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313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S141−S157
CONCLUSIONS: In this retrospective review study, more experience of ERAS programs (PORC) improved patient recovery process, and decreased the LOS along with cost-savings in patients after spinal fusion procedures (MSDRG S460). Future studies are needed to design and implement more detail ERAS protocols, and evaluate their efficacy through prospective randomized, double-blinded and controlled clinical trials. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.328
Saturday, September 28, 2019 10:30 AM − 12:00 PM Spinal Deformity VII
postop (pre 44˚, post 58˚) compared to the no change group (pre 36˚, post 50˚). Age at surgery (p=0.214), sex (p=0.955), Risser score (p=0.205), major coronal cobb angle (p=0.907), thoracic kyphosis (p=0.717), global sagittal alignment (C7-S1 SVA p=0.320), levels fused (p=0.064), fusion to the sacrum (p=.548), coronal pelvic obliquity (p=0.652), or hip position at rest (adducted/abducted/neutral; p=.284) were not associated with WHS. Reoperation was not associated with WHS (p=.304). CONCLUSIONS: Postoperative hyperlordosis (>60˚) is the only determined risk for WHS at 5Y after spinal fusion in nonambulant patients with cerebral palsy (GMFCS IV&V). WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbo-pelvic motion causing anterior femoracetabular impingement. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.329
312. Residual lumbar hyperlordosis is associated with worsened hip status 5 years after cerebral palsy scoliosis correction Aaron J. Buckland, MBBS, FRACS1, Herbert K. Graham, MD, FRCS2, Dainn Woo, BS3, Dennis Vasquez-Montes, MS, BA3, Michelle C. Marks, PT4, Thomas J. Errico, MD5, Paul D. Sponseller, MD6; 1 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 2 Royal Children’s Hospital, Melbourne, Victoria, Australia; 3 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 4 Setting Scoliosis Straight, San Diego, CA, US; 5 Center for Spinal Disorders, Orthopedic Surgery, Nicklaus Children’s Hospital, Miami, FL, US; 6 Baltimore, MD, US BACKGROUND CONTEXT: Cerebral palsy (CP) can be described as a “static encephalopathy with progressive musculoskeletal pathology.” Nonambulant children (GMFCS IV&V) have high rates of both spastic hip disease and neuromuscular scoliosis. Adult sagittal spinal deformity correction is known to cause acetabular retroversion and reduced pelvic tilt, resulting in increased rates of prosthetic hip dislocation; however, the role of spinal alignment on hip status in CP remains unknown. PURPOSE: To identify surgical factors and postoperative spinal alignment parameters that are associated with worsening postoperative hip status (WHS) (ie, subluxation, dislocation or resection) after spinal fusion. STUDY DESIGN/SETTING: Prospective multicenter outcomes study of nonambulant CP patients (GMFCS IV&V) requiring spinal fusion. PATIENT SAMPLE: A total of 142 operative CP patients with preoperative, 6-week, 1Y, 2Y and 5Y postoperative follow-up. OUTCOME MEASURES: Postoperative spinal alignment parameters associations with WHS up to 5Y postoperatively. METHODS: WHS was defined by permutations of baseline and 1Y, 2Y and 5Y hip status of left and right hips by a change from either a normal hip at baseline (BL) that became subluxated, dislocated or resected at postop intervals; or if a subluxated hip at BL became dislocated or resected at postop intervals. Hip status up to 5Y postop was analyzed according to age, sex, coronal spinal alignment (major curve Cobb, pelvic obliquity), sagittal spinal alignment (thoracic kyphosis, T12-S1 lumbar lordosis, C7S1 sagittal vertical axis), Risser score, hip position at rest, upper and lowerinstrumented vertebrae (UIV&LIV), levels fused and fusion to the sacrum. Potential cutoff values for alignment parameters at which the relationship with hip status was determined using receiver operating characteristic (ROC) curves. Logistic regression was used to determine odds ratios for predictors of WHS. RESULTS: Of 142 patients (mean age 13.7§2.5, 48.3% female), 36 (25.4%) had WHS postoperatively. 7 had reoperation of their spinal fusion, 3 for loose screws/bolts and 4 for prominent instrumentation. ROC curve analysis and multivariate logistic regression demonstrated that the only spino-pelvic alignment parameter that significantly correlated with WHS was lumbar hyperlordosis (T12-L5) >60˚ (p=.015), OR=2.61 (CI 1.195.75). Assessment of all patients demonstrated an increase in pre- to postop LL. Change in LL pre- to postoperative was no different between groups (p=.643), however the WHS group was more lordotic at baseline and
313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly Paramjit Singh, MD, MA1, John Ibrahim2, Deeptee Jain, MD3, Paul Eichenseer, DO3, Mayur Kardile, MD2, Shane Burch, MD4, Alexander A. Theologis, MD5, Sigurd H. Berven, MD6; 1 USC Orthopaedic Surgery, Los Angeles, CA, US; 2 San Francisco, CA, US; 3 Ortho Nuero, Dublin, OH, US; 4 University of California San Francisco, San Francisco, CA, US; 5 UCSF Spine Center, San Francisco, CA, US; 6 UCSF, Dept of Orthopaedic Surgery, San Francisco, CA, US BACKGROUND CONTEXT: Factors that influence length of stay (LOS), readmission, and reoperation after adult spinal deformity (ASD) operations are important to define in order to optimize outcomes and control costs. PURPOSE: To identify predictors of LOS and 30-day and 90-day readmissions and reoperations following ASD operations. STUDY DESIGN/SETTING: Single-center retrospective cohort. PATIENT SAMPLE: Adults age >60 years who underwent operation (>3 levels) for lumbar spinal pathology. OUTCOME MEASURES: Length of stay, reoperations, and readmissions at 30-days and 90-days post-operatively. METHODS: Adults age>60 years who underwent operation (>3 levels) for lumbar spinal pathology between April 2015 and July 2017 at a single institution for ASD were reviewed. Demographics, comorbidities and surgical invasiveness were assessed for each patient and used as predictor variables for LOS and 30-day and 90-day readmissions and reoperations. RESULTS: The study included 100 patients (avg age 69§6.8 years, male32). Average LOS was 9.9 days (range, 4-101 days). Rates of readmission at 30-days and 90-days were 10% and 13%, respectively. Rates of reoperation at 30-days and 90-days were 7% and 11%, respectively. Preoperative factors significantly associated with LOS were age>74, history of wound healing difficulty, liver disease, and respiratory disease. Readmissions at 30-days were significantly associated with history of surgical site infection. Readmissions at 90-days were significantly associated with a history of renal disease and rheumatologic disorders. Reoperations at 30-days were significantly associated with a history of renal disease and preoperative narcotic dosages, as expressed by Morphine Milligram Equivalents, greater than 50mg. Reoperations at 90-days were significantly associated with history of renal disease and rheumatologic disorders. CONCLUSIONS: In this single-center experience, preoperative factors associated with hospital LOS and 30-day and 90-day readmissions and revisions after operations for ASD span multiple domains including age, medical comorbidities and social factors. This information may be used to guide preoperative optimization and risk adjustment within alternative payment models. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.330
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.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S141−S157
CONCLUSIONS: In this retrospective review study, more experience of ERAS programs (PORC) improved patient recovery process, and decreased the LOS along with cost-savings in patients after spinal fusion procedures (MSDRG S460). Future studies are needed to design and implement more detail ERAS protocols, and evaluate their efficacy through prospective randomized, double-blinded and controlled clinical trials. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.328
Saturday, September 28, 2019 10:30 AM − 12:00 PM Spinal Deformity VII
postop (pre 44˚, post 58˚) compared to the no change group (pre 36˚, post 50˚). Age at surgery (p=0.214), sex (p=0.955), Risser score (p=0.205), major coronal cobb angle (p=0.907), thoracic kyphosis (p=0.717), global sagittal alignment (C7-S1 SVA p=0.320), levels fused (p=0.064), fusion to the sacrum (p=.548), coronal pelvic obliquity (p=0.652), or hip position at rest (adducted/abducted/neutral; p=.284) were not associated with WHS. Reoperation was not associated with WHS (p=.304). CONCLUSIONS: Postoperative hyperlordosis (>60˚) is the only determined risk for WHS at 5Y after spinal fusion in nonambulant patients with cerebral palsy (GMFCS IV&V). WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbo-pelvic motion causing anterior femoracetabular impingement. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.329
312. Residual lumbar hyperlordosis is associated with worsened hip status 5 years after cerebral palsy scoliosis correction Aaron J. Buckland, MBBS, FRACS1, Herbert K. Graham, MD, FRCS2, Dainn Woo, BS3, Dennis Vasquez-Montes, MS, BA3, Michelle C. Marks, PT4, Thomas J. Errico, MD5, Paul D. Sponseller, MD6; 1 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 2 Royal Children’s Hospital, Melbourne, Victoria, Australia; 3 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 4 Setting Scoliosis Straight, San Diego, CA, US; 5 Center for Spinal Disorders, Orthopedic Surgery, Nicklaus Children’s Hospital, Miami, FL, US; 6 Baltimore, MD, US BACKGROUND CONTEXT: Cerebral palsy (CP) can be described as a “static encephalopathy with progressive musculoskeletal pathology.” Nonambulant children (GMFCS IV&V) have high rates of both spastic hip disease and neuromuscular scoliosis. Adult sagittal spinal deformity correction is known to cause acetabular retroversion and reduced pelvic tilt, resulting in increased rates of prosthetic hip dislocation; however, the role of spinal alignment on hip status in CP remains unknown. PURPOSE: To identify surgical factors and postoperative spinal alignment parameters that are associated with worsening postoperative hip status (WHS) (ie, subluxation, dislocation or resection) after spinal fusion. STUDY DESIGN/SETTING: Prospective multicenter outcomes study of nonambulant CP patients (GMFCS IV&V) requiring spinal fusion. PATIENT SAMPLE: A total of 142 operative CP patients with preoperative, 6-week, 1Y, 2Y and 5Y postoperative follow-up. OUTCOME MEASURES: Postoperative spinal alignment parameters associations with WHS up to 5Y postoperatively. METHODS: WHS was defined by permutations of baseline and 1Y, 2Y and 5Y hip status of left and right hips by a change from either a normal hip at baseline (BL) that became subluxated, dislocated or resected at postop intervals; or if a subluxated hip at BL became dislocated or resected at postop intervals. Hip status up to 5Y postop was analyzed according to age, sex, coronal spinal alignment (major curve Cobb, pelvic obliquity), sagittal spinal alignment (thoracic kyphosis, T12-S1 lumbar lordosis, C7S1 sagittal vertical axis), Risser score, hip position at rest, upper and lowerinstrumented vertebrae (UIV&LIV), levels fused and fusion to the sacrum. Potential cutoff values for alignment parameters at which the relationship with hip status was determined using receiver operating characteristic (ROC) curves. Logistic regression was used to determine odds ratios for predictors of WHS. RESULTS: Of 142 patients (mean age 13.7§2.5, 48.3% female), 36 (25.4%) had WHS postoperatively. 7 had reoperation of their spinal fusion, 3 for loose screws/bolts and 4 for prominent instrumentation. ROC curve analysis and multivariate logistic regression demonstrated that the only spino-pelvic alignment parameter that significantly correlated with WHS was lumbar hyperlordosis (T12-L5) >60˚ (p=.015), OR=2.61 (CI 1.195.75). Assessment of all patients demonstrated an increase in pre- to postop LL. Change in LL pre- to postoperative was no different between groups (p=.643), however the WHS group was more lordotic at baseline and
313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly Paramjit Singh, MD, MA1, John Ibrahim2, Deeptee Jain, MD3, Paul Eichenseer, DO3, Mayur Kardile, MD2, Shane Burch, MD4, Alexander A. Theologis, MD5, Sigurd H. Berven, MD6; 1 USC Orthopaedic Surgery, Los Angeles, CA, US; 2 San Francisco, CA, US; 3 Ortho Nuero, Dublin, OH, US; 4 University of California San Francisco, San Francisco, CA, US; 5 UCSF Spine Center, San Francisco, CA, US; 6 UCSF, Dept of Orthopaedic Surgery, San Francisco, CA, US BACKGROUND CONTEXT: Factors that influence length of stay (LOS), readmission, and reoperation after adult spinal deformity (ASD) operations are important to define in order to optimize outcomes and control costs. PURPOSE: To identify predictors of LOS and 30-day and 90-day readmissions and reoperations following ASD operations. STUDY DESIGN/SETTING: Single-center retrospective cohort. PATIENT SAMPLE: Adults age >60 years who underwent operation (>3 levels) for lumbar spinal pathology. OUTCOME MEASURES: Length of stay, reoperations, and readmissions at 30-days and 90-days post-operatively. METHODS: Adults age>60 years who underwent operation (>3 levels) for lumbar spinal pathology between April 2015 and July 2017 at a single institution for ASD were reviewed. Demographics, comorbidities and surgical invasiveness were assessed for each patient and used as predictor variables for LOS and 30-day and 90-day readmissions and reoperations. RESULTS: The study included 100 patients (avg age 69§6.8 years, male32). Average LOS was 9.9 days (range, 4-101 days). Rates of readmission at 30-days and 90-days were 10% and 13%, respectively. Rates of reoperation at 30-days and 90-days were 7% and 11%, respectively. Preoperative factors significantly associated with LOS were age>74, history of wound healing difficulty, liver disease, and respiratory disease. Readmissions at 30-days were significantly associated with history of surgical site infection. Readmissions at 90-days were significantly associated with a history of renal disease and rheumatologic disorders. Reoperations at 30-days were significantly associated with a history of renal disease and preoperative narcotic dosages, as expressed by Morphine Milligram Equivalents, greater than 50mg. Reoperations at 90-days were significantly associated with history of renal disease and rheumatologic disorders. CONCLUSIONS: In this single-center experience, preoperative factors associated with hospital LOS and 30-day and 90-day readmissions and revisions after operations for ASD span multiple domains including age, medical comorbidities and social factors. This information may be used to guide preoperative optimization and risk adjustment within alternative payment models. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.330
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.