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P112. 30-day postoperative morbidity and readmissions following revision anterior cervical discectomy and fusion (ACDF)
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231
DJK (all R>.57, p<.001). cSVA=4cm corresponded to C2T4-Tilt of 10.4˚ and C2T10-Tilt of 28.0˚. DJK change=10˚ corresponded to C2T4-Tilt of 5.8˚ and C2T10-Tilt of 20.1˚. Severe DJK pts had the worst postoperative alignment by all measures including cSVA, TSCL, CPA, C2LIV-Tilt, (all p<.001). CONCLUSIONS: Simulated cervical deformity corrections demonstrated that severe DJK patients have insufficient corrections compared to patients without DJK. In-construct measures assess sagittal alignment within the fusion separate from DJK and subjacent compensation. They can be useful as intraoperative tools to gauge the adequacy of CD correction. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.536
P112. 30-day postoperative morbidity and readmissions following revision anterior cervical discectomy and fusion (ACDF) Azeem T. Malik, MBBS, Safdar N. Khan, MD, Jeffery Kim, MD, Elizabeth Yu, MD; The Ohio State University Wexner Medical Center, Columbus, OH, US
p<0.001). LOS >1 day was the only significant factor associated with a MAE (OR 14.65; p<0.001) and readmission within 30 days (OR 2.67; p=0.003). Thirty−day re-admission and re-operation rates following a revision ACDF were 3.4% (N=39) and 1.9% (N=22) respectively. The most common causes of readmissions were hematoma (N=3; 7.7%), pneumonia (N=3; 7.7%), pain (N=2; 5.1%) and pulmonary embolism (N=2; 5.1%). The most common causes of re-operation were due to hematoma (N=4; 18.2%), accidental dural puncture/tear (N=2; 9.1%) and bleeding (N=2; 9.1%). CONCLUSIONS: In conclusion, 4.5 % of patients experience an adverse event following a revision ACDF with up to 3.4% experiencing a re-admission. The study is the also the first of its kind to analyze the risk factors for experiencing an adverse event following a revision ACDF. Providers should utilize these data to enhance the dissemination of knowledge regarding postoperative outcomes following a revision ACDF among hospital staff and/or patients to improve shared decision-making, reduce fragmentation of services and increase the quality of care to improve outcomes and curb costs in these high-risk patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.537
BACKGROUND CONTEXT: Despite a 48% national increase in the incidence of revision anterior cervical fusions from 2007 to 2010, as well as higher inpatient costs and longer hospital length of stay as compared to primary ACDFs, current literature remains limited to with regard to how revision ACDF patients fare in the acute 30-day postoperative period. PURPOSE: Utilizing a national surgical database, the current study was designed to understand the incidence and risk factors for adverse outcomes and re-admissions following a revision ACDF. Furthermore, as a secondary objective, the study evaluated the causes of re-admissions and re-operations in these patients. STUDY DESIGN/SETTING: Retrospective cohort study performed using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. PATIENT SAMPLE: The 2012-2016 ACS-NSQIP database files were queried using Current Procedural Terminology codes for ACDF (22551, 22554 and 63075) combined with Current Procedural Terminology codes 22830 (exploration of spinal fusion) or 22855 (removal of anterior instrumentation) to identify revision cases. Patients undergoing concurrent posterior cervical fusion and/or decompression (laminectomies/laminotomies) were excluded from the study. In addition, patients undergoing posterior segmental/non-segmental instrumentation and/or corpectomies were also excluded. OUTCOME MEASURES: Thirty-day outcomes were categorized into severe adverse events (SAEs) and minor adverse events (MAEs). SAEs included the following − deep surgical site infection (SSI), organ/space SSI, wound disruption/dehiscence, unplanned intubation, postoperative ventilator use >48 hours, pulmonary embolism, deep venous thrombosis, myocardial infarction, cardiac arrest, stroke, acute renal failure, sepsis, septic shock, re-operation and death. MAEs included the occurrence of urinary tract infections, bleeding requiring transfusions, pneumonia, progressive renal insufficiency and superficial SSI. An additional variable defined as “any adverse event” or “AAE” recorded the presence of at least one SAE or MAE. METHODS: Multi-variate logistic regression analyses were used to identify significant risk factors associated with experiencing adverse 30-day outcomes following revision ACDFs. Descriptive analyses were used to report the causes of readmissions and re-operations in these patients. RESULTS: Out of a total of 1,140 patients, 51 (4.5%) experienced at least one adverse event (AAE), with 40 (3.5%) experiencing a severe adverse event (SAE) and 17 (1.5%) experiencing a minor adverse event (MAE). On multivariate analysis, AAEs were significantly associated with male gender (OR 1.98; p=0.023), 2-level vs 1-level fusion (OR 2.05; p=0.019) and a LOS>1 day (OR 7.70; p<0.001). SAEs were independently associated with male gender (OR 2.85; p=0.003), smoking (OR 0.33; p=0.025), 2-level vs 1-level fusion (OR 2.03; p=0.037) and LOS >1 day (OR 7.28;
P113. Integrated interbody fusion in multilevel cervical constructs in clinical practice Jason E. Garber, MD; Las Vegas Neurosurgical Institue Center for Spine and Brain Surgery, Las Vegas, NV, US BACKGROUND CONTEXT: Although extremely effective at a single level, anterior cervical discectomy and fusion (ACDF) with an anterior cervical plate (ACP) for a multilevel construct can be associated with a number of peri- and postoperative complications. Such complications include esophageal dysphagia, loss of sagittal balance secondary to plate installation, and technical difficulties with the placement of anterior cervical plate over a multiple fusion levels. As an alternative, and quite possibly superior to cervical plating, individual cervical integrated interbody fusions with subsequent compressive/lag fixation, has emerged as a promising alternative. This has the potential to allow for smaller exposure, zero anterior profile, and individual, but multilevel specific sagittal realignment. PURPOSE: The purpose of the study was to retrospectively evaluate patients treated from single to multiple levels with integrated interbody fusion by a single surgeon. STUDY DESIGN/SETTING: Retrospective patients’ data analysis. PATIENT SAMPLE: A total of 203 patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathy were surgically treated with a cervical integrated interbody fusion device with compressive fixation between the C3-C7 levels. OUTCOME MEASURES: Patients were evaluated for patient-derived outcome measures, and radiographic parameters (effect on device-level lordosis, overall cervical sagittal alignment and fusion status), and devicerelated complications. METHODS: A total of 203 patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathywere surgically treated with a cervical integrated interbody fusion device with compressive fixation between the C3-C7 levels. Patients were assessed pre- and postoperatively at 6 weeks, 3, 6 months, 1 and 2 years. RESULTS: The average age at time of surgery was 53.4§10.7 years. All had failed conservative treatment. Seventy-four patients underwent the procedure at single level, 68 patients at 2-levels, 39 patients at 3-levels, and 17 patients at 4-levels, 4 patients at 5-levels and 1 patient at 6-levels. Blood loss was minimal and no intraoperative complications were recorded. Hospital stay was minimal with 92% of patients being released the following day. Radiographic results showed lordosis was maintained in the global spine and bone formation was present in the inner column of the device. Overall fusion rate was 92%. The revision surgery patients showed better alignment than preoperatively with static plates. There were no signs
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) S195−S231
DJK (all R>.57, p<.001). cSVA=4cm corresponded to C2T4-Tilt of 10.4˚ and C2T10-Tilt of 28.0˚. DJK change=10˚ corresponded to C2T4-Tilt of 5.8˚ and C2T10-Tilt of 20.1˚. Severe DJK pts had the worst postoperative alignment by all measures including cSVA, TSCL, CPA, C2LIV-Tilt, (all p<.001). CONCLUSIONS: Simulated cervical deformity corrections demonstrated that severe DJK patients have insufficient corrections compared to patients without DJK. In-construct measures assess sagittal alignment within the fusion separate from DJK and subjacent compensation. They can be useful as intraoperative tools to gauge the adequacy of CD correction. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.536
P112. 30-day postoperative morbidity and readmissions following revision anterior cervical discectomy and fusion (ACDF) Azeem T. Malik, MBBS, Safdar N. Khan, MD, Jeffery Kim, MD, Elizabeth Yu, MD; The Ohio State University Wexner Medical Center, Columbus, OH, US
p<0.001). LOS >1 day was the only significant factor associated with a MAE (OR 14.65; p<0.001) and readmission within 30 days (OR 2.67; p=0.003). Thirty−day re-admission and re-operation rates following a revision ACDF were 3.4% (N=39) and 1.9% (N=22) respectively. The most common causes of readmissions were hematoma (N=3; 7.7%), pneumonia (N=3; 7.7%), pain (N=2; 5.1%) and pulmonary embolism (N=2; 5.1%). The most common causes of re-operation were due to hematoma (N=4; 18.2%), accidental dural puncture/tear (N=2; 9.1%) and bleeding (N=2; 9.1%). CONCLUSIONS: In conclusion, 4.5 % of patients experience an adverse event following a revision ACDF with up to 3.4% experiencing a re-admission. The study is the also the first of its kind to analyze the risk factors for experiencing an adverse event following a revision ACDF. Providers should utilize these data to enhance the dissemination of knowledge regarding postoperative outcomes following a revision ACDF among hospital staff and/or patients to improve shared decision-making, reduce fragmentation of services and increase the quality of care to improve outcomes and curb costs in these high-risk patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.537
BACKGROUND CONTEXT: Despite a 48% national increase in the incidence of revision anterior cervical fusions from 2007 to 2010, as well as higher inpatient costs and longer hospital length of stay as compared to primary ACDFs, current literature remains limited to with regard to how revision ACDF patients fare in the acute 30-day postoperative period. PURPOSE: Utilizing a national surgical database, the current study was designed to understand the incidence and risk factors for adverse outcomes and re-admissions following a revision ACDF. Furthermore, as a secondary objective, the study evaluated the causes of re-admissions and re-operations in these patients. STUDY DESIGN/SETTING: Retrospective cohort study performed using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. PATIENT SAMPLE: The 2012-2016 ACS-NSQIP database files were queried using Current Procedural Terminology codes for ACDF (22551, 22554 and 63075) combined with Current Procedural Terminology codes 22830 (exploration of spinal fusion) or 22855 (removal of anterior instrumentation) to identify revision cases. Patients undergoing concurrent posterior cervical fusion and/or decompression (laminectomies/laminotomies) were excluded from the study. In addition, patients undergoing posterior segmental/non-segmental instrumentation and/or corpectomies were also excluded. OUTCOME MEASURES: Thirty-day outcomes were categorized into severe adverse events (SAEs) and minor adverse events (MAEs). SAEs included the following − deep surgical site infection (SSI), organ/space SSI, wound disruption/dehiscence, unplanned intubation, postoperative ventilator use >48 hours, pulmonary embolism, deep venous thrombosis, myocardial infarction, cardiac arrest, stroke, acute renal failure, sepsis, septic shock, re-operation and death. MAEs included the occurrence of urinary tract infections, bleeding requiring transfusions, pneumonia, progressive renal insufficiency and superficial SSI. An additional variable defined as “any adverse event” or “AAE” recorded the presence of at least one SAE or MAE. METHODS: Multi-variate logistic regression analyses were used to identify significant risk factors associated with experiencing adverse 30-day outcomes following revision ACDFs. Descriptive analyses were used to report the causes of readmissions and re-operations in these patients. RESULTS: Out of a total of 1,140 patients, 51 (4.5%) experienced at least one adverse event (AAE), with 40 (3.5%) experiencing a severe adverse event (SAE) and 17 (1.5%) experiencing a minor adverse event (MAE). On multivariate analysis, AAEs were significantly associated with male gender (OR 1.98; p=0.023), 2-level vs 1-level fusion (OR 2.05; p=0.019) and a LOS>1 day (OR 7.70; p<0.001). SAEs were independently associated with male gender (OR 2.85; p=0.003), smoking (OR 0.33; p=0.025), 2-level vs 1-level fusion (OR 2.03; p=0.037) and LOS >1 day (OR 7.28;
P113. Integrated interbody fusion in multilevel cervical constructs in clinical practice Jason E. Garber, MD; Las Vegas Neurosurgical Institue Center for Spine and Brain Surgery, Las Vegas, NV, US BACKGROUND CONTEXT: Although extremely effective at a single level, anterior cervical discectomy and fusion (ACDF) with an anterior cervical plate (ACP) for a multilevel construct can be associated with a number of peri- and postoperative complications. Such complications include esophageal dysphagia, loss of sagittal balance secondary to plate installation, and technical difficulties with the placement of anterior cervical plate over a multiple fusion levels. As an alternative, and quite possibly superior to cervical plating, individual cervical integrated interbody fusions with subsequent compressive/lag fixation, has emerged as a promising alternative. This has the potential to allow for smaller exposure, zero anterior profile, and individual, but multilevel specific sagittal realignment. PURPOSE: The purpose of the study was to retrospectively evaluate patients treated from single to multiple levels with integrated interbody fusion by a single surgeon. STUDY DESIGN/SETTING: Retrospective patients’ data analysis. PATIENT SAMPLE: A total of 203 patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathy were surgically treated with a cervical integrated interbody fusion device with compressive fixation between the C3-C7 levels. OUTCOME MEASURES: Patients were evaluated for patient-derived outcome measures, and radiographic parameters (effect on device-level lordosis, overall cervical sagittal alignment and fusion status), and devicerelated complications. METHODS: A total of 203 patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathywere surgically treated with a cervical integrated interbody fusion device with compressive fixation between the C3-C7 levels. Patients were assessed pre- and postoperatively at 6 weeks, 3, 6 months, 1 and 2 years. RESULTS: The average age at time of surgery was 53.4§10.7 years. All had failed conservative treatment. Seventy-four patients underwent the procedure at single level, 68 patients at 2-levels, 39 patients at 3-levels, and 17 patients at 4-levels, 4 patients at 5-levels and 1 patient at 6-levels. Blood loss was minimal and no intraoperative complications were recorded. Hospital stay was minimal with 92% of patients being released the following day. Radiographic results showed lordosis was maintained in the global spine and bone formation was present in the inner column of the device. Overall fusion rate was 92%. The revision surgery patients showed better alignment than preoperatively with static plates. There were no signs
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.