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Similar Rates of Perioperative Complications in Cervical Disc Arthroplasty Patients and Fusion Patients
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
PATIENT SAMPLE: Cases of lumbar spondylosis were identified using International Classification of Disease, Ninth Edition code 721.3. Cases treated with TLIF, A/P fusion, and anterior fusion alone were identified by CPT codes. Single-level cases were isolated by excluding cases that included CPT codes for additional levels. OUTCOME MEASURES: Serious adverse events investigated included death, cardiac arrest, stroke, sepsis, myocardial infarction, renal failure, pulmonary embolism, peripheral nerve injury, ventilator time>48 hours, unplanned intubation, return to operating room, surgical site infection, wound dehiscence, graft failure, renal insufficiency, deep vein thrombosis, pneumonia, urinary tract infection and post operative blood transfusion. METHODS: Fisher’s exact or Pearson’s chi-squared tests were used to compare perioperative adverse event rates where appropriate. Data management and analyses were performed using Stata/IC 13.0 (StataCorp, College Station, TX). RESULTS: In total, 1274 patients were identified: 899 underwent singlelevel TLIF, 150 underwent single-level A/P fusion, and 225 underwent anterior fusion alone. Of the adverse events recorded in ACS-NSQIP, 19 occurred at least once in one of the groups. Therefore, the level of significance was adjusted to p=.003 according to Bonferroni’s correction. There were 81 adverse events among patients who underwent TLIF (9.0%), 20 among those who underwent A/P fusion (13.3%), and 24 among those who underwent anterior fusion alone (10.7%). These differences were not significant (p=.230). The rates of serious adverse events were similar between groups (4.8%, 8.0%, 5.3%, respectively, p=.263) as were the rates of minor adverse events (4.2%, 5.3%, 5.3%, respectively, p=.687). The rates of postoperative blood transfusions were greater in the A/P fusion group (13.7%, 31.3%, and 10.9%, p<.001). CONCLUSIONS: TLIF, A/P fusion, and anterior fusion alone for lumbar spondylosis were found to have similar adverse event rates at 30-day followup based on records of the 1274 cases in this national database. The greater rate of blood transfusion after A/P fusion may reflect that TLIF is more often performed using minimally invasive techniques. Because perioperative adverse event rates were similar, these findings suggest that surgeon preference and longer term patient outcomes should inform the recommendation for one approach or another. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.374
P50. Similar Rates of Perioperative Complications in Cervical Disc Arthroplasty Patients and Fusion Patients Susan Odum, PhD1, Bryce Van Doren, MPH1, Leo R. Spector, MD2, Bruce V. Darden II, MD3; 1OrthoCarolina Research Institute, Charlotte, NC, USA; 2OrthoCarolina, Charlotte, NC, USA; 3OrthoCarolina Spine Center, Charlotte, NC, USA BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) was developed as an alternative to cervical spine fusion (CSF). It is hoped that CDA will significantly reduce the occurrence of adjacent segment disease common in CSF patients. Yet, little is known about the immediate complication rates between the two surgeries. PURPOSE: The purpose of this study is compare the in-hospital complication rates between CDA and CSF patients. STUDY DESIGN/SETTING: Administrative data from the 2002–2013 Nationwide Inpatient Sample (NIS) releases were analyzed. Each release of the NIS includes a 20% sample of patients hospitalized in community hospitals in the United States during the respective year. PATIENT SAMPLE: Using International Classification of Diseases, 9th Revision and Clinical Modification (ICD-9-CM) 84.62 and 81.02/81.03 procedure codes, 3,938 CDA patients and 361,297 CSF patients were identified respectively. CDA and CSF patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities and preoperative severity/ loss of function. Exact matches were identified for 3,846 (97.6%) CDA patients, with a mean age of 46.5 years.
OUTCOME MEASURES: Using a previously reported classification system, ICD-9-CM diagnosis codes were utilized to classify major or minor inhospital complications. In-hospital mortality was also analyzed. METHODS: Unadjusted and adjusted minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression. RESULTS: The major in-hospital complication rate for CDA patients was 2.4% (92 of 3,846) versus 2.7% (102 of 3,846) for CSF patients (p=.47). The minor complication rate for CDA was 2.2% (85 of 3,846) compared to 2.6% (99 of 3,846) for CSF (p=.30). Fewer than 10 patients in either group died (p=1.00). When adjusted for case-mix, there were no significant differences in the risk of major in-hospital complications between groups [OR: 0.91 (95% CI: 0.68–1.22), p=.51]. There were also no significant differences in minor complication risks between the groups [OR: 0.76 (95% CI 0.55–1.05); p=.10]. CONCLUSIONS: In a matched cohort, cervical disc arthroplasty patients were no more likely to experience major complications, minor complications, or death. These data can guide surgeon and patient decision-making regarding the safety of both cervical procedures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.375
P51. Psoas Size Predicts Survival in Patients with Lung Cancer Metastasis to the Spine Hesham Zakaria, MD1, Azam Basheer, MD1, David Boyce-Fappiano, BS1, Erinma Elibe, BS1, Ian Lee, MD2, Brent Griffith, MD2, Farzan Siddiqui, MD, PhD3, Victor Chang, MD4; 1Henry Ford Hospital, Detroit, MI, USA; 2Henry Ford Health System, Detroit, MI, USA; 3Detroit, MI, USA; 4Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA BACKGROUND CONTEXT: Patient frailty has been defined as a decreased reserve to resistance to stressors, with decline across multiple physiologic systems, and is a common endpoint in human senescence. For a surgeon, the clinical appreciation of a frail patient is important, as a recent body of literature has shown that frailty can predict morbidity and mortality after general, vascular, transplant and neurological surgery. Unfortunately, measuring human frailty is subjective, burdensome, and impractical in most clinical settings, and so surrogate markers of frailty, namely sarcopenia, has been successfully used to predict postoperative morbidity and mortality following major neurosurgical, general, vascular and transplant surgery. Morphometrics is the measurement of patient attributes that are indicative of sarcopenia, and thus frailty by proxy. In terms of oncologic surgery, the observation has consistently been that patients who are sarcopenic, not only have increased postoperative morbidity and mortality, but also have a shorter progression free survival. The relationship with increased muscle mass and disease free survival has even been observed in oncologic patients who have not undergone any cancer surgery. This is an important observation, as current methodologies for predicting oncologic outcomes rely solely on histologic grade of the cancer and its TNM tumor staging. Identifying more accurate and specific markers of survival would enable oncologists to better identify which patients are appropriate candidates a specific treatment, whether it is chemotherapy, radiation, surgery or palliation. PURPOSE: In this study, we applied morphometric analysis of sarcopenia to predict oncologic outcomes in patients who have lung cancer metastases to the spine. In our previous work, we have applied this methodology to lumbar spine surgery using psoas area as a marker for sarcopenia. Our hypothesis was that patients with smaller psoas area would have shorter survival after being diagnosed with metastasis to the spine in patients with primary lung cancer. STUDY DESIGN/SETTING: Utilizing a retrospective registry of spinal metastases patients from 2002–2012 who have undergone stereotactic body radiation therapy (SBRT) to the spinal column, we identified a population
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
PATIENT SAMPLE: Cases of lumbar spondylosis were identified using International Classification of Disease, Ninth Edition code 721.3. Cases treated with TLIF, A/P fusion, and anterior fusion alone were identified by CPT codes. Single-level cases were isolated by excluding cases that included CPT codes for additional levels. OUTCOME MEASURES: Serious adverse events investigated included death, cardiac arrest, stroke, sepsis, myocardial infarction, renal failure, pulmonary embolism, peripheral nerve injury, ventilator time>48 hours, unplanned intubation, return to operating room, surgical site infection, wound dehiscence, graft failure, renal insufficiency, deep vein thrombosis, pneumonia, urinary tract infection and post operative blood transfusion. METHODS: Fisher’s exact or Pearson’s chi-squared tests were used to compare perioperative adverse event rates where appropriate. Data management and analyses were performed using Stata/IC 13.0 (StataCorp, College Station, TX). RESULTS: In total, 1274 patients were identified: 899 underwent singlelevel TLIF, 150 underwent single-level A/P fusion, and 225 underwent anterior fusion alone. Of the adverse events recorded in ACS-NSQIP, 19 occurred at least once in one of the groups. Therefore, the level of significance was adjusted to p=.003 according to Bonferroni’s correction. There were 81 adverse events among patients who underwent TLIF (9.0%), 20 among those who underwent A/P fusion (13.3%), and 24 among those who underwent anterior fusion alone (10.7%). These differences were not significant (p=.230). The rates of serious adverse events were similar between groups (4.8%, 8.0%, 5.3%, respectively, p=.263) as were the rates of minor adverse events (4.2%, 5.3%, 5.3%, respectively, p=.687). The rates of postoperative blood transfusions were greater in the A/P fusion group (13.7%, 31.3%, and 10.9%, p<.001). CONCLUSIONS: TLIF, A/P fusion, and anterior fusion alone for lumbar spondylosis were found to have similar adverse event rates at 30-day followup based on records of the 1274 cases in this national database. The greater rate of blood transfusion after A/P fusion may reflect that TLIF is more often performed using minimally invasive techniques. Because perioperative adverse event rates were similar, these findings suggest that surgeon preference and longer term patient outcomes should inform the recommendation for one approach or another. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.374
P50. Similar Rates of Perioperative Complications in Cervical Disc Arthroplasty Patients and Fusion Patients Susan Odum, PhD1, Bryce Van Doren, MPH1, Leo R. Spector, MD2, Bruce V. Darden II, MD3; 1OrthoCarolina Research Institute, Charlotte, NC, USA; 2OrthoCarolina, Charlotte, NC, USA; 3OrthoCarolina Spine Center, Charlotte, NC, USA BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) was developed as an alternative to cervical spine fusion (CSF). It is hoped that CDA will significantly reduce the occurrence of adjacent segment disease common in CSF patients. Yet, little is known about the immediate complication rates between the two surgeries. PURPOSE: The purpose of this study is compare the in-hospital complication rates between CDA and CSF patients. STUDY DESIGN/SETTING: Administrative data from the 2002–2013 Nationwide Inpatient Sample (NIS) releases were analyzed. Each release of the NIS includes a 20% sample of patients hospitalized in community hospitals in the United States during the respective year. PATIENT SAMPLE: Using International Classification of Diseases, 9th Revision and Clinical Modification (ICD-9-CM) 84.62 and 81.02/81.03 procedure codes, 3,938 CDA patients and 361,297 CSF patients were identified respectively. CDA and CSF patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities and preoperative severity/ loss of function. Exact matches were identified for 3,846 (97.6%) CDA patients, with a mean age of 46.5 years.
OUTCOME MEASURES: Using a previously reported classification system, ICD-9-CM diagnosis codes were utilized to classify major or minor inhospital complications. In-hospital mortality was also analyzed. METHODS: Unadjusted and adjusted minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression. RESULTS: The major in-hospital complication rate for CDA patients was 2.4% (92 of 3,846) versus 2.7% (102 of 3,846) for CSF patients (p=.47). The minor complication rate for CDA was 2.2% (85 of 3,846) compared to 2.6% (99 of 3,846) for CSF (p=.30). Fewer than 10 patients in either group died (p=1.00). When adjusted for case-mix, there were no significant differences in the risk of major in-hospital complications between groups [OR: 0.91 (95% CI: 0.68–1.22), p=.51]. There were also no significant differences in minor complication risks between the groups [OR: 0.76 (95% CI 0.55–1.05); p=.10]. CONCLUSIONS: In a matched cohort, cervical disc arthroplasty patients were no more likely to experience major complications, minor complications, or death. These data can guide surgeon and patient decision-making regarding the safety of both cervical procedures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.375
P51. Psoas Size Predicts Survival in Patients with Lung Cancer Metastasis to the Spine Hesham Zakaria, MD1, Azam Basheer, MD1, David Boyce-Fappiano, BS1, Erinma Elibe, BS1, Ian Lee, MD2, Brent Griffith, MD2, Farzan Siddiqui, MD, PhD3, Victor Chang, MD4; 1Henry Ford Hospital, Detroit, MI, USA; 2Henry Ford Health System, Detroit, MI, USA; 3Detroit, MI, USA; 4Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA BACKGROUND CONTEXT: Patient frailty has been defined as a decreased reserve to resistance to stressors, with decline across multiple physiologic systems, and is a common endpoint in human senescence. For a surgeon, the clinical appreciation of a frail patient is important, as a recent body of literature has shown that frailty can predict morbidity and mortality after general, vascular, transplant and neurological surgery. Unfortunately, measuring human frailty is subjective, burdensome, and impractical in most clinical settings, and so surrogate markers of frailty, namely sarcopenia, has been successfully used to predict postoperative morbidity and mortality following major neurosurgical, general, vascular and transplant surgery. Morphometrics is the measurement of patient attributes that are indicative of sarcopenia, and thus frailty by proxy. In terms of oncologic surgery, the observation has consistently been that patients who are sarcopenic, not only have increased postoperative morbidity and mortality, but also have a shorter progression free survival. The relationship with increased muscle mass and disease free survival has even been observed in oncologic patients who have not undergone any cancer surgery. This is an important observation, as current methodologies for predicting oncologic outcomes rely solely on histologic grade of the cancer and its TNM tumor staging. Identifying more accurate and specific markers of survival would enable oncologists to better identify which patients are appropriate candidates a specific treatment, whether it is chemotherapy, radiation, surgery or palliation. PURPOSE: In this study, we applied morphometric analysis of sarcopenia to predict oncologic outcomes in patients who have lung cancer metastases to the spine. In our previous work, we have applied this methodology to lumbar spine surgery using psoas area as a marker for sarcopenia. Our hypothesis was that patients with smaller psoas area would have shorter survival after being diagnosed with metastasis to the spine in patients with primary lung cancer. STUDY DESIGN/SETTING: Utilizing a retrospective registry of spinal metastases patients from 2002–2012 who have undergone stereotactic body radiation therapy (SBRT) to the spinal column, we identified a population
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.