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138. Rates of Infection Following Spine Surgery Based on 108,419 Procedures: A Report from The Scoliosis Research Society Morbidity and Mortality Committee
72S
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S–205S
specimens were tested non-destructively in flexion using a pure moment apparatus (7.0 Nm). RESULTS: Extension of the posterior fusion from the sacrum to the ilium resulted in a statistically significant increase in rigidity in the absence of anterior hardware (Figure; 62%614%, p!0.01) and with ALIF (77%619%, p!0.01). However, there was no significant increase in flexion rigidity with addition of AxiaLIF to L3-Ilium constructs (pO0.05). Addition of ALIF to L3-Sacrum constructs increased rigidity by 47%623% as compared to -2%699% for AxiaLIF (pO0.05 for difference ALIF vs. AxiaLIF). There was no correlation between the magnitude of the decrease in flexion angle and DEXA T-score (pO0.05) for either AxiaLIF or ALIF treatment groups. CONCLUSIONS: Our results suggest that extension of long fusion constructs to the ilium provides greater rigidity than supplementation with anterior fixation alone. Addition of an ALIF to the iliac construct appears to provide a more consistent, although modest, increase in segmental rigidity as compared to AxiaLIF. Addition of ALIF to L3-Sacrum constructs increased L5/S1 segmental rigidity; however, this increase was less substantial than extension of the posterior construct to the ilium. There was no statistical difference between L3-Sacrum instrumentation rigidity with supplemental AxiaLIF and L3-Ilium stand-alone constructs. Changes in segmental rigidity with AxiaLIF were highly variable (60% increase to 200% decrease) and may be related to the bone quality in the specimens tested.
Canada; 6The Royal National Orthopaedic Hospital and the Great Ormond Street Children’s Hospital, London, England, United Kingdom; 7 Orlando, FL, USA; 8Oregon Health & Science University, Portland, OR, USA; 9Hospital for Sick Children, Totonto, Ontario, Canada; 10University of Pittsburgh, Pittsburgh, PA, USA; 11University of Minnesota, Minneapolis, MN, USA; 12Twin Cities Spine Center, Minneapolis, MN, USA; 13Hospital for Special Surgery, New York, NY, USA
Figure.
BACKGROUND CONTEXT: The Centers for Medicare and Medicaid Services (CMS) has created a list of ‘‘never events’’ and proposed denial of hospital payment for their treatment. While some of these are preventable, including wrong side surgery, wound infection following spine surgery, which is also listed as a ‘‘never event’’, is multifactorial and occurs despite meticulous efforts. PURPOSE: The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. We used these data to assess infection rates following spine surgery. STUDY DESIGN/SETTING: This study was a retrospective review of a prospectively collected, multicentered database. PATIENT SAMPLE: The patient population consisted of consecutively reported cases from the SRS M&M database from 2004 to 2007. OUTCOME MEASURES: The primary outcome measure was whether or not postoperative patients developed a wound infection, either superficial or deep. METHODS: The SRS M&M database was queried for cases from 20042007. Cases were stratified based on adult ($21) vs pediatric (!21), primary vs revision, use of implants and diagnosis. Superficial and deep infection rates were calculated separately. RESULTS: 108,419 cases were identified, with an infection rate of 2.2% (superficial50.8%, deep51.3%). Revision cases (16,503) had a 65% higher rate of infection (3.3%) compared with primary cases (91,916; 2.0%). Pediatric cases (25,432) had a 35% higher rate of infection (2.7%), compared with adult cases (82,082; 2.0%). The infection rate for cases with implants (74,114) was 28% higher than the rate for cases without implants (34,305), 2.3% vs 1.8%, respectively. Rates of infection were calculated based on diagnosis, and a subset of these rates is shown in the table. CONCLUSIONS: Our data suggest that post-surgical infection, even among skilled spine surgeons, is an inherent potential complication. These data provide general benchmarks of infection rates as a basis for on-going efforts to improve safety of care and argue against their classification as ‘‘never events’’. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
FDA DEVICE/DRUG STATUS: TranS1: Approved for this indication.
doi: 10.1016/j.spinee.2009.08.168
doi: 10.1016/j.spinee.2009.08.166
Friday, November 13, 2009 7:25–8:25 AM General Session: Best Papers 138. Rates of Infection Following Spine Surgery Based on 108,419 Procedures: A Report from The Scoliosis Research Society Morbidity and Mortality Committee Justin Smith, MD, PhD1, Christopher Shaffrey, MD1, Charles Sansur, MD1, Sigurd Berven, MD2, Paul Broadstone, MD3, Theodore Choma, MD4, Michael Goytan, MD, FRCSC5, Hilali Noordeen, MD6, Raymond Knapp7, Robert Hart, MD8, Reinhard Zeller, MD, FRCSC9, William Donaldson, MD10, David Polly, Jr., MD11, Joseph Perra, MD12, Oheneba BoachieAdjei, MD13; 1University of Virginia, Charlottesville, VA, USA; 2University of California, San Francisco, San Francisco, CA, USA; 3Erangler Medical Center, Chattanooga, TN, USA; 4University of Missouri-Columbia, Columbia, MO, USA; 5University of Manitoba, Winnipeg, Manitoba,
139. The Minimum Clinically Important Difference in SRS-22 Appearance, Activity and Pain Domains after Surgical Correction of Adolescent Idiopathic Scoliosis Leah Carreon, MD, MSC1, James Sanders, MD2, Mohammad Diab, MD3, Peter Sturm, MD4, Daniel Sucato, MD5; 1Louisville, KY, USA; 2Rochester, NY, USA; 3San Francisco, CA, USA; 4Shriners Hospitals for ChildrenChicago, Chicago, IL, USA; 5Dallas, TX, USA BACKGROUND CONTEXT: The Minimum Clinically Important Difference (MCID), a threshold of improvement that is clinically relevant to the individual patient, is increasingly used to evaluate treatment effectiveness. MCID values for the Scoliosis Research Society-22 (SRS-22) domains have not been determined. PURPOSE: To determine the MCID of the SRS-22 Appearance, Activity and Pain domains in patients with adolescent idiopathic scoliosis (AIS) undergoing surgical correction of their spinal deformity. STUDY DESIGN/SETTING: Longitudinal cohort. PATIENT SAMPLE: 887 patients with AIS who underwent surgical correction and had completed SRS-22 pre-op and the SRS-30 at one-year
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S–205S
specimens were tested non-destructively in flexion using a pure moment apparatus (7.0 Nm). RESULTS: Extension of the posterior fusion from the sacrum to the ilium resulted in a statistically significant increase in rigidity in the absence of anterior hardware (Figure; 62%614%, p!0.01) and with ALIF (77%619%, p!0.01). However, there was no significant increase in flexion rigidity with addition of AxiaLIF to L3-Ilium constructs (pO0.05). Addition of ALIF to L3-Sacrum constructs increased rigidity by 47%623% as compared to -2%699% for AxiaLIF (pO0.05 for difference ALIF vs. AxiaLIF). There was no correlation between the magnitude of the decrease in flexion angle and DEXA T-score (pO0.05) for either AxiaLIF or ALIF treatment groups. CONCLUSIONS: Our results suggest that extension of long fusion constructs to the ilium provides greater rigidity than supplementation with anterior fixation alone. Addition of an ALIF to the iliac construct appears to provide a more consistent, although modest, increase in segmental rigidity as compared to AxiaLIF. Addition of ALIF to L3-Sacrum constructs increased L5/S1 segmental rigidity; however, this increase was less substantial than extension of the posterior construct to the ilium. There was no statistical difference between L3-Sacrum instrumentation rigidity with supplemental AxiaLIF and L3-Ilium stand-alone constructs. Changes in segmental rigidity with AxiaLIF were highly variable (60% increase to 200% decrease) and may be related to the bone quality in the specimens tested.
Canada; 6The Royal National Orthopaedic Hospital and the Great Ormond Street Children’s Hospital, London, England, United Kingdom; 7 Orlando, FL, USA; 8Oregon Health & Science University, Portland, OR, USA; 9Hospital for Sick Children, Totonto, Ontario, Canada; 10University of Pittsburgh, Pittsburgh, PA, USA; 11University of Minnesota, Minneapolis, MN, USA; 12Twin Cities Spine Center, Minneapolis, MN, USA; 13Hospital for Special Surgery, New York, NY, USA
Figure.
BACKGROUND CONTEXT: The Centers for Medicare and Medicaid Services (CMS) has created a list of ‘‘never events’’ and proposed denial of hospital payment for their treatment. While some of these are preventable, including wrong side surgery, wound infection following spine surgery, which is also listed as a ‘‘never event’’, is multifactorial and occurs despite meticulous efforts. PURPOSE: The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. We used these data to assess infection rates following spine surgery. STUDY DESIGN/SETTING: This study was a retrospective review of a prospectively collected, multicentered database. PATIENT SAMPLE: The patient population consisted of consecutively reported cases from the SRS M&M database from 2004 to 2007. OUTCOME MEASURES: The primary outcome measure was whether or not postoperative patients developed a wound infection, either superficial or deep. METHODS: The SRS M&M database was queried for cases from 20042007. Cases were stratified based on adult ($21) vs pediatric (!21), primary vs revision, use of implants and diagnosis. Superficial and deep infection rates were calculated separately. RESULTS: 108,419 cases were identified, with an infection rate of 2.2% (superficial50.8%, deep51.3%). Revision cases (16,503) had a 65% higher rate of infection (3.3%) compared with primary cases (91,916; 2.0%). Pediatric cases (25,432) had a 35% higher rate of infection (2.7%), compared with adult cases (82,082; 2.0%). The infection rate for cases with implants (74,114) was 28% higher than the rate for cases without implants (34,305), 2.3% vs 1.8%, respectively. Rates of infection were calculated based on diagnosis, and a subset of these rates is shown in the table. CONCLUSIONS: Our data suggest that post-surgical infection, even among skilled spine surgeons, is an inherent potential complication. These data provide general benchmarks of infection rates as a basis for on-going efforts to improve safety of care and argue against their classification as ‘‘never events’’. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
FDA DEVICE/DRUG STATUS: TranS1: Approved for this indication.
doi: 10.1016/j.spinee.2009.08.168
doi: 10.1016/j.spinee.2009.08.166
Friday, November 13, 2009 7:25–8:25 AM General Session: Best Papers 138. Rates of Infection Following Spine Surgery Based on 108,419 Procedures: A Report from The Scoliosis Research Society Morbidity and Mortality Committee Justin Smith, MD, PhD1, Christopher Shaffrey, MD1, Charles Sansur, MD1, Sigurd Berven, MD2, Paul Broadstone, MD3, Theodore Choma, MD4, Michael Goytan, MD, FRCSC5, Hilali Noordeen, MD6, Raymond Knapp7, Robert Hart, MD8, Reinhard Zeller, MD, FRCSC9, William Donaldson, MD10, David Polly, Jr., MD11, Joseph Perra, MD12, Oheneba BoachieAdjei, MD13; 1University of Virginia, Charlottesville, VA, USA; 2University of California, San Francisco, San Francisco, CA, USA; 3Erangler Medical Center, Chattanooga, TN, USA; 4University of Missouri-Columbia, Columbia, MO, USA; 5University of Manitoba, Winnipeg, Manitoba,
139. The Minimum Clinically Important Difference in SRS-22 Appearance, Activity and Pain Domains after Surgical Correction of Adolescent Idiopathic Scoliosis Leah Carreon, MD, MSC1, James Sanders, MD2, Mohammad Diab, MD3, Peter Sturm, MD4, Daniel Sucato, MD5; 1Louisville, KY, USA; 2Rochester, NY, USA; 3San Francisco, CA, USA; 4Shriners Hospitals for ChildrenChicago, Chicago, IL, USA; 5Dallas, TX, USA BACKGROUND CONTEXT: The Minimum Clinically Important Difference (MCID), a threshold of improvement that is clinically relevant to the individual patient, is increasingly used to evaluate treatment effectiveness. MCID values for the Scoliosis Research Society-22 (SRS-22) domains have not been determined. PURPOSE: To determine the MCID of the SRS-22 Appearance, Activity and Pain domains in patients with adolescent idiopathic scoliosis (AIS) undergoing surgical correction of their spinal deformity. STUDY DESIGN/SETTING: Longitudinal cohort. PATIENT SAMPLE: 887 patients with AIS who underwent surgical correction and had completed SRS-22 pre-op and the SRS-30 at one-year