Charles Wang

Complications, Readmissions, and Reoperations in Posterior Cervical Fusion.

Study Design. Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2012. Objective. Minimizing the morbidity of posterior cervical fusion can be improved with identification of patient risk factors. Summary of Background Data. Posterior cervical fusion is an effective technique for treating a variety of pathology. Stability and neurological improvement have been well documented. The increasing frequency of these procedures necessitates further investigation into the factors that may negatively impact perioperative care. Methods. The American College of Surgeons National Surgical Quality Improvement Program was queried for all patients undergoing posterior cervical fusion in 2011 and 2012. Preoperative and intraoperative variables were investigated for correlation to complications, readmissions, prolonged intubation, reintubation, and reoperation. A frailty-based score was used to assess preoperative risk. Regression models for prediction were performed. Results. The study identified 5627 patients of posterior cervical fusion in 2011 and 2012. Of these, 2029 patients (36.1%) had any of our identified complications. Transfusion was the most common in 1482 (26.3%) patients. Excluding transfusion, the complication rate was 9.8%. Prolonged intubation greater than 48 hours occurred in 83 (1.5%) patients. Reintubation occurred in 72 (1.3%) patients. Readmission occurred in 398 (7.8%) patients. Reoperation was necessary in 273 (4.9%) patients with postoperative infection being the most common reason. The frailty-based score was shown to be predictive of any of the above events (P < 0.0001). The majority of patients (54.9%) in the group that had complications was found to have a frailty score of 1 or higher. Conclusion. The predictors for any event included female sex, increased surgical time, combined anterior-posterior procedures, preoperative inpatient status, diabetes, smoking, American Society of Anesthesiologists class 3 or higher, and increasing age. The frailty-based score is a viable option to predict morbidity in posterior cervical fusion. Level of Evidence: 3

The Influence of Body Mass Index on Achieving Age-Adjusted Alignment Goals in Adult Spinal Deformity Corrective Surgery with Full-Body Analysis at 1 Year

BACKGROUND The impact of obesity on global spinopelvic alignment is poorly understood. This study investigated the effect of body mass index on achieving alignment targets and compensation mechanisms after corrective surgery for adult spinal deformity (ASD). METHODS Retrospective review of a single-center database. Inclusion: patients ≥18 years with full-body stereographic images (baseline and 1 year) and who met ASD criteria (sagittal vertical axis [SVA] >5 cm, pelvic incidence minus lumbar lordosis [PI-LL] >10°, coronal curvature >20° or pelvic tilt >20°). Patients were stratified by age (<40, 40-65, and ≥65 years) and body mass index (<25, 25-30, and >30). Postoperative alignment was compared with age-adjusted ideal values. Prevalence of patients who matched ideals and unmatched (undercorrected/overcorrected) was assessed. Health-related quality of life (HRQL) scores, alignment, and compensatory mechanisms were compared across cohorts using analysis of variance and temporally with paired t tests. RESULTS A total of 116 patients were included (average age, 62 years; 66% female). After corrective surgery, obese and overweight patients had more residual malalignment (worse PI-LL, T1 pelvic angle, pelvic tilt, and SVA) compared with normal patients (P < 0.05). In addition, obese and overweight patients recruited more pelvic shift (obese, 62.36; overweight, 49.80; normal, 31.50) and had a higher global sagittal angle (obese, 6.51; overweight, 6.35; normal, 3.40) (P < 0.05). Obese and overweight patients showed lower overcorrection rates and higher undercorrection rates (P < 0.05). Obese patients showed worse postoperative HRQL scores (Scoliosis Research Society 22 Questionnaire, Oswestry Disability Index, visual analog scale-leg) than did overweight and normal patients (P < 0.05). Obese and overweight patients who matched age-adjusted alignment targets for SVA or PI-LL showed no HRQL improvements (P > 0.05). CONCLUSIONS After surgery, obese patients were undercorrected, showed more residual malalignment, recruited more pelvic shift, and had a greater global sagittal angle and worse HRQL scores. The benefits from age-adjusted alignment targets seem to be less substantial for obese and overweight patients.

Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010

OBJECTIVE This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications. MATERIALS AND METHODS Retrospective review of the Nationwide Inpatient Sample 2001-2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9years] vs. adolescent [10-18year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality. RESULTS 6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p<0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p<0.001), cardiac (OR 0.27, p<0.001), respiratory (OR 0.26, p<0.001), digestive system (OR 0.32, p<0.001), puncture nerve/vessel (OR 0.56, p=0.009), wound (OR 0.25, p<0.001), infection (OR 0.29, p<0.001), posthemorrhagic anemia (OR 0.04, p=0.002), ARDS (OR 0.13, p<0.001), and venous thrombotic (OR 0.53, p=0.043) complications. Detethering increased nervous system (OR 1.34, p=0.049) and urinary (OR 2.60, p<0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p<0.001), LOS (5.77 vs. 4.13days, p<0.001), and charges (

Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Etiology, Concurrent Injuries and Complications Among 488,262 Patients from 2005-2013

54,592.28 vs.

Operative Distal Humerus Fractures in Older Patients: Predictors for Early Complications Based on a National Database

33,043.83, p<0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p<0.001) than pediatric. CONCLUSIONS With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.