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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery
The Spine Journal 18 (2018) S70 S128 BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure for cervical spine pathology. Extended length of stay (LOS) and 90-day hospital readmission following ACDF are associated with increased costs and complications. In the setting of escalating health care costs spinal surgeons are becoming incentivized to minimize the overall cost of surgery. PURPOSE: To identify risk factors for extended LOS and 90-day readmissions following ACDF. STUDY DESIGN/SETTING: Retrospective. Single center. PATIENT SAMPLE: A total of 1,943 consecutive patients from 2013 to 2015. OUTCOME MEASURES: Length of stay and 90-day hospital readmissions. METHODS: We queried our institution’s medical records for patients who underwent ACDF from 2013 to 2015. Cases meeting inclusion criteria were subjected to chart review to obtain demographic and clinical information. Eligible patients were subset into two groups: LOS<2 and LOS>1 day. Demographic and clinical factors were compared between the LOS groups using Welch’s t-tests for continuous variables and chi squared tests for categorical variables. Logistic multivariable models were used to determine variables associated with extended LOS and 90-day readmission. RESULTS: Our sample included 1,943 patients; 281 (14.5%) had LOS>1, and 125 (6.4%) had a 90-day readmission. Risk factors associated with extended LOS included patient age (p<.001), African American race (p<.001), psychologic illness (p<.001), diabetes (p<.001), and CAD (p=.02). Risk factors significant for 90-day readmission included African American race (OR 1.69, p=.02), CHF (OR 4.6, p=.003), and COPD (OR 2.78, p=.004). CONCLUSIONS: Anterior cervical discectomy and fusion is a safe surgery with the 90-day hospital readmission rate being 6.4%. A total of 85.5% of patients were discharged home on the day of surgery or postoperative one. At risk patients for extended LOS and 90-day hospital readmissions should be recognized and medically optimized for surgery with the goal being to reduce postoperative complications and hospital costs. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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corpectomy, posterior or revision surgery were excluded. All patients underwent ACDF via the anterior approach with implants based on surgeon preference. Patients with identical surgery and discharge dates were grouped as SDD and admitted patients were grouped as same day admission (SDA). Using our electronic health record's analytics, readmissions in the 90-day postoperative period were identified. RESULTS: A total of 434 patients underwent one- or two-level ACDF from March 2016 to March 2017 of which 126 patients were SDD and 308 were SDA. Due to the protocol, baseline characteristics such as age, operative time and time in the recovery room was significantly different between the two groups. In each group there was one readmission during the 30-day postoperative period and the SDA group had one additional readmission in the 90-day postoperative period. This resulted in an overall, noninferior readmission rate of 0.8% in the SDD group and 0.6% in the SDA group (p=.86). CONCLUSIONS: Proper identification of patients suitable for outpatient ACDF using our protocol for patient selection and discharge results in a noninferior readmission rate. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.420
155. Same-day discharge after anterior cervical discectomy and fusion in suitable patients has similarly low readmission rates as admitted patients Kartik Shenoy, MD1, Abidemi Adenikinju, MD2, Ezra Dweck, MD2, Aaron J. Buckland, MBBS, FRACS1, John A. Bendo, MD3; 1 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA; 2 New York, NY, USA; 3 NYU Langone Orthopedic Hospital, New York, NY, USA
156. Indicators for nonroutine discharge following cervical deformitycorrective surgery: radiographic, surgical, and patient-related predictors Cole Bortz, BA1, Peter G. Passias, MD2, Virginie Lafage, PhD3, Justin S. Smith, MD, PhD4, Breton Line, BS5, Gregory M. Mundis Jr, MD6, Khaled M. Kebaish, MD7, Michael P. Kelly, MD8, Themistocles S. Protopsaltis, MD9, Daniel M. Sciubba, MD10, Alexandra Soroceanu, MD, MPH11, Eric O. Klineberg, MD12, Douglas C. Burton, MD13, Robert A. Hart, MD14, Frank J. Schwab, MD3, Shay Bess, MD15, Christopher I. Shaffrey, MD16, Christopher P. Ames, MD17; International Spine Study Group 18; 1 New York, NY, USA; 2 NY Spine Institute, NYU Langone Health, New York, NY, USA; 3 Hospital for Special Surgery, New York, NY, USA; 4 UVA Health System, Charlottesville, VA, USA; 5 Denver International Spine Center, Denver, CO, USA; 6 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, USA; 7 Baltimore, MD, USA; 8 Washington University, Saint Louis, MO, USA; 9 Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY, USA; 10 John Hopkins University/School of Medicine, Baltimore, MD, USA; 11 University of Calgary, Calgary, Canada; 12 UC, Davis School of Medicine, Sacramento, CA, USA; 13 University of Kansas Medical Center, Kansas City, KS, USA; 14 Swedish Neuroscience Institute, Seattle, WA, USA; 15 Denver, CO, USA; 16 University of Virginia, Charlottesville, VA, USA; 17 University of California, San Francisco, San Francisco, CA, USA; 18 Brighton, CO, USA
BACKGROUND CONTEXT: Outpatient ACDFs are being performed at an increasing rate and prior studies have shown similar complication and readmission rates when compared to traditional admission. However, the ideal patient for same day ACDF has yet to be identified. A multidisciplinary group at a tertiary academic center developed a protocol for patient selection and discharge for patients undergoing same day discharge ACDF with the aim of ensuring patient safety and reducing the likelihood of readmission. PURPOSE: Our aim was to show that utilizing a standardized protocol to select patients for outpatient ACDF will result in a noninferior readmission rate compared to traditional overnight admission. STUDY DESIGN/SETTING: Retrospective review of a prospectively implemented protocol. PATIENT SAMPLE: A total of 434 patients undergoing one or two-level ACDF from March 2016 to March 2017 at a tertiary academic institution. OUTCOME MEASURES: A total of 30 and 90 day readmission rates. METHODS: A retrospective chart review was performed to identify patients undergoing one or two level primary ACDF who were eligible for same day discharge (SDD) according to the institutional protocol. Patients undergoing cervical disc replacement, three or more level surgery,
BACKGROUND CONTEXT: Recent studies suggest nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost of care. Given the rising prevalence of cervical-deformity (CD)-corrective surgery and the necessity of valuebased health care, it is important to identify indicators for nonroutine discharge in surgical CD patients. PURPOSE: Identify predictors of nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. STUDY DESIGN/SETTING: Retrospective review of prospective, multicenter CD database. PATIENT SAMPLE: Surgical CD patients (C2–C7 Cobb>10°, CL>10°, cSVA>4cm, or CBVA>25°). OUTCOME MEASURES: Discharge location, health-related quality of life (HRQL) outcomes. METHODS: Included: patients>18 years with discharge and baseline (BL) radiographic data. Nonroutine discharge was defined: inpatient rehab or skilled nursing facility (SNF). Conditional inference decision trees identified factors predictive of nonroutine discharge, and cut-off points at which factors have a global effect. A conditional variable importance table
https://doi.org/10.1016/j.spinee.2018.06.419
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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corpectomy, posterior or revision surgery were excluded. All patients underwent ACDF via the anterior approach with implants based on surgeon preference. Patients with identical surgery and discharge dates were grouped as SDD and admitted patients were grouped as same day admission (SDA). Using our electronic health record's analytics, readmissions in the 90-day postoperative period were identified. RESULTS: A total of 434 patients underwent one- or two-level ACDF from March 2016 to March 2017 of which 126 patients were SDD and 308 were SDA. Due to the protocol, baseline characteristics such as age, operative time and time in the recovery room was significantly different between the two groups. In each group there was one readmission during the 30-day postoperative period and the SDA group had one additional readmission in the 90-day postoperative period. This resulted in an overall, noninferior readmission rate of 0.8% in the SDD group and 0.6% in the SDA group (p=.86). CONCLUSIONS: Proper identification of patients suitable for outpatient ACDF using our protocol for patient selection and discharge results in a noninferior readmission rate. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.420
155. Same-day discharge after anterior cervical discectomy and fusion in suitable patients has similarly low readmission rates as admitted patients Kartik Shenoy, MD1, Abidemi Adenikinju, MD2, Ezra Dweck, MD2, Aaron J. Buckland, MBBS, FRACS1, John A. Bendo, MD3; 1 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA; 2 New York, NY, USA; 3 NYU Langone Orthopedic Hospital, New York, NY, USA
156. Indicators for nonroutine discharge following cervical deformitycorrective surgery: radiographic, surgical, and patient-related predictors Cole Bortz, BA1, Peter G. Passias, MD2, Virginie Lafage, PhD3, Justin S. Smith, MD, PhD4, Breton Line, BS5, Gregory M. Mundis Jr, MD6, Khaled M. Kebaish, MD7, Michael P. Kelly, MD8, Themistocles S. Protopsaltis, MD9, Daniel M. Sciubba, MD10, Alexandra Soroceanu, MD, MPH11, Eric O. Klineberg, MD12, Douglas C. Burton, MD13, Robert A. Hart, MD14, Frank J. Schwab, MD3, Shay Bess, MD15, Christopher I. Shaffrey, MD16, Christopher P. Ames, MD17; International Spine Study Group 18; 1 New York, NY, USA; 2 NY Spine Institute, NYU Langone Health, New York, NY, USA; 3 Hospital for Special Surgery, New York, NY, USA; 4 UVA Health System, Charlottesville, VA, USA; 5 Denver International Spine Center, Denver, CO, USA; 6 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, USA; 7 Baltimore, MD, USA; 8 Washington University, Saint Louis, MO, USA; 9 Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY, USA; 10 John Hopkins University/School of Medicine, Baltimore, MD, USA; 11 University of Calgary, Calgary, Canada; 12 UC, Davis School of Medicine, Sacramento, CA, USA; 13 University of Kansas Medical Center, Kansas City, KS, USA; 14 Swedish Neuroscience Institute, Seattle, WA, USA; 15 Denver, CO, USA; 16 University of Virginia, Charlottesville, VA, USA; 17 University of California, San Francisco, San Francisco, CA, USA; 18 Brighton, CO, USA
BACKGROUND CONTEXT: Outpatient ACDFs are being performed at an increasing rate and prior studies have shown similar complication and readmission rates when compared to traditional admission. However, the ideal patient for same day ACDF has yet to be identified. A multidisciplinary group at a tertiary academic center developed a protocol for patient selection and discharge for patients undergoing same day discharge ACDF with the aim of ensuring patient safety and reducing the likelihood of readmission. PURPOSE: Our aim was to show that utilizing a standardized protocol to select patients for outpatient ACDF will result in a noninferior readmission rate compared to traditional overnight admission. STUDY DESIGN/SETTING: Retrospective review of a prospectively implemented protocol. PATIENT SAMPLE: A total of 434 patients undergoing one or two-level ACDF from March 2016 to March 2017 at a tertiary academic institution. OUTCOME MEASURES: A total of 30 and 90 day readmission rates. METHODS: A retrospective chart review was performed to identify patients undergoing one or two level primary ACDF who were eligible for same day discharge (SDD) according to the institutional protocol. Patients undergoing cervical disc replacement, three or more level surgery,
BACKGROUND CONTEXT: Recent studies suggest nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost of care. Given the rising prevalence of cervical-deformity (CD)-corrective surgery and the necessity of valuebased health care, it is important to identify indicators for nonroutine discharge in surgical CD patients. PURPOSE: Identify predictors of nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. STUDY DESIGN/SETTING: Retrospective review of prospective, multicenter CD database. PATIENT SAMPLE: Surgical CD patients (C2–C7 Cobb>10°, CL>10°, cSVA>4cm, or CBVA>25°). OUTCOME MEASURES: Discharge location, health-related quality of life (HRQL) outcomes. METHODS: Included: patients>18 years with discharge and baseline (BL) radiographic data. Nonroutine discharge was defined: inpatient rehab or skilled nursing facility (SNF). Conditional inference decision trees identified factors predictive of nonroutine discharge, and cut-off points at which factors have a global effect. A conditional variable importance table
https://doi.org/10.1016/j.spinee.2018.06.419
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.