Sultan Aldebeyan

Predictors of Discharge Destination After Lumbar Spine Fusion Surgery

Study Design. Retrospective cohort study of the prospective collected American College of Surgeons National Surgical Quality Improvement Program database. Objective. The aim of the study was to identify predictive factors for the need of discharging patients to a facility other than home after lumbar spine fusion surgery. Summary of Background Data. Lumbar spine fusion surgery is a common surgical procedure used to treat a variety of lumbar spine conditions. A great number of patients fail to go home after surgery and require admission to a rehabilitation center. Predictive factors for discharging patients to a facility other than home after lumbar fusion surgery do not exist in the literature. Methods. A total of 15,092 patients undergoing lumbar spine fusion were dichotomized based on discharge destination to patients who were discharged home (Nu200a=u200a12,339) and others who were discharged to a facility other than home (Nu200a=u200a2753). Outcomes included patient demographics, comorbidities, and clinical characteristics. A multivariate logistic regression was used to identify whether outcomes studied were predictive factors for discharging patients to a facility other than home after lumbar fusion surgery. Results. Majority of patients were discharged home after lumbar fusion surgery (81.76%), with only some discharged to a facility other than home (18.24%). Multivariate analysis identified age, female sex, comorbidities (diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension, and obesity), minor and major complications, hospital length of stay, operative time at least 259 minutes, and multilevel surgery as significant predictive factors of discharging patients to a facility other than home after lumbar fusion surgery. Conclusion. The identified predictive factors can help the health system in developing an algorithm for early recognition of patients requiring postoperative admission to a facility other than home and possibly decreasing their hospital length of stay. This can significantly decrease the hospital costs for such patients. Level of Evidence: 3

Thirty-Day Complications of Conventional and Computer-Assisted Total Knee and Total Hip Arthroplasty: Analysis of 103,855 Patients in the American College of Surgeons National Surgical Quality Improvement Program Database.

BACKGROUNDnComputer-assisted surgery (CAS) has gained popularity in orthopedics for both total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the past decades.nnnMETHODSnThe American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent a primary, unilateral THA and TKA from 2011 to 2013. Multivariate analysis was conducted to compare the postoperative complications in patients whose surgery involved the use of CAS with those by conventional techniques.nnnRESULTSnWe identified 103,855 patients who had THA and TKA in the database between 2011 and 2013. There were higher overall adverse events (odds ratio [OR], 1.40; CI, 1.22-1.59), minor events (OR, 1.38; CI, 1.21-1.58), and requirements for blood transfusion (OR, 1.44; CI, 1.25-1.67) in the conventional group when compared with CAS for TKA. However, rate of reoperation was higher in the CAS group for TKA (OR, 1.60; CI, 1.15-2.25). The results also showed higher overall adverse events (OR, 2.61; CI, 2.09-3.26), minor events (OR, 2.82; CI, 2.24-3.42), and requirements for blood transfusion (OR, 3.41; CI, 2.62-4.44) in the conventional group when compared to CAS for THA. Nevertheless, superficial wound infections (OR, 0.46; CI, 0.26-0.81) were shown to be higher in the CAS group undergoing THA.nnnCONCLUSIONnThe use of CAS in THA and TKA reduced the number of minor adverse events in the first 30 days postoperatively. However, CAS was associated with an increased number of reoperations and superficial infections. The clinical benefits and disadvantages of CAS should be considered when determining the potential benefit-cost ratio of this technology.

Complete tear of the distal hamstring tendons in a professional football player: a case report and review of the literature

Semimembranosus tendon ruptures are rare and are often associated with involvement of the cruciate ligaments. We present a 24-year-old American football player who sustained a complete rupture of the semimembranosus tendon near its insertion associated with an avulsion fracture of the conjoint attachment of the lateral collateral ligament (LCL) and biceps femoris with intact cruciate ligaments and menisci during practice. At the scene he was immobilized and was taken to the hospital immediately. The diagnosis was reached after radiographs and an MRI of the affected knee were obtained. The semimembranosus tendon and the avulsion of the biceps femoris insertion were repaired surgically. We also review the literature for previously reported cases of distal hamstring injuries.

Hamstring Injuries in Athletes: Diagnosis and Treatment

Hamstring injuries are one of the most common sports injuries as they can affect both recreational and elite athletes1-3. These injuries have gained considerable attention in the literature because of the length of time lost from sports and the burden both on athletes and indirectly on their teams. Although fairly common, these types of injuries are considered a difficult entity to treat. Controversy …

Impact of Living With Scoliosis: A utility Outcome Score Assessment.

Study Design. Survey. Objective. The aim of this study was to objectify the burden of adolescent idiopathic scoliosis (AIS) to better advocate for scoliosis care in the future. Summary of Background Data. AIS is a common spinal deformity that can affect individuals on many levels. Patients with big curves usually seek medical advice for surgical correction of their deformity. Methods. Participants completed an online questionnaire to help measure the health burden of AIS. Three utility outcome measures were then calculated. These included the visual analog scale, time trade off, and standard gamble. Student t test and linear regression were used for statistical analysis. Results. One hundred and ten participants were included in the analysis. The mean visual analog scale, time trade off, and standard gamble scores for AIS were 0.77u200a±u200a0.16, 0.90u200a±u200a0.11, and 0.91u200a±u200a0.13, respectively. Factors such as age, sex, income, and level of education were dependent predictors of utility scores for AIS. Conclusion. Our participants demonstrated a significant perceived burden of AIS. If faced with AIS, participants were willing to sacrifice 3.6 years of their lives and undergo a procedure with 9% mortality rate to gain perfect health. Such findings can guide future allocation of resources for better scoliosis care and management. Level of Evidence: 4

Hypoalbuminaemia—a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures

OBJECTIVEnOur aim was to determine the effect of hypoalbuminaemia as a marker of malnutrition on the 30-day postoperative complication rate and mortality in patients receiving surgical treatment for hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.nnnMETHODSnWe analyzed all patients admitted with hip fractures receiving surgical treatment from 2011 to 2013. Patients were dichotomized based on their albumin levels; hypoalbuminaemia (albumin <3.5g/dL), and nonhypoalbuminaemia (albumin >3.5g/dL). Patient demographics, postoperative complications, and length of stay were analysed. Logistic regression analysis was conducted to assess the ability of albumin level for predicting postoperative complications, length of stay, and mortality.nnnRESULTSnA total of 10,117 patients with hip fractures were identified with 5414 patients with normal albumin levels, and 4703 with low albumin. Multivariate analysis showed that when controlling for comorbidities; hypoalbuminaemia alone was a predictor of postoperative complications (death, unplanned intubation, being on a ventilatoru2009>48h, sepsis, and blood transfusion), and increased length of stay (6.90±7.23 versus 8.44±8.70, CI 0.64-1.20, P<0.001).nnnCONCLUSIONnHypoalbuminaemia alone can predict postoperative outcomes in patients with hip fractures. Furthermore, patients with hypoalbuminaemia had a longer hospital length of stay. Further studies are needed to assess whether nutritional support can improve postoperative complications in patients with hypoalbuminaemia.

Use of Computer Assistance in Lumbar Fusion Surgery: Analysis of 15 222 Patients in the ACS-NSQIP Database:

Study Design: Retrospective cohort study. Objective: Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of computer-assisted surgery (CAS). Yet few studies have compared the incidence of postoperative complications between CAS and conventional techniques. The objective of this study is to determine the difference in postoperative complication rates between CAS and conventional techniques in spine surgery. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in postoperative complication rates between CAS and conventional techniques in spine surgery. Results: Out of 15u2009222 patients, 14u2009382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had fewer odds to experience adverse events postoperatively (odds ratio [OR] = 0.57, P < .001). Minor adverse events occurred in 2905 (20.2%) patients in the conventional group and in 98 (13.2%) patients in the CAS group (OR = 0.57, P < .001). Blood transfusion was present in 2488 (17.3%) of the patients in the conventional group compared to 81 (11.0%) of the patients in the CAS group (OR = 0.56, P < .001). The mean operative time in the conventional group was 205.2 ± 106.1 minutes, and it was 227.0 ± 111.9 minutes in the CAS group. This difference was statistically significant (r = 20.14, P < .001). Conclusion: This article examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar fusion surgeries.

Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting technique

Posterior shoulder dislocations are rare and are often associated with seizures, electrocution, and high-energy trauma. They can be missed and, therefore, left untreated. Early diagnosis and treatment can help avoid future complications and surgical intervention.

Differences between Manufacturers of CT-based Computer Assisted Surgery Systems Do Exist: A Systematic Literature Review

Summary of Background Data Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CT-based navigation systems. Yet, there has been no systematic review directly comparing accuracy of pedicle screw placement between different CT-based navigation systems. The aim of this study was to review the results presented in the literature and compare CT-based navigation systems relative to screw placement accuracy. Methods A systematic review of the literature was preformed using CENTRAL, Medline, PubMed and Embase databases. Studies included were randomized clinical trials, case series, and case control reporting the accuracy of pedicle screws placement using CT-based navigation. Two independent reviewers extracted the data from the selected studies that met our inclusion criteria. Papers were grouped based on the CT-based navigation system used for pedicle screws placement. Results 33 Papers met all of our inclusion criteria and were included in the final analysis, which showed a significant statistical difference (Pu2009<u20090.0001) in accuracy of pedicle screws placement between three different CT-based navigation systems. The mean (weighted) accuracy of pedicle screws placement based on the CT-based navigation system was found to be 96.8%u2009±u20093.8% in StealthStation, 96.07%u2009±u20093.8% in VectorVision and 97.7%u2009±u20091.7% in SurgiGate. Post hoc analysis showed a significant statistical difference between StealthStation vs VictorVision (pu2009<u20090.0001) and StealthStation vs SurgiGate (pu2009<u20090.0001) as well. Conclusion This paper summarizes results presented in the literature and compares screw placement accuracy using different CT-based navigation systems. The differences in accuracy demonstrated in this review should be considered by spine surgeons, and need to be validated for effects on patients outcome. Level of Evidence Level I.

Complications with and without the Use of Computer-Assistance in Lumbar Fusion Surgery: Analysis of 15,222 Patients in ACS-NSQIP Database

Introduction The objective of this paper is to demonstrate the difference in post-operative complication rates between Computer-assisted surgery (CAS) and conventional techniques in spine surgery. Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CAS. Yet, few studies have compared the incidence of post-operative complications between CAS and conventional techniques. Material and Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between CAS and conventional techniques in spine surgery. Results Out of 15,222 patients, 14,382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had less odds to experience adverse events post-operatively (OR 0.57, pu2009<u20090.001). Minor adverse events occurred in 2905 (20.2%) patients in the conventional group and 98 (13.2%) patients in CAS group (OR=0.57, pu2009<u20090.001). Blood transfusion was present in 2488 (17.3%) of the patients in the conventional group compared with 98 of the patients in CAS group (10.95%)(OR=0.56, pu2009<u20090.001). The mean operative time in the conventional group was 205.2u2009±u2009106.1 minutes, and 227.0u2009±u2009111.9 minutes in the CAS group. This difference was statistically significant (r=20.14, pu2009<u20090.001). Conclusion This paper examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar fusion surgeries.