay was not associated with differential odds of an unplanned hospital readmission (OR 0.97, 95% CI 0.89%-1.06%, p = 0.55). CONCLUSIONS In this NSQIP analysis that evaluated patients who underwent craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated with differential rates of unplanned readmission.

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“…The accuracy of data collection by the NSQIP (including cumulative incidence and reasons for readmission) has been externally validated, 84 and this data source has been previously used to evaluate patients undergoing neurosurgical intervention, 4,8,12,14,15,28,29,45,54,83 including spine surgery. 2,6,9,10,25,40,53,59,61,82,91 Our institutional review board has exempted the de-identified NSQIP data set from individual review.…”

Section: Data Sourcementioning

confidence: 99%

“…3,7,9,49,59,60,61,71,77,90,91 Despite its utility in evaluating perioperative complications and adverse outcomes, few studies have used the NSQIP to analyze the outcomes of patients undergoing surgery for spinal tumors. The goal of this study was to evaluate the 30-day cumulative incidence, time to event, and predictors of major complications, unplanned reoperations, and readmissions after surgery for primary and secondary spinal tumors.…”

mentioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

100

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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Thirty-Day Perioperative Outcomes in Spinal Fusion by Specialty Within the NSQIP Database

Abstract: 3.

Cited by 68 publications

References 11 publications

Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study

Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

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