Amanda Sergesketter

Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

Unplanned 30‐day readmission rates contribute significantly to growing national healthcare expenditures. Drivers of unplanned 30‐day readmission after spinal cord stimulator (SCS) implantation are relatively unknown. The aim of this study was to determine drivers of 30‐day unplanned readmission following SCS implantation.

Impact of surgical approach on complication rates after elective spinal fusion (≥3 levels) for adult spine deformity

BACKGROUND While there are variations in techniques and surgical approaches to spinal fusion, there is not a defined consensus on a recommended surgical approach. The aim of this study is to determine if there was a difference in intra- and post-operative complication rates between different surgical approaches after elective spinal fusion (≥3 levels) for adult spine deformity. METHODS The medical records of 443 adult spine deformity patients undergoing elective spinal fusion (≥3) at a major academic institution from 2005 to 2015 were reviewed. We identified 96 (21.7%) anterior only, 225 (50.8%) posterior only, and 122 (27.5%) combined anterior/posterior approaches taken for spinal fusion (anterior: n=96; posterior: n=225). Patient demographics, comorbidities, anatomical location, and complication rates were collected for each patient. The primary outcome investigated in this study was the rate of intra- and post-operative complications. RESULTS Patient demographics and comorbidities were similar between all groups. The posterior approach had significantly higher EBL (P<0.0001) and number of PRBC blood transfusions (P<0.002), while the combined approach had a higher operative time (P<0.0001). The posterior approach had a significantly higher rate of intraoperative durotomies than anterior and combined (anterior: 0% vs. posterior: 11.1% vs. combined: 4.1%, P<0.0001). There was no significant difference in the rate 30-day readmissions between the cohorts (anterior: 10.4% vs. posterior: 12.8% vs. combined: 13.1%, P=0.80). CONCLUSIONS Our study suggests that posterior approaches to spinal fusion may lead to a higher incidence of complications compared to anterior or combined anterior/posterior approaches.

Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis

OBJECTIVE Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short- and long-term outcomes. The aim of this study was to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources. METHODS A unique comanagement model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program (POSH) was launched with the aim of improving outcomes in elderly patients (>65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, comanages daily throughout hospital course, and coordinates multidisciplinary rehabilitation, along with the neurosurgical team. We retrospectively reviewed the first 100 cases after the initiation of the POSH protocol and compared them with the immediately preceding 25 cases to assess the rates of ICU transfer and independent predictors of ICU admission. RESULTS A total of 125 patients undergoing lumbar decompression and fusion surgery were enrolled in this pilot program. Baseline characteristics and intraoperative variables, as well as number of fusion levels and duration of surgery, were similar between both cohorts. There was a significant difference in the use of ICU services (ICU admission rates) between both cohorts, with the non-POSH cohort having a 3-fold increase compared with the POSH cohort (P < 0.0001). In a multivariate analysis, lack of an interdisciplinary comanagement team approach was an independent predictor for ICU transfers in elderly patients undergoing corrective surgery (odds ratio 8.51, 95% confidence interval 2.972-24.37, P < 0.0001). CONCLUSIONS Our study suggests that an interdisciplinary comanagement model between geriatrics and neurosurgery is independently associated with reduced use of critical care services.

Thirty-day complication and readmission rates associated with resection of metastatic spinal tumors: a single institutional experience

Background This study aims to assess 30-day complication and unplanned readmission rates associated with resection of metastatic spinal tumors. Methods Medical records were reviewed for 135 adults who underwent elective resection of a spinal cord tumor. Patient demographics, comorbidities, and tumor characteristics were collected. Tumor pathology was analyzed and diagnosed by a pathologist. The primary outcomes were intra- and 30-day post-operative complication and readmission rates. Results Of the 135 spinal tumor resections, 30 (22.2%) cases were metastatic. The most common tumor pathology was bone (13.3%) and the most common locations were thoracic (45.2%), and cervical (32.7%). Most patients had an open surgery (96.7%), with a mean laminectomy/laminoplasty level of 1.9±1.5 and mean operative time of 328.4±658.0 min. There was a 3.3% incidence rate of intraoperative durotomies, with no spinal cord or nerve root injuries. Post-operatively, 44.8% of patients were transferred to the intensive care unit (ICU). The most common post-operative complications were weakness (20.0%), new sensory deficits (16.7%), and hypotension (13.3%). The mean length of stay was 8.8±7.6 days, with the majority of patients discharged home (96.7%). The 30-day readmission rate was 9.7%, with the most common 30-day complications being uncontrolled pain (16.7%), sensory-motor deficits (13.3%), and fever (10.0%). Conclusions Our study suggests that weakness, sensory deficits, and uncontrolled pain are the most common complications after resection of spinal metastases, with a relatively high associated 30-day readmission rate. Further studies are necessary to corroborate our findings and identify strategies to reduce complication and readmission rates after resection of spinal metastases.

Post-operative drain use in patients undergoing decompression and fusion: incidence of complications and symptomatic hematoma

Background Surgical drains are commonly used after spine surgery to minimize infection and hematoma formation. The aim of this study was to determine the incidence of post-operative complications after spinal decompression and fusion with and without a subfascial drain. Methods The medical records of 139 adult (≥18 years old) spinal deformity patients undergoing elective spinal decompression and fusion at a major academic institution were reviewed. We identified 116 (83.5%) who had a post-operative drain and 23 (16.5%) who did not have a postoperative drain (No-Drain: n=23; Drain-Use: n=116). Patient demographics, comorbidities, intra- and post-operative complication rates were collected for each patient. The primary outcome investigated in this study was the rate of post-operative complications, specifically surgical site infections (SSI) and hematoma formation. Results Patient demographics and comorbidities were similar between both cohorts, with the body mass index (BMI) slightly higher in the Drain-Use cohort (No-Drain: 26.1 kg/m2vs. Drain-Use: 29.1 kg/m2, P=0.02). Operative time and the median number of levels fused were similar between the cohorts. The postoperative complications profile was similar between both cohorts, including deep and superficial SSIs (P=0.52 and P=0.66, respectively), and incidence of hematoma formation (P=0.66). Length of hospital stay (LOS) was significantly higher for the Drain-use cohort compared to the No-Drain cohort (5.0 vs. 2.8 days, P<0.0001). There were no significant differences in the 30-day hospital readmission rate or incidence of 30-day wound dehiscence, draining wound, incision & drainage (I & D), or bleeding between both patient groups. Conclusions Our study suggests that the use of postoperative subfascial drains in patients undergoing spinal decompression with fusion may not be associated with a reduction in SSIs or hematoma formation.

Review of Neurosurgery Medical Professional Liability Claims in the United States

BACKGROUND Due to disparaging costs and rates of malpractice claims in neurosurgery, there has been significant interest in identifying high-risk specialties, types of malpractice claims, and characteristics of claim-prone physicians. OBJECTIVE To characterize the malpractice claims against neurosurgeons. METHODS This was a comprehensive analysis of all malpractice liability claims involving a neurosurgeon as the primary defendant, conducted using the Physician Insurers Association of America Data Sharing Project from January 1, 2003 and December 31, 2012. RESULTS From 2003 to 2012, 2131 closed malpractice claims were filed against a neurosurgeon. The total amount of indemnity paid collective between 1998 to 2002, 2003 to 2007, and 2008 to 2012 was

Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation

109 614 935,

Prevalence and Cost Analysis of Chronic Pain After Hernia Repair: A Potential Alternative Approach With Neurostimulation: PAIN AFTER HERNIA REPAIR: A POTENTIAL WITH NEUROSTIMULATION

140 031 875, and

Check the Record: Remote CT Scans for Breast Flap Perforator Mapping

122 577 230, respectively. Of all the neurosurgery claims, the most prevalent chief medical factor was improper performance (42.1%,

Correlation of 2-year SRS-22r and ODI patient-reported outcomes with 5-year patient-reported outcomes after complex spinal fusion: a 5-year single-institution study of 118 patients

124 943 933), presenting medical condition was intervertebral disc disorder (20.6%,