- Email: [email protected]
72. Operation timing affects outcomes after adult spinal deformity surgery
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58 2
2 1
Goodwin, MD, PhD , Isaac O. Karikari, MD ; Duke University, Durham, NC, US; 2 Duke University Medical Center, Durham, NC, US BACKGROUND CONTEXT: The anterior column realignment (ACR) technique is increasingly becoming popular for treating patients with flatback deformity. The degreed of correction achieved with ACR performed at L2-3 disc has not been well studied. PURPOSE: The purpose of this study was to compare the degree of deformity correction and perioperative outcomes between ACR and PSO being performed at L2 for iatrogenic flatback deformity. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: N = 27 patients, 9 ACR and 18 PSO. The patients were matched 1:2 (ACR:PSO) based on preoperative deformity parameters. OUTCOME MEASURES: Primary outcome: Lumbo-pelvic parameters (LL-PI mismatch, SVA, PT). Secondary outcomes: estimated blood loss, transfusion requirement, length of hospital stay, operative time, postoperative complication, and hospital readmission rates. METHODS: Patients were identified between 2012 and 2016 who underwent revision surgery using either the PSO or ACR technique at the L2-3 level to correct sagittal deformity. Patients who underwent ACR were matched to PSO patients in a 1:2 fashion based on preoperative lumbar lordosis (LL) and lumbar lordosis pelvis incidence (LL-PI) mismatch. Patient demographics, surgical variables, pre- and postoperative radiographic parameters, and perioperative characteristics were compared between the treatment groups using t-tests, chi-square tests, and multivariable regression models. RESULTS: The cohort included 27 patients; 9 ACR patients matched to 18 PSO patients. The PSO group achieved a greater degree of lumbar lordosis compared to the ACR group (31˚ vs 14.23˚, p<0.001). The average LL-PI mismatch following correction was 11.96 in the PSO group and 17.7 in the ACR group. PSO resulted in a greater correction of the SVA (8.15cm vs 1.93cm, p=0.003). ACR surgery was associated with decreased blood loss (p<0.001), intraoperative transfusion requirements (p=0.004), length of hospitalization (p=0.007), and perioperative complication rate (p=0.001). All stated conclusions held true when controlling for number of levels fused (10.6 levels in PSO vs 7.3 in ACR). CONCLUSIONS: PSO surgery resulted in significantly improved lumbar lordosis and sagittal alignment correction compared to the ACR group. While ACR resulted in some improvement of lumbar lordosis, it resulted in residual lumbo-pelvic mismatch compared with patients treated with PSO. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.083
71. High preoperative T1 slope is a marker for global sagittal malalignment Ethan W. Ayres, MPH1, Dainn Woo, BS1, Dennis Vasquez-Montes, MS, BA1, Avery Brown, BS1, Haddy Alas, BS1, Edem J. Abotsi, BA1, Christopher Varlotta, BS1, Cole Bortz, BA2, Erik Wang, BA1, Katherine E. Pierce, BS2, Michael Smith, MD2, Yong H. Kim, MD1, Aaron J. Buckland, MBBS, FRACS1, Themistocles S. Protopsaltis, MD1; 1 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 2 New York, NY, US BACKGROUND CONTEXT: T1 slope (T1S) is a parameter typically discussed in the context of cervical deformity and is correlated with health-related quality of life outcomes. Although prior research has suggested that T1S is related to global alignment, a definition for “high” T1S has not been established. Most patients undergoing cervical surgery do not receive full spine imaging. Therefore, it would be beneficial to have a parameter obtained from cervical radiographs that is associated with thoracolumbar malalignment. PURPOSE: To define a threshold for T1S that is associated with thoracolumbar malalignment
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STUDY DESIGN/SETTING: Retrospective review of a prospective adult spinal deformity(ASD) database PATIENT SAMPLE: A total of 226 preoperative ASD patients. OUTCOME MEASURES: Baseline sagittal alignment: T1S, thoracic kyphosis(TK), C7 sagittal vertical axis (SVA), T1 pelvic angle (TPA), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL). METHODS: A database of preoperative ASD patients was analyzed. Patients without preoperative full-spine images were excluded. Measures obtained from standing lateral radiographs included: T1S, TK, SVA, TPA, PT, and PI-LL. T1S was correlated to each of these parameters. Decision tree analysis was then used to determine the T1S corresponding to published thresholds for high TK (40˚), SVA (40mm), TPA (25˚), and PT (25ׄ˚). Alignment between high and normal T1S patients was compared via t-tests and chi-square tests. RESULTS: A total of 226 preoperative ASD patients were included (mean 58§16y 62% F). At baseline, 30% had high TK, 54% had high SVA, 46% had high TPA, and 46% had high PT. Larger T1S was significantly correlated with greater SVA (R=.365) TPA (R=.302), TK (R=.606), and PT (R=.230)(all p<.001). Decision tree analysis yielded a threshold of 30˚ for high T1S, which 50% of patients had. Compared to patients with T1S<30˚, those with T1S>30˚ had higher TK (41.5˚ vs 25.8˚), SVA (78.7mm vs 33.7mm), TPA (27.6˚ vs 18.3˚), and PT (26.3˚ vs 20.8˚), and PI-LL (18.2˚ vs 11.7˚)(all p<0.05). Seventy-nine percent of patients with high T1S had high TK (T1S<30= 13%), 69% had high SVA (T1S<30=38%), 66% had high TPA (T1S<30= 37%), 60% had PT>25˚ (T1S<30= 42%), and 47% had PI-LL>20˚ (T1S<30= 34%) (all p<.05). T1S was not associated with PI. CONCLUSIONS: Similar to previous studies higher T1S was associated with worse global alignment. T1S was most strongly associated with TK. A T1S=30˚ corresponds to thresholds for high TK, SVA, TPA, and PT. Therefore, surgeons should consider obtaining full-spine radiographs if a T1S>30˚ is present on cervical imaging. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.084
72. Operation timing affects outcomes after adult spinal deformity surgery Tina Raman, MD1, Igor Dolgalev, MS1, Thomas J. Errico, MD2; 1 New York, NY, US; 2 Center for Spinal Disorders, Orthopedic Surgery, Nicklaus Children’s Hospital, Miami, FL, US BACKGROUND CONTEXT: Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures in patients with multiple comorbidities. Postoperative complications can range from minor complications such as ileus, to significant neurologic injury. ASD surgery is commonly scheduled for weekdays, with first start times. It is unclear if there is any effect of time-related performance impairment on the surgical team. PURPOSE: To investigate the rate of complications based on day of the week, or time of day, that ASD surgeries are performed. STUDY DESIGN/SETTING: Retrospective review of prospectively collected single center database. PATIENT SAMPLE: 1040 ASD patients (Age: 46 § 23; BMI 25 § 7, ASA 2.5 § 0.6, Levels fused 10 § 4, Revision procedure: 9%, 3CO: 13%) were included in the analysis. OUTCOME MEASURES: Overall complication rate, and 90-day readmission and reoperation rates. METHODS: We collected start times and day of the week for ASD cases occurring at our institution from 2011-2018. First start was designated as any case starting at 7:30 AM; late start was designated as any case starting 11 AM and after. Day of week was modelled as a categorical variable, with Monday as the reference group. RESULTS: 1040 ASD patients (Age: 46 § 23; BMI 25 § 7, ASA 2.5 § 0.6, Levels fused 10 § 4, Revision procedure: 9%, 3CO: 13%) were included. After controlling for patient and case characteristics, there
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.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58
was no association between day of week and length of stay, or 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases (n=269) had higher rates of 90-day readmission (10.4% vs 6.0%, p=0.02), reoperation (11.9% vs 6.6%, p=0.008), and neurologic injury (5.2% vs 2.3%, 0.019). Sub-analysis of types of neurologic complications encountered demonstrated that in late start cases, there was a higher rate of postoperative radiculopathy (3.3% vs 0.9%, p=0.007), and residual central or foraminal stenosis (2.2% vs 0.6%, p=0.029). Late start cases were predictive of increased risk for 90-day readmission (OR 1.8, CI: 1.1-3.0, p=0.02), unplanned reoperation (OR 1.9, CI:1.2-3.1, p=0.009), and neurologic complication (OR 2.1, CI: 1.0-4.3, p=0.046). CONCLUSIONS: Risk of morbidity after elective ASD surgery is not associated with day of the week, in an analysis of over 1000 cases. A late OR start time was predictive of increased risk for neurologic complication, and 90-day readmission and unplanned reoperation. Well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.085
73. Tranexamic acid in patients undergoing adult spinal deformity surgery Tina Raman, MD1, Aaron J. Buckland, MBBS, FRACS2, Christopher Varlotta, BS2, Peter G. Passias, MD3, Thomas J. Errico, MD4; 1 New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 NY Spine Institute, NYU Langone Health, New York, NY, US; 4 Center for Spinal Disorders, Orthopedic Surgery, Nicklaus Children’s Hospital, Miami, FL, US BACKGROUND CONTEXT: Antifibrinolytic agents are used during ASD surgery to minimize blood loss and transfusion requirements. Tranexamic acid (TXA) reduces the risk of blood loss and transfusion after ASD surgery, but there persists concern for prothrombotic effects, myocardial infarction, stroke, and postoperative neurologic events including seizures. PURPOSE: To investigate perioperative blood loss and transfusion after TXA for ASD surgery. STUDY DESIGN/SETTING: Retrospective review of prospectively collected single center database. PATIENT SAMPLE: 469 patients who received TXA, and 354 patients who did not receive TXA. OUTCOME MEASURES: Perioperative blood loss and blood product transfusion rate, and complications. METHODS: Using a single-institution multi-surgeon database, we performed a retrospective review of patients undergoing ASD surgery from 2011-2018. We identified 469 patients who received TXA, and 354 patients who did not receive TXA. We investigated perioperative blood loss and blood product transfusion rate, and complications occurring after surgery. RESULTS: There was no significant difference in age, BMI, or frailty between the TXA (age: 45 § 23, BMI: 25 § 6) and non-TXA group (age: 47 § 24, BMI: 26 § 7). The prevalence of coronary artery disease, chronic kidney disease, and history of pulmonary embolism was higher in the nonTXA group, presumably due to surgeon preoperative screening, with no difference in other medical comorbidities. There were more revision surgeries and pelvic fixation procedures in the TXA group, with no other differences in surgical complexity. The group that received TXA had significantly lower EBL (1693 § 1343 mL vs 2009 § 1892 mL, p=0.019), and were transfused less platelets intraoperatively (.07 § .3 U vs 0.25 § 0.86 U, p=0.012). There was no difference in rates of perioperative pRBC transfusion between the groups. The most common complications in both groups were ileus and urinary retention. There was no difference in rate of
thrombotic, cardiac, or renal complications, or seizures between the two groups. There was no significant difference in 90-day complication, readmission, or revision rates. CONCLUSIONS: Among patients undergoing ASD surgery, TXA was associated with a lower estimated blood loss, without a higher risk for any morbid event. To our knowledge, this is the largest study to date to evaluate the safety of TXA for ASD surgery. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication. https://doi.org/10.1016/j.spinee.2019.05.086
Wednesday, September 25, 2019 10:35 AM − 12:00 PM Interdisciplinary Care 74. Trends in utilization of radiotherapy for spinal meningiomas: insights from the 2004-2015 National Cancer Database Yagiz U. Yolcu, MD1, Anshit Goyal, MD2, Mohammed Ali Alvi, MD2, F M Moinuddin, PhD2, Mohamad Bydon, MD2; 1 Rochester, MN, US; 2 Mayo Clinic, Rochester, MN, US BACKGROUND CONTEXT: Meningiomas are one of the most frequently encountered tumor types in the spinal cord, accounting for 20-25% of all spine tumors. Treatment strategies may include observation (active surveillance), surgical excision, radiotherapy/radiosurgery or combination of modalities. Surgery continues to be the most frequently utilized treatment modality, but radiotherapy is also an available treatment option most commonly reserved for high grade or recurrent lesions. Moreover, recent studies have reported on the useful role of radiosurgery for local control and symptom relief for spinal meningioma. PURPOSE: To evaluate national utilization trends of radiotherapy/radiosurgery, investigate possible factors associated with its use in patients with spinal meningioma and its impact on survival for atypical tumors. STUDY DESIGN/SETTING: Retrospective study from the national cancer database (NCDB). PATIENT SAMPLE: Patients with spinal meningiomas in the 2004-2015 National Cancer Database. OUTCOME MEASURES: Outcome measures were utilization rates of radiotherapy and radiosurgery and overall survival. METHODS: The National Cancer Database (NCDB) was queried for patients diagnosed with spinal meningioma between 2004 and 2015 using ICD-O-3 topographical codes of 70.1, 72.0 and 72.1 and histological codes of 9350-9535 and 9537-9539. Patients receiving radiation in addition to surgery and patients receiving radiation as the only treatment modality were analyzed for factors associated with each treatment. RESULTS: We found a total of 269 patients who received any type of radiation. Patients were divided into two main groups for the analysis as radiation alone 137 (51.1%) and radiation plus surgery 131 (48.9%). Age >69 (p=0.03), male sex (p=0.04), tumor size >6 cm (p=0.008) were found to be associated with significantly higher odds while Charlson score >=2 (p=0.04) to be associated with significantly lower odds of receiving radiation alone. In addition, a higher tumor size (2-3 cm, p=0.001; 3-4 cm, p<0.001; 4-5 cm, p<0.001; 5-6 cm, p<0.001; and >6 cm, p<0.001; ref=1-2 cm), as well as borderline (p<0.001) and malignant tumors (p<0.001) were found to be associated with increased odds of receiving radiation in addition to surgery. Receving adjuvant radiation following surgery was associated with decreased survival (71 vs 107 months, p=0.0003). Cox proportional hazards analysis adjusted for age, sex, Charlson score, extent of resection, tumor size and behavior (borderline vs malignant revealed higher mortality in patients receiving adjuvant radiation following surgical resection of borderline/ malignant tumors (HR=1.98, CI: 1.01-3.89, p=0.045). CONCLUSIONS: The current analysis from a national cancer database revealed a small increase in utilization of radiation for management, without benefit to overall survival. Higher tumor size and borderline/malignant behavior were found to be associated with increased utilization. The
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.
2 1
Goodwin, MD, PhD , Isaac O. Karikari, MD ; Duke University, Durham, NC, US; 2 Duke University Medical Center, Durham, NC, US BACKGROUND CONTEXT: The anterior column realignment (ACR) technique is increasingly becoming popular for treating patients with flatback deformity. The degreed of correction achieved with ACR performed at L2-3 disc has not been well studied. PURPOSE: The purpose of this study was to compare the degree of deformity correction and perioperative outcomes between ACR and PSO being performed at L2 for iatrogenic flatback deformity. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: N = 27 patients, 9 ACR and 18 PSO. The patients were matched 1:2 (ACR:PSO) based on preoperative deformity parameters. OUTCOME MEASURES: Primary outcome: Lumbo-pelvic parameters (LL-PI mismatch, SVA, PT). Secondary outcomes: estimated blood loss, transfusion requirement, length of hospital stay, operative time, postoperative complication, and hospital readmission rates. METHODS: Patients were identified between 2012 and 2016 who underwent revision surgery using either the PSO or ACR technique at the L2-3 level to correct sagittal deformity. Patients who underwent ACR were matched to PSO patients in a 1:2 fashion based on preoperative lumbar lordosis (LL) and lumbar lordosis pelvis incidence (LL-PI) mismatch. Patient demographics, surgical variables, pre- and postoperative radiographic parameters, and perioperative characteristics were compared between the treatment groups using t-tests, chi-square tests, and multivariable regression models. RESULTS: The cohort included 27 patients; 9 ACR patients matched to 18 PSO patients. The PSO group achieved a greater degree of lumbar lordosis compared to the ACR group (31˚ vs 14.23˚, p<0.001). The average LL-PI mismatch following correction was 11.96 in the PSO group and 17.7 in the ACR group. PSO resulted in a greater correction of the SVA (8.15cm vs 1.93cm, p=0.003). ACR surgery was associated with decreased blood loss (p<0.001), intraoperative transfusion requirements (p=0.004), length of hospitalization (p=0.007), and perioperative complication rate (p=0.001). All stated conclusions held true when controlling for number of levels fused (10.6 levels in PSO vs 7.3 in ACR). CONCLUSIONS: PSO surgery resulted in significantly improved lumbar lordosis and sagittal alignment correction compared to the ACR group. While ACR resulted in some improvement of lumbar lordosis, it resulted in residual lumbo-pelvic mismatch compared with patients treated with PSO. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.083
71. High preoperative T1 slope is a marker for global sagittal malalignment Ethan W. Ayres, MPH1, Dainn Woo, BS1, Dennis Vasquez-Montes, MS, BA1, Avery Brown, BS1, Haddy Alas, BS1, Edem J. Abotsi, BA1, Christopher Varlotta, BS1, Cole Bortz, BA2, Erik Wang, BA1, Katherine E. Pierce, BS2, Michael Smith, MD2, Yong H. Kim, MD1, Aaron J. Buckland, MBBS, FRACS1, Themistocles S. Protopsaltis, MD1; 1 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 2 New York, NY, US BACKGROUND CONTEXT: T1 slope (T1S) is a parameter typically discussed in the context of cervical deformity and is correlated with health-related quality of life outcomes. Although prior research has suggested that T1S is related to global alignment, a definition for “high” T1S has not been established. Most patients undergoing cervical surgery do not receive full spine imaging. Therefore, it would be beneficial to have a parameter obtained from cervical radiographs that is associated with thoracolumbar malalignment. PURPOSE: To define a threshold for T1S that is associated with thoracolumbar malalignment
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STUDY DESIGN/SETTING: Retrospective review of a prospective adult spinal deformity(ASD) database PATIENT SAMPLE: A total of 226 preoperative ASD patients. OUTCOME MEASURES: Baseline sagittal alignment: T1S, thoracic kyphosis(TK), C7 sagittal vertical axis (SVA), T1 pelvic angle (TPA), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL). METHODS: A database of preoperative ASD patients was analyzed. Patients without preoperative full-spine images were excluded. Measures obtained from standing lateral radiographs included: T1S, TK, SVA, TPA, PT, and PI-LL. T1S was correlated to each of these parameters. Decision tree analysis was then used to determine the T1S corresponding to published thresholds for high TK (40˚), SVA (40mm), TPA (25˚), and PT (25ׄ˚). Alignment between high and normal T1S patients was compared via t-tests and chi-square tests. RESULTS: A total of 226 preoperative ASD patients were included (mean 58§16y 62% F). At baseline, 30% had high TK, 54% had high SVA, 46% had high TPA, and 46% had high PT. Larger T1S was significantly correlated with greater SVA (R=.365) TPA (R=.302), TK (R=.606), and PT (R=.230)(all p<.001). Decision tree analysis yielded a threshold of 30˚ for high T1S, which 50% of patients had. Compared to patients with T1S<30˚, those with T1S>30˚ had higher TK (41.5˚ vs 25.8˚), SVA (78.7mm vs 33.7mm), TPA (27.6˚ vs 18.3˚), and PT (26.3˚ vs 20.8˚), and PI-LL (18.2˚ vs 11.7˚)(all p<0.05). Seventy-nine percent of patients with high T1S had high TK (T1S<30= 13%), 69% had high SVA (T1S<30=38%), 66% had high TPA (T1S<30= 37%), 60% had PT>25˚ (T1S<30= 42%), and 47% had PI-LL>20˚ (T1S<30= 34%) (all p<.05). T1S was not associated with PI. CONCLUSIONS: Similar to previous studies higher T1S was associated with worse global alignment. T1S was most strongly associated with TK. A T1S=30˚ corresponds to thresholds for high TK, SVA, TPA, and PT. Therefore, surgeons should consider obtaining full-spine radiographs if a T1S>30˚ is present on cervical imaging. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.084
72. Operation timing affects outcomes after adult spinal deformity surgery Tina Raman, MD1, Igor Dolgalev, MS1, Thomas J. Errico, MD2; 1 New York, NY, US; 2 Center for Spinal Disorders, Orthopedic Surgery, Nicklaus Children’s Hospital, Miami, FL, US BACKGROUND CONTEXT: Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures in patients with multiple comorbidities. Postoperative complications can range from minor complications such as ileus, to significant neurologic injury. ASD surgery is commonly scheduled for weekdays, with first start times. It is unclear if there is any effect of time-related performance impairment on the surgical team. PURPOSE: To investigate the rate of complications based on day of the week, or time of day, that ASD surgeries are performed. STUDY DESIGN/SETTING: Retrospective review of prospectively collected single center database. PATIENT SAMPLE: 1040 ASD patients (Age: 46 § 23; BMI 25 § 7, ASA 2.5 § 0.6, Levels fused 10 § 4, Revision procedure: 9%, 3CO: 13%) were included in the analysis. OUTCOME MEASURES: Overall complication rate, and 90-day readmission and reoperation rates. METHODS: We collected start times and day of the week for ASD cases occurring at our institution from 2011-2018. First start was designated as any case starting at 7:30 AM; late start was designated as any case starting 11 AM and after. Day of week was modelled as a categorical variable, with Monday as the reference group. RESULTS: 1040 ASD patients (Age: 46 § 23; BMI 25 § 7, ASA 2.5 § 0.6, Levels fused 10 § 4, Revision procedure: 9%, 3CO: 13%) were included. After controlling for patient and case characteristics, there
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.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58
was no association between day of week and length of stay, or 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases (n=269) had higher rates of 90-day readmission (10.4% vs 6.0%, p=0.02), reoperation (11.9% vs 6.6%, p=0.008), and neurologic injury (5.2% vs 2.3%, 0.019). Sub-analysis of types of neurologic complications encountered demonstrated that in late start cases, there was a higher rate of postoperative radiculopathy (3.3% vs 0.9%, p=0.007), and residual central or foraminal stenosis (2.2% vs 0.6%, p=0.029). Late start cases were predictive of increased risk for 90-day readmission (OR 1.8, CI: 1.1-3.0, p=0.02), unplanned reoperation (OR 1.9, CI:1.2-3.1, p=0.009), and neurologic complication (OR 2.1, CI: 1.0-4.3, p=0.046). CONCLUSIONS: Risk of morbidity after elective ASD surgery is not associated with day of the week, in an analysis of over 1000 cases. A late OR start time was predictive of increased risk for neurologic complication, and 90-day readmission and unplanned reoperation. Well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.085
73. Tranexamic acid in patients undergoing adult spinal deformity surgery Tina Raman, MD1, Aaron J. Buckland, MBBS, FRACS2, Christopher Varlotta, BS2, Peter G. Passias, MD3, Thomas J. Errico, MD4; 1 New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 NY Spine Institute, NYU Langone Health, New York, NY, US; 4 Center for Spinal Disorders, Orthopedic Surgery, Nicklaus Children’s Hospital, Miami, FL, US BACKGROUND CONTEXT: Antifibrinolytic agents are used during ASD surgery to minimize blood loss and transfusion requirements. Tranexamic acid (TXA) reduces the risk of blood loss and transfusion after ASD surgery, but there persists concern for prothrombotic effects, myocardial infarction, stroke, and postoperative neurologic events including seizures. PURPOSE: To investigate perioperative blood loss and transfusion after TXA for ASD surgery. STUDY DESIGN/SETTING: Retrospective review of prospectively collected single center database. PATIENT SAMPLE: 469 patients who received TXA, and 354 patients who did not receive TXA. OUTCOME MEASURES: Perioperative blood loss and blood product transfusion rate, and complications. METHODS: Using a single-institution multi-surgeon database, we performed a retrospective review of patients undergoing ASD surgery from 2011-2018. We identified 469 patients who received TXA, and 354 patients who did not receive TXA. We investigated perioperative blood loss and blood product transfusion rate, and complications occurring after surgery. RESULTS: There was no significant difference in age, BMI, or frailty between the TXA (age: 45 § 23, BMI: 25 § 6) and non-TXA group (age: 47 § 24, BMI: 26 § 7). The prevalence of coronary artery disease, chronic kidney disease, and history of pulmonary embolism was higher in the nonTXA group, presumably due to surgeon preoperative screening, with no difference in other medical comorbidities. There were more revision surgeries and pelvic fixation procedures in the TXA group, with no other differences in surgical complexity. The group that received TXA had significantly lower EBL (1693 § 1343 mL vs 2009 § 1892 mL, p=0.019), and were transfused less platelets intraoperatively (.07 § .3 U vs 0.25 § 0.86 U, p=0.012). There was no difference in rates of perioperative pRBC transfusion between the groups. The most common complications in both groups were ileus and urinary retention. There was no difference in rate of
thrombotic, cardiac, or renal complications, or seizures between the two groups. There was no significant difference in 90-day complication, readmission, or revision rates. CONCLUSIONS: Among patients undergoing ASD surgery, TXA was associated with a lower estimated blood loss, without a higher risk for any morbid event. To our knowledge, this is the largest study to date to evaluate the safety of TXA for ASD surgery. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication. https://doi.org/10.1016/j.spinee.2019.05.086
Wednesday, September 25, 2019 10:35 AM − 12:00 PM Interdisciplinary Care 74. Trends in utilization of radiotherapy for spinal meningiomas: insights from the 2004-2015 National Cancer Database Yagiz U. Yolcu, MD1, Anshit Goyal, MD2, Mohammed Ali Alvi, MD2, F M Moinuddin, PhD2, Mohamad Bydon, MD2; 1 Rochester, MN, US; 2 Mayo Clinic, Rochester, MN, US BACKGROUND CONTEXT: Meningiomas are one of the most frequently encountered tumor types in the spinal cord, accounting for 20-25% of all spine tumors. Treatment strategies may include observation (active surveillance), surgical excision, radiotherapy/radiosurgery or combination of modalities. Surgery continues to be the most frequently utilized treatment modality, but radiotherapy is also an available treatment option most commonly reserved for high grade or recurrent lesions. Moreover, recent studies have reported on the useful role of radiosurgery for local control and symptom relief for spinal meningioma. PURPOSE: To evaluate national utilization trends of radiotherapy/radiosurgery, investigate possible factors associated with its use in patients with spinal meningioma and its impact on survival for atypical tumors. STUDY DESIGN/SETTING: Retrospective study from the national cancer database (NCDB). PATIENT SAMPLE: Patients with spinal meningiomas in the 2004-2015 National Cancer Database. OUTCOME MEASURES: Outcome measures were utilization rates of radiotherapy and radiosurgery and overall survival. METHODS: The National Cancer Database (NCDB) was queried for patients diagnosed with spinal meningioma between 2004 and 2015 using ICD-O-3 topographical codes of 70.1, 72.0 and 72.1 and histological codes of 9350-9535 and 9537-9539. Patients receiving radiation in addition to surgery and patients receiving radiation as the only treatment modality were analyzed for factors associated with each treatment. RESULTS: We found a total of 269 patients who received any type of radiation. Patients were divided into two main groups for the analysis as radiation alone 137 (51.1%) and radiation plus surgery 131 (48.9%). Age >69 (p=0.03), male sex (p=0.04), tumor size >6 cm (p=0.008) were found to be associated with significantly higher odds while Charlson score >=2 (p=0.04) to be associated with significantly lower odds of receiving radiation alone. In addition, a higher tumor size (2-3 cm, p=0.001; 3-4 cm, p<0.001; 4-5 cm, p<0.001; 5-6 cm, p<0.001; and >6 cm, p<0.001; ref=1-2 cm), as well as borderline (p<0.001) and malignant tumors (p<0.001) were found to be associated with increased odds of receiving radiation in addition to surgery. Receving adjuvant radiation following surgery was associated with decreased survival (71 vs 107 months, p=0.0003). Cox proportional hazards analysis adjusted for age, sex, Charlson score, extent of resection, tumor size and behavior (borderline vs malignant revealed higher mortality in patients receiving adjuvant radiation following surgical resection of borderline/ malignant tumors (HR=1.98, CI: 1.01-3.89, p=0.045). CONCLUSIONS: The current analysis from a national cancer database revealed a small increase in utilization of radiation for management, without benefit to overall survival. Higher tumor size and borderline/malignant behavior were found to be associated with increased utilization. The
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.