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  1. Artikel: Does Surgical Day of the Week Affect Hospital Course and Outcomes for Patients Undergoing Adult Spinal Deformity Surgery?

    Graham, Benjamin C / Lucasti, Christopher / Scott, Maxwell M / Baker, Seth C / Vallee, Emily K / Patel, Dil V / Hamill, Christopher L

    Global spine journal

    2024  , Seite(n) 21925682241226821

    Abstract: Study design: Retrospective Cohort Analysis.: Objectives: Extended hospital length of stay (LOS) poses a significant cost burden to patients undergoing adult spinal deformity (ASD) surgery. The purpose of this study is to investigate the relationship ...

    Abstract Study design: Retrospective Cohort Analysis.
    Objectives: Extended hospital length of stay (LOS) poses a significant cost burden to patients undergoing adult spinal deformity (ASD) surgery. The purpose of this study is to investigate the relationship between late-week surgery and LOS in patients undergoing ASD surgery.
    Methods: 256 patients who underwent ASD surgery between January 2018 and December 2021 by a single fellowship-trained orthopedic spine surgeon comprised the patient sample. Demographics, intraoperative, and perioperative data were collected for the 256 patients who underwent ASD surgery. Patients were divided into two groups based on surgical day of the week: (1) Early-week (Monday/Tuesday) n = 126 and (2) Late-week (Thursday/Friday) n = 130. Descriptive statistics, T-tests, and linear and logistic regression models were used to analyze the data.
    Results: Surgical details and sociodemographic characteristics did not differ between the groups. When controlling for TLIF/DLIF status and PSO status there was no difference in mean length of stay between the groups. The late-week group was associated with a greater risk of 30-day readmission, but there was no difference in complications, infections, or intraoperative complications.
    Conclusions: We found no difference in mean length of stay between surgeries performed early in the week vs late in the week. Although late-week surgeries had higher 30-day readmission risk, all other outcomes, including complication rates, showed no significant differences. When adequate weekend post-operative care is available, we do not advise restricting ASD surgeries to specific weekdays.
    Sprache Englisch
    Erscheinungsdatum 2024-01-10
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 2648287-3
    ISSN 2192-5690 ; 2192-5682
    ISSN (online) 2192-5690
    ISSN 2192-5682
    DOI 10.1177/21925682241226821
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Predicting Complications in 153 Lumbar Pedicle Subtraction Osteotomies by a Single Surgeon Over a 6-Year Period.

    Baker, Seth C / Lucasti, Christopher / Graham, Benjamin C / Scott, Maxwell M / Vallee, Emily K / Kowalski, David / Patel, Dil V / Hamill, Christopher L

    The Journal of the American Academy of Orthopaedic Surgeons

    2024  

    Abstract: Introduction: Pedicle subtraction osteotomy (PSO) is a complex surgical procedure that provides correction of moderate sagittal imbalance. Surgical complications have adverse effects on patient outcomes and healthcare costs, making it imperative for ... ...

    Abstract Introduction: Pedicle subtraction osteotomy (PSO) is a complex surgical procedure that provides correction of moderate sagittal imbalance. Surgical complications have adverse effects on patient outcomes and healthcare costs, making it imperative for clinical researchers to focus on minimizing complications. However, when it comes to risk modeling of PSO surgery, there is currently no consensus on which patient characteristics or measures should be used. This study aimed to describe complications and compare the performance of various sociodemographic characteristics, surgical variables, and established risk indices in predicting postoperative complications, infections, and readmissions after lumbar PSO surgeries.
    Methods: A review was conducted on 191 patients who underwent PSO surgery at a single institution by a single fellowship-trained orthopaedic spine surgeon between January 1, 2018, and December 31, 2021. Demographic, intraoperative, and postoperative data within 30 days, 1 year, and 2 years of the index procedure were evaluated. Descriptive statistics, t-test, chi-squared analysis, and logistic regression models were used.
    Results: Intraoperative complications were significantly associated with coronary artery disease (odds ratios [OR] 3.95, P = 0.03) and operating room time (OR 1.01, P = 0.006). 30-day complications were significantly cardiovascular disease (OR 2.68, P = 0.04) and levels fused (OR 1.10, P = 0.04). 2-year complications were significantly associated with cardiovascular disease (OR 2.85, P = 0.02). 30-day readmissions were significantly associated with sex (4.47, 0.04) and length of hospital stay (χ2 = 0.07, P = 0.04). 2-year readmissions were significantly associated with age (χ2 = 0.50, P = 0.03), hypertension (χ2 = 4.64, P = 0.03), revision surgeries (χ2 = 5.46, P = 0.02), and length of hospital stay (χ2 = 0.07, P = 0.03).
    Discussion: This study found that patients with coronary vascular disease and longer fusions were at higher risk of postoperative complications and patients with notable intraoperative blood loss were at higher risk of postoperative infections. In addition, physicians should closely follow patients with extended postoperative hospital stays, with advanced age, and undergoing revision surgery because these patients were more likely to be readmitted to the hospital.
    Sprache Englisch
    Erscheinungsdatum 2024-05-23
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 1200524-1
    ISSN 1940-5480 ; 1067-151X
    ISSN (online) 1940-5480
    ISSN 1067-151X
    DOI 10.5435/JAAOS-D-23-01263
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: The Surgical Outcomes of Pedicle Subtraction Osteotomy per Different First Assistant: Retrospective Analysis of 312 Cases.

    Lee, Andrew / Lucasti, Christopher / Scott, Maxwell M / Patel, Dil V / Kohut, Kevin / Pavlesen, Sonja / Bayers-Thering, Mary / Hamill, Christopher L

    The Journal of the American Academy of Orthopaedic Surgeons

    2023  Band 32, Heft 1, Seite(n) e33–e43

    Abstract: Introduction: Pedicle subtraction osteotomies (PSOs) are complex spinal deformity surgeries that are associated with high complication rates. They are typically done by an experienced spine surgeon with another attending, resident, or physician ... ...

    Abstract Introduction: Pedicle subtraction osteotomies (PSOs) are complex spinal deformity surgeries that are associated with high complication rates. They are typically done by an experienced spine surgeon with another attending, resident, or physician assistant serving as the first assistant. The purpose of this study was to determine whether selecting a surgical team for single-level PSO based on case difficulty and fusion length could equalize intraoperative and perioperative outcomes among three groups: dual-attending (DA), attending and orthopaedic resident (RS), and attending and physician assistant (PA).
    Methods: This study was a retrospective cohort analysis of 312 patients undergoing single-level thoracic or lumbar PSO from January 2007 to December 2020 by a fellowship-trained orthopaedic spine surgeon. Demographic, intraoperative, and perioperative data within 30 days and 2 years of the index procedure were analyzed.
    Results: Patient demographics did not markedly differ between surgical groups. The mean cohort age was 64.5 years with BMI 31.9 kg/m 2 . Patients with the DA approach had a significantly longer surgical time (DA = 412 min vs. resident = 372 min vs. physician assistant = 323 min; P < 0.001). Patients within the DA group experienced a significantly lower rate of infection (DA = 2.1% [3/140] vs. RS = 7.9% [9/114] vs. PA = 1.7% [1/58], P = 0.043), surgical complication rate (DA = 26% [37/140] vs. RS = 41% [47/114] vs. PA = 33% [19/58], P < 0 .001), and readmission rate (DA = 6.4% [9/140] vs. RS = 12.3% [14/114] vs. PA = 19% [11/58] P = 0.030) within 30 days of surgery. No notable differences were observed among groups in 2-year complication, infection, readmission, or revision surgery rates.
    Conclusions: These study results support the DA surgeon approach. Resident involvement, even in less complex cases, can still negatively affect perioperative outcomes. Additional selection criteria development is needed.
    Mesh-Begriff(e) Humans ; Middle Aged ; Retrospective Studies ; Osteotomy/adverse effects ; Osteotomy/methods ; Spine ; Cohort Studies ; Spinal Fusion/methods ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2023-07-18
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 1200524-1
    ISSN 1940-5480 ; 1067-151X
    ISSN (online) 1940-5480
    ISSN 1067-151X
    DOI 10.5435/JAAOS-D-23-00157
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: Debate: to fuse or not to fuse to the sacrum, the fate of the L5-S1 disc.

    Polly, David W / Hamill, Christopher L / Bridwell, Keith H

    Spine

    2006  Band 31, Heft 19 Suppl, Seite(n) S179–84

    Mesh-Begriff(e) Diskectomy/methods ; Diskectomy/standards ; Female ; Humans ; Intervertebral Disc/anatomy & histology ; Intervertebral Disc/physiology ; Intervertebral Disc/surgery ; Intervertebral Disc Displacement/etiology ; Intervertebral Disc Displacement/physiopathology ; Intervertebral Disc Displacement/prevention & control ; Low Back Pain/etiology ; Low Back Pain/physiopathology ; Low Back Pain/prevention & control ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/pathology ; Lumbar Vertebrae/surgery ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology ; Postoperative Complications/prevention & control ; Radiography ; Range of Motion, Articular/physiology ; Reoperation ; Sacrum/anatomy & histology ; Sacrum/surgery ; Scoliosis/diagnostic imaging ; Scoliosis/physiopathology ; Scoliosis/surgery ; Spinal Fusion/methods ; Spinal Fusion/standards ; Treatment Failure
    Sprache Englisch
    Erscheinungsdatum 2006-09-01
    Erscheinungsland United States
    Dokumenttyp Case Reports ; Journal Article
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/01.brs.0000234761.87368.ee
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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    Verfügbar in ZB MED Köln/Königswinter

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  5. Artikel ; Online: The impact of perioperative complications on clinical outcome in adult deformity surgery.

    Glassman, Steven D / Hamill, Christopher L / Bridwell, Keith H / Schwab, Frank J / Dimar, John R / Lowe, Thomas G

    Spine

    2007  Band 32, Heft 24, Seite(n) 2764–2770

    Abstract: Study design: Retrospective case-control series.: Objective: The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.: Summary of background data: ... ...

    Abstract Study design: Retrospective case-control series.
    Objective: The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.
    Summary of background data: Increasingly, the benefit of surgical intervention is being evaluated based on patient reported outcomes and standardized health related quality of life (HRQOL) measures. As improvement or deterioration in HRQOL scores becomes a standard for clinical evaluation in adult spinal deformity, the correlation between HRQOL outcome scores and historic benchmarks, such as curve correction, sagittal balance, fusion healing, or the occurrence of a complication, must be clarified.
    Methods: This study analyzes a prospective multicenter data base for adult spinal deformity. Patients with major, minor, and no complications were matched using a logistic regression technique producing 46 patients in each group. Standardized outcome measures at baseline and at 1 year postop were compared.
    Results: Forty-seven major complications were reported in 46 patients. Sixty-two minor complications were noted in 46 patients. Comparison between the 3 complication groups revealed that 1-year postoperative outcome measures were not statistically different for the Scoliosis Research Society Outcomes Instrument, Medical Outcomes Short Form-36 (SF-12), Oswestry Disability Index, or Numerical Pain Scales. The only significant interaction was in the rate of change from preop to 1-year postop for the SF-12 general health subscale. For the group with major complications, SF-12 general health deteriorated by 2.1 points from preop to 1-year postop. During the same period, the group with minor complications experienced an improvement of 4.2 points and the group with no complications experienced an improvement of 1.5 points.
    Conclusion: This study suggests that risk for minor complications may be a less substantial obstacle than previously assumed for surgical treatment in adult spinal deformity. In contrast, major complications were reported in approximately 10% of cases and adversely affected outcome as evidenced by the deterioration in SF-12 general health scores at 1 year after surgery.
    Mesh-Begriff(e) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Databases, Factual ; Female ; Follow-Up Studies ; Health Status ; Humans ; Intraoperative Complications/epidemiology ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Quality of Life ; Retrospective Studies ; Risk Factors ; Spinal Diseases/epidemiology ; Spinal Diseases/surgery ; Spinal Fusion/statistics & numerical data ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2007-11-15
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Multicenter Study
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0b013e31815a7644
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel ; Online: Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age.

    Smith, Justin S / Shaffrey, Christopher I / Glassman, Steven D / Berven, Sigurd H / Schwab, Frank J / Hamill, Christopher L / Horton, William C / Ondra, Stephen L / Sansur, Charles A / Bridwell, Keith H

    Spine

    2011  Band 36, Heft 10, Seite(n) 817–824

    Abstract: Study design: Retrospective review of a prospective, multicenter database.: Objective: The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures ...

    Abstract Study design: Retrospective review of a prospective, multicenter database.
    Objective: The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.
    Summary of background data: Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.
    Methods: This is a retrospective review of a prospective, multicenter spinal deformity database. Patients complete the Oswestry Disability Index (ODI), SF-12, Scoliosis Research Society-22 (SRS-22), and numerical rating scale (NRS; 0-10) for back and leg pain. Inclusion criteria included age 25 to 85 years, scoliosis (Cobb ≥ 30°), plan for scoliosis surgery, and 2-year follow-up.
    Results: Two hundred six of 453 patients (45%) completed 2-year follow-up, which is distributed among age groups as follows: 25 to 44 (n = 47), 45 to 64 (n = 121), and 65 to 85 (n = 38) years. The percentages of patients with 2-year follow-up by age group were as follows: 25 to 44 (45%), 45 to 64 (48%), and 65 to 85 (40%) years. These groups had perioperative complication rates of 17%, 42%, and 71%, respectively (P < 0.001). At baseline, elderly patients (65-85 years) had greater disability (ODI, P = 0.001), worse health status (SF-12 physical component score (PCS), P < 0.001), and more severe back and leg pain (NRS, P = 0.04 and P = 0.01, respectively) than younger patients. Mean SRS-22 did not differ significantly at baseline. Within each age group, at 2-year follow-up there were significant improvements in ODI (P ≤ 0.004), SRS-22 (P ≤ 0.001), back pain (P < 0.001), and leg pain (P ≤ 0.04). SF-12 PCS did not improve significantly for patients aged 25 to 44 years but did among those aged 45 to 64 (P < 0.001) and 65 to 85 years (P = 0.001). Improvement in ODI and leg pain NRS were significantly greater among elderly patients (P = 0.003, P = 0.02, respectively), and there were trends for greater improvements in SF-12 PCS (P = 0.07), SRS-22 (P = 0.048), and back pain NRS (P = 0.06) among elderly patients, when compared with younger patients.
    Conclusion: Collectively, these data demonstrate the potential benefits of surgical treatment for adult scoliosis and suggest that the elderly, despite facing the greatest risk of complications, may stand to gain a disproportionately greater improvement in disability and pain with surgery.
    Mesh-Begriff(e) Adult ; Age Factors ; Aged ; Aged, 80 and over ; Databases, Factual ; Decompression, Surgical/adverse effects ; Disability Evaluation ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Osteotomy/adverse effects ; Pain/etiology ; Pain/physiopathology ; Postoperative Complications ; Prospective Studies ; Retrospective Studies ; Risk Assessment ; Scoliosis/physiopathology ; Scoliosis/rehabilitation ; Scoliosis/surgery ; Severity of Illness Index ; Spinal Fusion/adverse effects ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2011-05-01
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0b013e3181e21783
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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