Maxwell Boakye

Risk Factors for Postoperative Spinal Wound Infections After Spinal Decompression and Fusion Surgeries

Study Design. This is a multivariate analysis of a prospectively collected database. Objective. To determine preoperative, intraoperative, and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing spinal surgery. Summary of Background Data. Current literature sites a postoperative infection rate of approximately 4%; however, few have completed multivariate analysis to determine factors which contribute to risk of infection. Methods. Our study identified patients who underwent a spinal decompression and fusion between 1997 and 2006 from the Veterans Affairs’ National Surgical Quality Improvement Program database. Multivariate logistic regression analysis was used to determine the effect of various preoperative variables on postoperative infection. Results. Data on 24,774 patients were analyzed. Wound infection was present in 752 (3.04%) patients, 287 (1.16%) deep, and 468 (1.89%) superficial. Postoperative infection was associated with longer hospital stay (7.12 vs. 4.20 days), higher 30-day mortality (1.06% vs. 0.5%), higher complication rates (1.24% vs. 0.05%), and higher return to the operating room rates (37% vs. 2.45%). Multivariate logistic regression identified insulin dependent diabetes (odds ratios [OR] = 1.50), current smoking (OR = 1.19) ASA class of 3 (OR = 1.45) or 4 to 5 (OR = 1.66), weight loss (OR = 2.14), dependent functional status (1.36) preoperative HCT <36 (1.37), disseminated cancer (1.83), fusion (OR = 1.24) and an operative duration of 3 to 6 hours (OR = 1.33) or >6 hours (OR = 1.40) as statistically significant predictors of postoperative infection. Conclusion. Using multivariate analysis of a large prospectively collected data from the National Surgical Quality Improvement Program database, we identified the most important risk factors for increased postoperative spinal wound infection. We have demonstrated the high mortality, morbidity, and hospitalization costs associated with postoperative spinal wound infections. The information provided should help alert clinicians to presence of these risks factors and the likelihood of higher postoperative infections and morbidity in spinal surgery patients.

National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis.

Study Design. Database study using Nationwide Inpatient Sample (NIS) administrative data from 1993 to 2002. Objective. To determine rates of in-hospital complications and complex disposition for patients undergoing posterior lumbar fusion for degenerative spondylolisthesis, and the association of demographic factors. Summary of Background Data. Spondylolisthesis affects primarily elderly populations. Recent data suggests a benefit of surgical treatment for acquired lumbar spondylolisthesis. However, the risks of these procedures, and the impact of patient demographics on risk, have not been nationally quantified. Methods. Data from 66,601 patients in the NIS (1993–2002) with diagnostic and procedure codes specifying posterior lumbar fusion for acquired spondylolisthesis were included. Patients were grouped by age, sex, race, number of comorbidities, hospital size, and time period of procedure. Multivariate analysis correlated patient and hospital characteristics with complex disposition and complications. Results. Mortality rate was 0.15%. Eleven percent of patients had one or more in-hospital complications; overall complication rate was 13 per 100 operations. Hematoma/seroma (5.4 per 100) was the most common complication, followed by pulmonary (2.6), renal (1.8), and cardiac (1.2) complications. Infection and neurologic injury occurred in <1% of patients. Older patients and those with a number of comorbidities had greater rates of in-hospital complication and complex disposition. Compared to those aged 45 to 64, patients aged 65 to 84 were almost 70% more likely to have complications (OR: 1.67) and 5 times as likely to have complex disposition (OR: 5.84). Having 3 or greater comorbidities, compared to no comorbidities, was also associated with increased risk of complication (OR: 1.6) and complex disposition (OR: 2.3). Conclusion. Posterior lumbar fusion for acquired lumbar spondylolisthesis is safe. However, age and comorbidity independently increase in-hospital complications and complex disposition. These data may improve national estimates of surgical risk, patient selection, informed consent, and cost-efficacy analysis for posterior lumbar fusion operations for acquired spondylolisthesis.

Cervical spondylotic myelopathy: complications and outcomes after spinal fusion.

OBJECTIVE There is little information about in-hospital complication rates, adverse outcomes, and mortality after spinal fusion for cervical spondylotic myelopathy (CSM). The aim of this study was to report inpatient mortality, complications, and outcomes on a national level. METHODS We used the National Inpatient Sample to identify 58,115 admissions of patients with CSM who underwent spinal fusion in the United States from 1993 to 2002. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on outcomes such as mortality, complications, discharge disposition, and length of stay. RESULTS A total of 58,115 patients with CSM underwent spinal fusion with an average mortality rate of 0.6%, a complication rate of 13.4%, and a mean length of stay of 4 days. Pulmonary (3.6%) and postoperative hemorrhages or hematomas (2.3%) were the most common complications reported. One postoperative complication led to a 4-day increase in mean length of stay, increased the mortality rate 20-fold, and added more than

Morbid Obesity Increases Cost and Complication Rates in Spinal Arthrodesis

10,000 to hospital charges. Multivariate analysis identified age, comorbidity, and admission type as the main predictors of mortality, complication rate, and adverse outcome. Patients aged > or =85 or 65 to 84 years had respective 44- and 14-fold increases in mortality, compared with patients in the 18- to 44-year age group. Patients older than 84 years had a 40-fold increase in adverse outcomes and a 5-fold likelihood of medical complications. Patients with three or more comorbidities had an increased risk of medical complications (odds ratio [OR], 1.98), adverse discharge (OR, 2.17), and in-hospital mortality (OR, 2.36). Elective admissions were associated with much lower rates of mortality (OR, 0.28), complication (OR, 0.68), and adverse outcome (OR, 0.26). Complications were greater for posterior fusion (16.4%) versus anterior fusion (11.9%) procedures. Anterior fusions were associated with a greater incidence of dysphagia (3%) and hoarseness (0.21%). Cervical spondylosis patients who presented without myelopathy had a much lower incidence of complications (6.3%). CONCLUSIONS We provide a national estimate of inpatient complications and outcomes after spinal fusion for CSM patients in the United States. We demonstrate the impacts of age, complications, and medical comorbidities on the outcome of surgery for patients with this common disorder. We provide complication rates stratified by age and medical comorbidities for elderly patients who present with CSM who need spinal fusion.

Visual Loss After Spine Surgery : A Population-Based Study

Study Design. A retrospective cross-sectional study of all spinal fusions in California from 2003 to 2007. Objective. This study analyzes whether morbid obesity alters rates of complications and charges in patients undergoing spinal fusion. Summary of Background Data. Prior studies of obesity have focused on lumbar fusion; some identified increases in wound complications. However, these studies typically do not account for comorbidities, do not examine nonlumbar fusions, and usually are small single institution series. Methods. Our study used the Healthcare Cost and Utilization Projects California State Inpatient Databases (CA-SID) to identify normal weight and morbidly obese patients admitted in California between 2003 and 2007 for 4 types of spinal fusion: anterior cervical fusion (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] procedure code 810.2), posterior cervical fusion (810.3), anterior lumbar fusion (810.6), and posterior lumbar fusion (810.8). Demographic, comorbidity, and complications data were collected. Primary outcome was in-hospital complication; secondary outcomes were total cost, length of stay, and in-hospital mortality. Multivariate logistic regression was performed. Results. In total 84,607 admissions were identified, of which 1455 were morbidly obese. Morbid obesity was associated with 97% higher in-hospital complication rates (13.6% vs. 6.9%), sustained across nearly all complication types (cardiac, renal, pulmonary, wound complications, among others). Mortality among the morbidly obese was slightly higher (0.41 vs. 0.13, P < 0.01) as were average hospital costs (

Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients.

108,604 vs.

National inpatient complications and outcomes after surgery for spinal metastasis from 1993–2002

84,861, P < 0.0001). Length of stay was longer as well (4.8 d vs. 3.5 d, P < 0.0001). All effects were less pronounced in posterior cervical fusions. On multivariate analysis, morbid obesity was the most significant predictor of complications in the anterior cervical and posterior lumbar fusion groups (more than age, demography, and other comorbidity). Conclusion. Morbid obesity seems to increase the risk of multiple complication types in spinal fusion surgery, most particularly in anterior cervical and posterior lumbar approaches.

A prospective, multicenter, phase I matched-comparison group trial of safety, pharmacokinetics, and preliminary efficacy of riluzole in patients with traumatic spinal cord injury.

Study Design. Retrospective cohort study using National inpatient sample administrative data. Objective. To determine national estimates of visual impairment and ischemic optic neuropathy after spine surgery. Summary of Background Data. Loss of vision after spine surgery is rare but has devastating complications that has gained increasing recognition in the recent literature. National population-based studies of visual complications after spine surgery are lacking. Methods. All patients from 1993 to 2002 who underwent spine surgery (Clinical Classifications software procedure code: 3, 158) and who had ischemic optic neuropathy (ION) (ICD9-CM code 377.41), central retinal artery occlusion (CRAO) (ICD9-CM code 362.31) or non-ION, non-CRAO perioperative visual impairment (ICD9-CM codes: 369, 368.4, 368.8–9368.11–13) were included. Univariate and multivariate analysis were performed to identify potential risk factors. Results. The overall incidence of visual disturbance after spine surgery was 0.094%. Spine surgery for scoliosis correction and posterior lumbar fusion had the highest rates of postoperative visual loss of 0.28% and 0.14% respectively. Pediatric patients (<18 years) were 5.8 times and elderly patients (>84 years) were 3.2 times more likely than, patients 18 to 44 years of age to develop non-ION, non-CRAO visual loss after spine surgery. Patients with peripheral vascular disease (OR = 2.0), hypertension (OR = 1.3), and those who received blood transfusion (OR = 2.2) were more likely to develop non-ION, non-CRAO vision loss after spine surgery. Ischemic optic neuropathy was present in 0.006% of patients. Hypotension (OR = 10.1), peripheral vascular disease (OR = 6.3) and anemia (OR = 5.9) were the strongest risk factors identified for the development of ION. Conclusion. We used multivariate analysis to identify significant risk factors for visual loss after spine surgery. National population-based estimate of visual impairment after spine surgery confirms that ophthalmic complications after spine surgery are rare. Since visual loss may be reversible in the early stages, awareness, evaluation and prompt management of this rare but potentially devastating complication is critical.

Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program

Study Design. This is a retrospective cohort study using the National Inpatient Sample database. Objective. The objective is to report mortality and complications after lumbar laminectomy in the elderly. Summary of Background Data.— As the population continues to age in the United States, it is important to consider the surgical complications and outcomes in the elderly. A review of the literature reveals controversy over the safety of lumbar laminectomy in the elderly and disagreement over estimates of risks in this population. Methods. Outcome measures were abstracted from the National Inpatient Sample. Multivariate analysis was performed to analyze the effect of patient and hospital characteristics on outcome measures. Results. A total of 471,215 patients underwent lumbar laminectomy without fusion for lumbar stenosis from 1993 to 2002. The in-hospital mortality rate was 0.17%, and the complication rate was 12.17%. Postoperative hemorrhage or hematoma (5.2%) and nonspecific renal complications (2.8%) were the most common complications. Complication and mortality rates increased with age and comorbidities with an 18.9% complication rate and 1.4% mortality rate in patients over the age of 85 with 3 or more comorbidities, 14.7% complication rate and 0.22% mortality rate in patients over 85 with no comorbidities, and only a 6% complication rate and 0.05% mortality rate in patient between 18 and 44 with no comorbidities. Multivariate analysis revealed increased odds of mortality with increasing number of comorbidities and complications in the greater than 85 year age group. Increasing age, number of comorbidities, complication rate, and female sex also increased the odds of discharge to institution other than home. Conclusion. Elderly patients with comorbidities are at a higher risk for complications and adverse outcome after lumbar spine surgery. The effects of age and comorbidities on patient outcomes have been quantified. This information is critical in counseling elderly patients about the risk of surgery in their age group.

National trends in spinal fusion for cervical spondylotic myelopathy

Information regarding patient outcomes, complications, and mortality after surgery for spinal metastasis has previously been derived from single‐institution series. The aim of this study was to report inpatient mortality, complications, and outcomes on a national level.