- Email: [email protected]
Clinical and Surgical Predictors of Complications following Surgery for the Treatment of Cervical Spondylotic Myelopathy: Results from the Multicenter, Prospective AOSpine International Study of 479 Patients
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S PURPOSE: This report examines the use of medial edge of C1 posterior arch (MEC1) as a fixed and easy reference for the entry point of ALM screw. STUDY DESIGN/SETTING: Interventional study. PATIENT SAMPLE: Ten adult human fresh cadavers were utilized. OUTCOME MEASURES: Screw placement accuracy into ALM using another O-arm 3D imaging. METHODS: Posterior exposure of ALM of all cadavers was performed. O-arm 3D imaging was performed for anatomy verification. Entry point was 2-3 mm lateral to MEC1. It was 1mm medial to a nutrient vessel foramen frequently found (but not well described previously). The trajectory was guided by inferior arch border (IBC1) into ALM. Multiaxial vertex screws (Medtronic, USA) were inserted perpendicular to ALM. RESULTS: 20 screws were successfully inserted within ALM. No encroachment found into the spinal canal or foramen transversarium. 2 screws were superiorly directed and violated the occipitocervical joint. They were not parallel to C1 arch. CONCLUSIONS: The MEC1 provides a fixed and easy landmark for ALM instrumentation. IBC1 also provides a guide for the screw trajectory. This may avoid extensive dissection in a tight area that has a rich venous plexus. Biomechanical studies are required to determine the pull out strength of these screws compare to standard techniques. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
241S
complications were on average older (57.91610.90 years) and had a higher BMI (26.7164.57 kg/m2) compared to patients without complications 56.06612.09 years, 25.6064.54 kg/m2), although these relationships did not reach statistical significance (age, OR: 1.01, p50.21; BMI, OR: 1.05, p50.10). Patients with more severe myelopathy (odds ratio: 0.94, p50.14) or a longer duration of symptoms (odds ratio: 1.14, p50.14) were not at a higher risk of experiencing a complication perioperatively. Univariately, the major clinical risk factors were ossification of the posterior longitudinal ligament (OPLL) (p50.055), the number of comorbidities (p50.0018), co-morbidity score (p50.0060), diabetes (p50.0008), and co-existing gastrointestinal (p50.039) and cardiovascular (p50.046) disorders. Patients undergoing a two-stage surgery (p50.0023) and those with a longer operative duration (p50.0002) were also at a greater risk of perioperative complications. A final prediction model consisted of diabetes (odds ratio51.96, p50.060), number of co-morbidities (odds ratio51.20, p50.069), operative duration (odds ratio51.005,p50.0015), and OPLL (odds ratio51.75, p50.040). CONCLUSIONS: Patients undergoing surgery for CSM are at a higher risk of perioperative complications if they have a greater number of comorbidities, co-existing diabetes, OPLL and a longer operative duration. This information can be used by surgeons to discuss the risks and benefits of surgery with their patients; to plan case-specific preventive strategies; and to ensure appropriate management in the postoperative period. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2015.07.359 http://dx.doi.org/10.1016/j.spinee.2015.07.360
P123. Clinical and Surgical Predictors of Complications following Surgery for the Treatment of Cervical Spondylotic Myelopathy: Results from the Multicenter, Prospective AOSpine International Study of 479 Patients Michael G. Fehlings, MD, PhD, FRCSC1, Lindsay Tetreault2, Branko Kopjar, MD, PhD3, Pierre Cote, DPT, PhD4, Paul M. Arnold, MD5, Natalia Nugaeva, PhD6; 1Toronto Western Hospital, Toronto, ON, Canada; 2 University of Toronto, Oakville, ON, Canada; 3University of Washington, Seattle, WA, US; 4Toronto Western Research Institute, Toronto, ON, Canada; 5University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US; 6University of Toronto, Toronto, ON, Canada BACKGROUND CONTEXT: Although surgery for the treatment of cervical spondylotic myelopathy (CSM) is generally safe and effective, complications do occur in 11%-38% of patients. Knowledge of important clinical and surgical predictors of complications will help clinicians identify high-risk patients and institute appropriate prevention plans. PURPOSE: This study aims to identify important clinical and surgical predictors of perioperative complications in patients with CSM. STUDY DESIGN/SETTING: Analysis of the prospective, multicenter AOSpine CSM-International study. PATIENT SAMPLE: 479 symptomatic CSM patients were enrolled in the prospective CSM-International study at 16 global sites. All received surgical decompression of the cervical spine and were followed for 2-years postoperatively. OUTCOME MEASURES: Perioperative complications, defined as surgery-related events occurring within 30 days of surgery. METHODS: A panel of physicians reviewed all adverse events and classified each one as either related to surgery, related to CSM or unrelated. Univariate analyses were performed to determine demographic and surgical differences between patients who experienced a perioperative complication and those who did not. A complication prediction rule was developed using multiple logistic regression. RESULTS: 78 patients experienced 89 perioperative complications (16.25%). The most common complications were dysphagia (4.38%), dural tear (2.92%) and superficial infection (2.09%). Patients with
P124. Risk Factors for Hospital-Acquired Conditions (HAC) and Associated Complications following Anterior Cervical Discectomy and Fusion (ACDF) Dante M. Leven, DO, PT1, Nathan J. Lee, BS2, Jeremy Steinberger, MD3, Branko Skovrlj, MD4, Javier Guzman, BS2, Parth Kothari, BS2, John I. Shin, BS1, Samuel K. Cho, MD5; 1Mount Sinai School of Medicine, New York, NY, US; 2Mount Sinai School of Medicine, New York, NY, US; 3 New York, NY, US; 4Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 5Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Considerable controversy has surfaced regarding patients’ developing a hospital-acquired condition (HAC) postoperatively and they are associated with inferior patient outcomes. The three most common conditions are surgical site infections (SSI), deep vein thromboembolism (VTE) and urinary tract infections (UTI). The most common surgical procedure of the cervical spine is ACDF and consistent risk factors for these postoperative events have not been identified utilizing a large database. PURPOSE: Our objective was to analyze the incidence and risk factors associated with developing a HAC within 30 days following ACDF. STUDY DESIGN/SETTING: Retrospective analysis of prospectively collected data. PATIENT SAMPLE: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients O 18 years old undergoing elective ACDF. OUTCOME MEASURES: Development of complications, mortality and HACs within 30 days following ACDF. METHODS: This was a retrospective analysis of prospectively collected data from the NSQIP database of patients O 18 years old undergoing elective ACDF between 2005 and 2012. Patient baseline factors, perioperative data, preoperative labs and postoperative course were recorded. Patients with SSI, VTE or UTI were compared using multivariate logistic regression analysis with significance defined as p ! 0.05. Odds ratio (OR) was calculated with a 95% confidence interval. RESULTS: 3,845 patients met inclusion criteria with 50.3% of patients male and 80.5% performed as inpatient procedures. Overall rate of HAC
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
241S
complications were on average older (57.91610.90 years) and had a higher BMI (26.7164.57 kg/m2) compared to patients without complications 56.06612.09 years, 25.6064.54 kg/m2), although these relationships did not reach statistical significance (age, OR: 1.01, p50.21; BMI, OR: 1.05, p50.10). Patients with more severe myelopathy (odds ratio: 0.94, p50.14) or a longer duration of symptoms (odds ratio: 1.14, p50.14) were not at a higher risk of experiencing a complication perioperatively. Univariately, the major clinical risk factors were ossification of the posterior longitudinal ligament (OPLL) (p50.055), the number of comorbidities (p50.0018), co-morbidity score (p50.0060), diabetes (p50.0008), and co-existing gastrointestinal (p50.039) and cardiovascular (p50.046) disorders. Patients undergoing a two-stage surgery (p50.0023) and those with a longer operative duration (p50.0002) were also at a greater risk of perioperative complications. A final prediction model consisted of diabetes (odds ratio51.96, p50.060), number of co-morbidities (odds ratio51.20, p50.069), operative duration (odds ratio51.005,p50.0015), and OPLL (odds ratio51.75, p50.040). CONCLUSIONS: Patients undergoing surgery for CSM are at a higher risk of perioperative complications if they have a greater number of comorbidities, co-existing diabetes, OPLL and a longer operative duration. This information can be used by surgeons to discuss the risks and benefits of surgery with their patients; to plan case-specific preventive strategies; and to ensure appropriate management in the postoperative period. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2015.07.359 http://dx.doi.org/10.1016/j.spinee.2015.07.360
P123. Clinical and Surgical Predictors of Complications following Surgery for the Treatment of Cervical Spondylotic Myelopathy: Results from the Multicenter, Prospective AOSpine International Study of 479 Patients Michael G. Fehlings, MD, PhD, FRCSC1, Lindsay Tetreault2, Branko Kopjar, MD, PhD3, Pierre Cote, DPT, PhD4, Paul M. Arnold, MD5, Natalia Nugaeva, PhD6; 1Toronto Western Hospital, Toronto, ON, Canada; 2 University of Toronto, Oakville, ON, Canada; 3University of Washington, Seattle, WA, US; 4Toronto Western Research Institute, Toronto, ON, Canada; 5University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US; 6University of Toronto, Toronto, ON, Canada BACKGROUND CONTEXT: Although surgery for the treatment of cervical spondylotic myelopathy (CSM) is generally safe and effective, complications do occur in 11%-38% of patients. Knowledge of important clinical and surgical predictors of complications will help clinicians identify high-risk patients and institute appropriate prevention plans. PURPOSE: This study aims to identify important clinical and surgical predictors of perioperative complications in patients with CSM. STUDY DESIGN/SETTING: Analysis of the prospective, multicenter AOSpine CSM-International study. PATIENT SAMPLE: 479 symptomatic CSM patients were enrolled in the prospective CSM-International study at 16 global sites. All received surgical decompression of the cervical spine and were followed for 2-years postoperatively. OUTCOME MEASURES: Perioperative complications, defined as surgery-related events occurring within 30 days of surgery. METHODS: A panel of physicians reviewed all adverse events and classified each one as either related to surgery, related to CSM or unrelated. Univariate analyses were performed to determine demographic and surgical differences between patients who experienced a perioperative complication and those who did not. A complication prediction rule was developed using multiple logistic regression. RESULTS: 78 patients experienced 89 perioperative complications (16.25%). The most common complications were dysphagia (4.38%), dural tear (2.92%) and superficial infection (2.09%). Patients with
P124. Risk Factors for Hospital-Acquired Conditions (HAC) and Associated Complications following Anterior Cervical Discectomy and Fusion (ACDF) Dante M. Leven, DO, PT1, Nathan J. Lee, BS2, Jeremy Steinberger, MD3, Branko Skovrlj, MD4, Javier Guzman, BS2, Parth Kothari, BS2, John I. Shin, BS1, Samuel K. Cho, MD5; 1Mount Sinai School of Medicine, New York, NY, US; 2Mount Sinai School of Medicine, New York, NY, US; 3 New York, NY, US; 4Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 5Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Considerable controversy has surfaced regarding patients’ developing a hospital-acquired condition (HAC) postoperatively and they are associated with inferior patient outcomes. The three most common conditions are surgical site infections (SSI), deep vein thromboembolism (VTE) and urinary tract infections (UTI). The most common surgical procedure of the cervical spine is ACDF and consistent risk factors for these postoperative events have not been identified utilizing a large database. PURPOSE: Our objective was to analyze the incidence and risk factors associated with developing a HAC within 30 days following ACDF. STUDY DESIGN/SETTING: Retrospective analysis of prospectively collected data. PATIENT SAMPLE: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients O 18 years old undergoing elective ACDF. OUTCOME MEASURES: Development of complications, mortality and HACs within 30 days following ACDF. METHODS: This was a retrospective analysis of prospectively collected data from the NSQIP database of patients O 18 years old undergoing elective ACDF between 2005 and 2012. Patient baseline factors, perioperative data, preoperative labs and postoperative course were recorded. Patients with SSI, VTE or UTI were compared using multivariate logistic regression analysis with significance defined as p ! 0.05. Odds ratio (OR) was calculated with a 95% confidence interval. RESULTS: 3,845 patients met inclusion criteria with 50.3% of patients male and 80.5% performed as inpatient procedures. Overall rate of HAC
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.