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  1. Article ; Online: Costs of revision operations for distal junctional kyphosis following thoracic posterior spinal fusion for adolescent idiopathic scoliosis.

    Theologis, Alekos A / Wu, Hao-Hua / Oeding, Jacob F / Diab, Mohammad

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

    2024  

    Abstract: Purpose: To assess direct costs and risks associated with revision operations for distal junctional kyphosis/failure (DJK) following thoracic posterior spinal instrumented fusions (TPSF) for adolescent idiopathic scoliosis (AIS).: Methods: Children ... ...

    Abstract Purpose: To assess direct costs and risks associated with revision operations for distal junctional kyphosis/failure (DJK) following thoracic posterior spinal instrumented fusions (TPSF) for adolescent idiopathic scoliosis (AIS).
    Methods: Children who underwent TPSF for AIS by a single surgeon (2014-2020) were reviewed. Inclusion criteria were minimum follow-up of 2 years, thoracolumbar posterior instrumented fusion with a lower instrumented vertebra (LIV) cranial to L2. Patients who developed DJK requiring revision operations were identified and compared with those who did not develop DJK.
    Results: Seventy-nine children were included for analysis. Of these, 6.3% developed DJK. Average time to revision was 20.8 ± 16.2 months. Comparing index operations, children who developed DJK had significantly greater BMIs, significantly lower thoracic kyphosis postoperatively, greater post-operative lumbar Cobb angles, and significantly more LIVs cranial to the sagittal stable vertebrae (SSV), despite having statistically similar pre-operative coronal and sagittal alignment parameters and operative details compared with non-DJK patients. Revision operations for DJK, when compared with index operations, involved significantly fewer levels, longer operative times, greater blood loss, and longer hospital lengths of stay. These factors resulted in significantly greater direct costs for revision operations for DJK ($76,883 v. $46,595; p < 0.01).
    Conclusions: In this single-center experience, risk factors for development of DJK were greater BMI, lower post-operative thoracic kyphosis, and LIV cranial to SSV. As revision operations for DJK were significantly more costly than index operations, all efforts should be aimed at strategies to prevent DJK in the AIS population.
    Language English
    Publishing date 2024-02-20
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1115375-1
    ISSN 1432-0932 ; 0940-6719
    ISSN (online) 1432-0932
    ISSN 0940-6719
    DOI 10.1007/s00586-024-08160-6
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  2. Article ; Online: Correction: Costs of revision operations for distal junctional kyphosis following thoracic posterior spinal fusion for adolescent idiopathic scoliosis.

    Theologis, Alekos A / Wu, Hao-Hua / Oeding, Jacob F / Diab, Mohammad

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

    2024  

    Language English
    Publishing date 2024-04-10
    Publishing country Germany
    Document type Published Erratum
    ZDB-ID 1115375-1
    ISSN 1432-0932 ; 0940-6719
    ISSN (online) 1432-0932
    ISSN 0940-6719
    DOI 10.1007/s00586-024-08207-8
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    Zs.A 3437: Show issues Location:
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  3. Article ; Online: Thoracic posterior spinal instrumented fusion vs. thoracic anterior spinal tethering for adolescent idiopathic scoliosis with a minimum of 2-year follow-up: a cost comparison of index and revision operations.

    Theologis, Alekos A / Wu, Hao-Hua / Diab, Mohammad

    Spine deformity

    2022  Volume 11, Issue 2, Page(s) 359–366

    Abstract: Purpose: To compare direct costs of index and revision operations of thoracic posterior spinal instrumented fusion (TPSIF) and thoracic anterior spinal tethering (TAST) for adolescent idiopathic thoracic scoliosis in children.: Methods: Children ( ... ...

    Abstract Purpose: To compare direct costs of index and revision operations of thoracic posterior spinal instrumented fusion (TPSIF) and thoracic anterior spinal tethering (TAST) for adolescent idiopathic thoracic scoliosis in children.
    Methods: Children (ages 11-18 years) who underwent TPSIF and TAST (2/2013-9/2019) were reviewed. Follow-up < 2 years and cervical instrumentation and/or instrumentation of a lumbar level at L3 or below were exclusion criteria. Patient demographics, radiographic curve magnitude, index operations and postoperative data, as well as indications for revisions/readmissions were collected. Direct costs were identified and compared for index and revision operations during follow-up.
    Results: One hundred and four patients were included (TPSIF: 78; TAST: 25). TAST procedures were performed in children significantly younger and for smaller curve magnitudes. They had significantly fewer levels instrumented, shorter operating room (OR) times, and less estimated blood loss (EBL). After operation, a significantly higher percentage of TAST were admitted to ICU. Hospital length of stay (LOS) was similar between groups. Index operations' average direct costs were significantly higher for TAST than TPSIF ($52,947 v. $46,641; p = 0.02). Major cost drivers for both groups were implants, OR services, post-anesthesia care unit (PACU), and room/board. Revisions following TAST were more frequent than for TPSIF (36 v. 11.5%). Majority of TPSIF revisions were for junctional deformity. Curve progression and overcorrection were most common reason for TAST revisions. Average direct costs for revisions/readmissions were similar between groups (TPSIF: $28,485 v. TAST: $27,590; p = 0.46).
    Conclusions: Index operations' average direct costs were statistically similar between TPSIF and TAST for adolescent idiopathic scoliosis. Major cost drivers were implants, OR services, PACU, and room/board. TAST index operations' direct costs and associated direct costs for implants and room/board were significantly higher, while their anesthesia and OR services were significantly lower than TPSIF. TAST revisions were for overcorrection and curve progression, while TPSIF revisions were most commonly for junctional deformity. Overall average direct costs for revisions were similar despite revision rates being higher for TAST.
    Level of evidence: III.
    MeSH term(s) Child ; Humans ; Adolescent ; Scoliosis/surgery ; Treatment Outcome ; Retrospective Studies ; Kyphosis ; Spinal Fusion/methods ; Costs and Cost Analysis
    Language English
    Publishing date 2022-09-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2717704-X
    ISSN 2212-1358 ; 2212-134X ; 2212-1358
    ISSN (online) 2212-1358 ; 2212-134X
    ISSN 2212-1358
    DOI 10.1007/s43390-022-00586-6
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  4. Article ; Online: The Socioeconomic consequences of femoral shaft fracture for patients in Malawi.

    Mody, Kush S / Wu, Hao-Hua / Chokotho, Linda C / Mkandawire, Nyengo C / Young, Sven / Lau, Brian C / Shearer, David / Agarwal-Harding, Kiran J

    Malawi medical journal : the journal of Medical Association of Malawi

    2024  Volume 35, Issue 3, Page(s) 141–150

    Abstract: Background: Femoral shaft fractures are common in Malawi, with an annual incidence of 44 per 100,000 people. Inadequate treatment and delayed presentation often result in functional, biopsychosocial, and financial challenges for patients. The purpose of ...

    Abstract Background: Femoral shaft fractures are common in Malawi, with an annual incidence of 44 per 100,000 people. Inadequate treatment and delayed presentation often result in functional, biopsychosocial, and financial challenges for patients. The purpose of this study was to examine the socioeconomic consequences of femoral shaft fractures for patients in Malawi.
    Methods: This study of 42 patients was part of a larger study that prospectively examined quality of life. Questionnaires were distributed to patients at 1-year follow-up following femoral shaft fracture treatment. Patients reported pre- and post-injury standard of living and financial well-being.
    Results: Patients reported relatively high transportation costs to and from the hospital. One year after injury, 17 patients (40%) had not returned to work. Of the 25 (60%) who had returned, 5 (20%) changed jobs due to their injury, all reported decreased productivity. Household income decreased for 29% of patients. 20 (49%) of 41 patients reported food insecurity in the week prior to questionnaire completion. Many patients reported changing their residence, borrowing money, selling personal property, and unenrolling children from school due to financial hardship caused by their injury.
    Conclusion: While the Malawian public healthcare system is free at the point of care, it lacks the financial risk protection that is essential to universal health coverage (UHC). In this study, we found that the indirect costs of care due to femoral shaft fractures had substantial socioeconomic consequences on the majority of patients and their families. Increased investment of financial and human capital should be made into capacity building and preventative measures to decrease the burden of injury, increase access to care, improve care delivery, and provide financial risk protection for patients with traumatic injuries in Malawi.
    MeSH term(s) Child ; Humans ; Malawi/epidemiology ; Quality of Life ; Femoral Fractures/epidemiology ; Femoral Fractures/therapy ; Hospitals ; Socioeconomic Factors
    Language English
    Publishing date 2024-02-01
    Publishing country Malawi
    Document type Journal Article
    ISSN 1995-7270 ; 1995-7262
    ISSN (online) 1995-7270
    ISSN 1995-7262
    DOI 10.4314/mmj.v35i3.2
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    Extramed: Show issues

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  5. Article ; Online: The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes.

    Tedesco, Amanda / Sharma, Abhinav K / Acharya, Nischal / Rublev, George / Hashmi, Sohaib / Wu, Hao-Hua / Lee, Yu-Po / Scolaro, John / Bhatia, Nitin

    JBJS reviews

    2024  Volume 12, Issue 4

    Abstract: Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient ...

    Abstract » Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.» Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.» Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.» Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.
    MeSH term(s) Humans ; Nutritional Status ; Orthopedic Procedures/adverse effects ; Orthopedics ; Malnutrition ; Dietary Supplements
    Language English
    Publishing date 2024-04-12
    Publishing country United States
    Document type Review ; Journal Article
    ISSN 2329-9185
    ISSN (online) 2329-9185
    DOI e23.00242
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  6. Article ; Online: Cervical Spine Surgery Following COVID-19 Infection: When is it Safe to Proceed?

    Chan, Justin P / Hoang, Henry / Wu, Hao-Hua / Park, Don Y / Lee, Yu-Po / Bhatia, Nitin / Hashmi, Sohaib Z

    Clinical spine surgery

    2024  Volume 37, Issue 4, Page(s) 155–163

    Abstract: Study design: Retrospective.: Objective: We utilized the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile of patients undergoing spine surgery during multiple time windows following the COVID-19 infection.: ... ...

    Abstract Study design: Retrospective.
    Objective: We utilized the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile of patients undergoing spine surgery during multiple time windows following the COVID-19 infection.
    Summary of background data: While the impact of COVID-19 on various organ systems is well documented, there is limited knowledge regarding its effect on perioperative complications following spine surgery or the optimal timing of surgery after an infection.
    Methods: We asked the National COVID Cohort Collaborative for patients who underwent cervical spine surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0-2 weeks, 2-6 weeks, or 6-12 weeks before surgery.
    Results: A total of 29,449 patients who underwent anterior approach cervical spine surgery and 46,379 patients who underwent posterior approach cervical spine surgery were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events, sepsis, 30-day mortality, and 1-year mortality, irrespective of the anterior or posterior approach. Among patients undergoing surgery between 2 and 6 weeks after COVID-19 infection, the 30-day mortality risk remained elevated in patients undergoing a posterior approach only. Patients undergoing surgery between 6 and 12 weeks from the date of the COVID-19 infection did not show significantly elevated rates of any complications analyzed.
    Conclusions: Patients undergoing either anterior or posterior cervical spine surgery within 2 weeks from the initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events, sepsis, and mortality. Elevated perioperative complication risk does not persist beyond 2 weeks, except for 30-day mortality in posterior approach surgeries. On the basis of these results, it may be warranted to postpone nonurgent spine surgeries for at least 2 weeks following a COVID-19 infection and advise patients of the increased perioperative complication risk when urgent surgery is required.
    MeSH term(s) Humans ; COVID-19 ; Male ; Cervical Vertebrae/surgery ; Female ; Middle Aged ; Aged ; Retrospective Studies ; Postoperative Complications/etiology ; SARS-CoV-2 ; Adult ; Risk Factors
    Language English
    Publishing date 2024-04-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2849646-2
    ISSN 2380-0194 ; 2380-0186
    ISSN (online) 2380-0194
    ISSN 2380-0186
    DOI 10.1097/BSD.0000000000001609
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    Zs.A 2427: Show issues Location:
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  7. Article ; Online: Comparison of 90-day complications and two-year reoperation rates between anterior and posterior interbody fusion for single-level degenerative spondylolisthesis.

    Georgiou, Stephen / Saggi, Satvir / Wu, Hao-Hua / Metz, Lionel

    North American Spine Society journal

    2022  Volume 10, Page(s) 100127

    Abstract: Background: For the surgical treatment of single-level degenerative spondylolisthesis (DS), patients can be treated with either an anterior or posterior interbody fusion. Prior studies have shown that patients with symptomatic degenerative ... ...

    Abstract Background: For the surgical treatment of single-level degenerative spondylolisthesis (DS), patients can be treated with either an anterior or posterior interbody fusion. Prior studies have shown that patients with symptomatic degenerative spondylolisthesis treated surgically maintain substantially greater pain relief and improvement in function when compared to those treated non-operatively, but no consensus has emerged between which approach results in the best outcomes.
    Methods: The PearlDiver MARINER database was queried for patients with single-level DS who underwent either an anterior or posterior lumbar interbody fusion. Both populations were compared on multiple outcomes, including reoperation, post-operative complications, and readmission rates at 90 days, as well as rates of reoperation and cauda equina syndrome two-years postoperatively.
    Results: At 90 days patients who underwent anterior interbody were found to have higher rates of DVT (OR 2.53, 95% CI 1.74 - 3.70, p<0.001), ileus (OR 1.43, 95% CI 1.25 - 1.64, p<0.001), and readmission (OR 1.28, 95% CI 1.19 - 1.38, p<0.001). Patients who underwent posterior interbody fusion were found to have higher rates of revision procedures (OR 0.63, 95% CI 0.59 - 0.66, p<0.001), transfusion (OR 0.68, 95% CI 0.58 - 0.78, p<0.001), acute kidney injury (OR 0.84, 95% CI 0.75 - 0.95, p=0.0046), and cauda equina syndrome (OR 0.53, 95% CI 0.40 - 0.69, p<0.001). At 2 years, patients who underwent posterior fusion required revision procedures (OR 0.70, 95% CI 0.67 - 0.74, p<0.001) and developed cauda equina syndrome (OR 0.62, 95% CI 0.50 - 0.77, p<0.001) at a higher rate than those who underwent anterior fusion.
    Conclusions: Patients who underwent anterior interbody fusion for treatment of degenerative spondylolisthesis were found to have increased rates of DVT, ileus, and were more likely to be readmitted to the hospital within 90 days, while patients who underwent posterior interbody fusion were found to have higher rates of reoperation, transfusion, AKI, and cauda equina syndrome. Increased rates of reoperation and development of cauda equina in the posterior fusion group persisted at 2 years post-operatively.
    Language English
    Publishing date 2022-05-21
    Publishing country United States
    Document type Journal Article
    ISSN 2666-5484
    ISSN (online) 2666-5484
    DOI 10.1016/j.xnsj.2022.100127
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  8. Article: Erratum: Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents.

    Carrillo, Laura A / Wu, Hao Hua / Callahan, Matt / Chopra, Aman / Katyal, Toshali / Swarup, Ishaan

    World journal of orthopedics

    2023  Volume 14, Issue 6, Page(s) 502–504

    Abstract: This corrects the article on p. 1001 in vol. 12, PMID: 35036342.]. ...

    Abstract [This corrects the article on p. 1001 in vol. 12, PMID: 35036342.].
    Language English
    Publishing date 2023-06-18
    Publishing country United States
    Document type Published Erratum
    ZDB-ID 2649712-8
    ISSN 2218-5836
    ISSN 2218-5836
    DOI 10.5312/wjo.v14.i6.502
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  9. Article: Avoiding Pitfalls in Adult Spinal Deformity.

    Wu, Hao-Hua / Kelly, Michael / Neuman, Brian / Protopsaltis, Themistocles / Hershman, Stuart

    Instructional course lectures

    2023  Volume 73, Page(s) 641–649

    Abstract: To avoid the high rate of complications associated with the surgical management of adult spinal deformity, it is important to recognize and avoid three major pitfalls. The first is patient selection and determining which cases are appropriately indicated. ...

    Abstract To avoid the high rate of complications associated with the surgical management of adult spinal deformity, it is important to recognize and avoid three major pitfalls. The first is patient selection and determining which cases are appropriately indicated. The second is optimizing modifiable medical issues that can lead to a poor outcome, such as smoking, vitamin D deficiency, nutritional status, and poor bone quality. The third is optimizing surgical factors such as defining clinically appropriate, patient-specific target alignment goals as well as using techniques to avoid proximal junctional kyphosis and proximal junctional failure. It is important to describe these three key pitfalls that are commonly seen in the treatment of patients with adult spinal deformity and to describe methods to avoid them.
    MeSH term(s) Adult ; Humans ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Kyphosis/etiology ; Kyphosis/surgery ; Spinal Fusion/adverse effects ; Spinal Fusion/methods
    Language English
    Publishing date 2023-12-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 802490-x
    ISSN 0065-6895
    ISSN 0065-6895
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    Zs.MO 230: Show issues

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  10. Article ; Online: Utility of Spine Surgery Fellowship Training for Orthopaedic Surgeons in the United States.

    Silvestre, Jason / Wu, Hao Hua / Thompson, Terry L / Kang, James D

    The Journal of the American Academy of Orthopaedic Surgeons

    2022  Volume 31, Issue 7, Page(s) 335–340

    Abstract: Introduction: Orthopaedic spine surgeons gain surgical experience through cases conducted during residency and fellowship training. This study elucidates the incremental benefit in spine surgery volume from orthopaedic spine surgery fellowship training.! ...

    Abstract Introduction: Orthopaedic spine surgeons gain surgical experience through cases conducted during residency and fellowship training. This study elucidates the incremental benefit in spine surgery volume from orthopaedic spine surgery fellowship training.
    Methods: This was a retrospective national cohort study of orthopaedic surgery residents and orthopaedic spine surgery fellows graduating from US Accreditation Council for Graduate Medical Education-accredited training programs during the 2017 to 2020 academic years. Comparisons in spine surgery case volume were made with parametric tests.
    Results: One hundred fourteen spine surgery fellows and 3,000 orthopaedic surgery residents were included. There was a 3.5-fold increase in total spine surgery cases conducted during fellowship versus residency (314 ± 129 vs. 89 ± 61, P < 0.001). Spine surgery fellows one standard deviation more than the mean reported 443 total spine cases. The largest differences between fellows and residents were Decompression (104 ± 48 vs. 28 ± 23, P < 0.001), Posterior Arthrodesis (94 ± 46 vs. 21 ± 18, P < 0.001), Anterior Arthrodesis (64 ± 31 vs. 13 ± 13, P < 0.001), and Instrumentation (43 ± 25 vs. 22 ± 12, P < 0.001).
    Discussion: Spine surgery fellowship training affords orthopaedic surgeons the opportunity to increase spine surgery case volume by over threefold. The greatest increases in case volume were reported for Decompression, Posterior Arthrodesis, Anterior Arthrodesis, and Instrumentation.
    MeSH term(s) United States ; Humans ; Retrospective Studies ; Fellowships and Scholarships ; Cohort Studies ; Orthopedic Surgeons ; Education, Medical, Graduate ; Internship and Residency ; Arthrodesis
    Language English
    Publishing date 2022-12-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200524-1
    ISSN 1940-5480 ; 1067-151X
    ISSN (online) 1940-5480
    ISSN 1067-151X
    DOI 10.5435/JAAOS-D-22-00788
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