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P114. Incidence and predictors of prolonged length of stay and readmissions following cervical disc arthroplasty
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231 of heterotopic ossification of the ligaments or vertebral bodies. At 6 months, none of the patients reported chronic dysphagia. There were no device failures out to last follow-up. Eighty-six percent of patients were able to return to the same level of work as prior to surgery. CONCLUSIONS: For patients undergoing single and multi-level cervical fusion, integrated interbody fusion with compressive/lag fixation appears to be a viable alternative. Previously, studies with static integrated interbody fixation devices have not reported as well as ACP with regards to fusion and clinical outcomes. The benefit of a lag design to provide better fixation and more accurate maintenance of the lordotic curve of the cervical spine was seen in our series. Patients reported they were well satisfied with their results and experienced significant pain relief. The opportunity to either revise a previous ACDF with ACP or add to a pre-existing ACDF offers greater flexibility to treat the pathology at the index level rather than approach as a global construct. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.538
P114. Incidence and predictors of prolonged length of stay and readmissions following cervical disc arthroplasty Nikita Lakomkin, BA1, Vadim Goz, MD2, Darrel S. Brodke, MD3, W. Ryan Spiker, MD4; 1 Nashville, TN, US; 2 University of Utah, Salt Lake City, UT, US; 3 University Orthopaedic Center, Salt Lake City, UT, US; 4 University of Utah Orthopaedics, Salt Lake City, UT, US BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) has emerged as a viable alternative to discectomy and fusion in the treatment of degenerative disc disease, offering advantages in range of motion and more rapid return to work. While the number of disc replacements has rapidly increased in recent years, little is known regarding the rates and predictors of suboptimal postoperative outcomes. PURPOSE: The purpose of this study was to identify the incidence and specific causes of readmissions and prolonged length of stay (LOS) following CDA. STUDY DESIGN/SETTING: Analysis of prospectively collected registry data. PATIENT SAMPLE: Patients undergoing cervical disc arthroplasty. OUTCOME MEASURES: Postoperative complications, prolonged LOS, and 30-day readmissions. METHODS: The 2012-2017 National Surgical Quality Improvement Program (NSQIP) database was employed to identify all patients undergoing cervical disc arthroplasty. A variety of variables, including demographics, comorbidities, operative characteristics, postoperative complications, LOS and 30-day readmissions were collected. Patients were considered to experience a prolonged LOS if they remained in the hospital for 2 or more days (>90th percentile). Bivariate statistical analysis followed by multivariable regression modeling was employed to identify significant predictors of readmissions and prolonged LOS. Specific causes of readmissions were identified for all patients who were readmitted within 30 days following surgery. RESULTS: A total of 3,221 patients undergoing CDA were identified. Of these, 472 (14.7%) experienced a prolonged LOS. A total of 36 (1.1%) patients were readmitted within 30 days following surgery. The most common causes of readmission were infectious complications (n=4), followed by orthopedic adverse events, such as vertebral fracture (n=1), displacement of the prosthesis (n=1) and neck pain (n=2). Postoperative superficial wound infection (OR=73.8; p<0.001), ASA classification (OR=2.0; p=0.048) and BMI (OR=1.06; p=0.02) were significant predictors of readmission. Female sex (OR=1.76; p<0.001), diabetes (OR=1.50; p=0.02), postoperative wound dehiscence (OR=13.11; p=0.04), ASA score (OR=1.43; p=0.001) and operative time (OR=1.01; p<0.001) were significantly associated with prolonged LOS. CONCLUSIONS: Wound complications, including superficial wound infection and dehiscence, were significantly associated with prolonged
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LOS and were among the most common causes of readmission following CDA. Meticulous infection prophylaxis, which has been adopted in other areas of orthopedics such as hip and knee arthroplasty, may be beneficial in improving outcomes in this patient population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.539 P115. Evaluation of PROMIS physical function in anterior cervical discectomy and fusion Dil V. Patel, BS1, Joon S. Yoo, BA2, Benjamin Khechen, BA3, Brittany E. Haws, MD1, Sailee S. Karmarkar, BS3, Eric H. Lamoutte, BS3, Kern Singh, MD1; 1 Rush University Medical Center, Chicago, IL, US; 2 Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: As Patient-Reported Outcomes Measurement Information System (PROMIS) becomes increasingly utilized, it is important to assess its validity procedure-specific populations. PURPOSE: This study aims to evaluate the utility of PROMIS physical function (PF) domain as compared to legacy measures of patient reported outcomes (PROs) among patients undergoing an anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 57 patients undergoing a primary, 1-3 level ACDF. OUTCOME MEASURES: PROMIS PF, NDI, VAS Neck and Arm, SF-12. METHODS: Patients undergoing a primary, 1-3 level ACDF were retrospectively identified from a prospectively-maintained surgical registry. PROMIS PF and legacy PRO scores were obtained at preoperative and 6week, 12-week, and 6-month postoperative visits. Legacy PROs included Neck Disability Index (NDI), Short Form-12 (SF-12) physical composite, Visual Analog Scale (VAS) neck pain and VAS arm pain. Postoperative improvements in PROs were assessed using paired t-tests. Correlations between PROMIS and legacy PROs were tested using Pearson correlation coefficient with strength of association interpreted as follows: jrj=0.1-0.3, weak; jrj=0.3-0.5, moderate; jrj=0.5-1.0, strong. RESULTS: A total of 57 ACDF patients were included in this analysis. PROMIS PF scores significantly improved at 12 weeks and 6 months postoperatively, but not at 6 weeks. NDI, VAS neck pain, and VAS arm pain scores demonstrated significant improvement at all postoperative timepoints. SF-12 scores exhibited significant improvement at the 6-month follow up visit. Significant correlations between PROMIS PF and NDI and SF-12 were identified at all preoperative and postoperative timepoints. PROMIS PF exhibited strong correlations with VAS neck pain at postoperative timepoints and a moderate correlation preoperatively. CONCLUSIONS: Patients undergoing a primary 1-3 level ACDF experience significant improvements in PROMIS PF scores at 12-week and 6month postoperative visits, but not at 6-weeks. PROMIS PF exhibits strong correlations to NDI and SF-12 at all preoperative and postoperative timepoints. These results suggest that PROMIS PF accurately measures physical function and may be used in lieu of legacy physical function instruments for patients undergoing ACDF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.540
P116. Swallowing function following anterior cervical discectomy and fusion with and without anterior plating Dil V. Patel, BS1, Joon S. Yoo, BA2, Brittany E. Haws, MD1, Benjamin Khechen, BA3, Arash Sayari, BS, MD1, Eric H. Lamoutte, BS3, Sailee S. Karmarkar, BS3, Kern Singh, MD1; 1 Rush University Medical Center, Chicago, IL, US; 2 Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US
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.
P114. Incidence and predictors of prolonged length of stay and readmissions following cervical disc arthroplasty Nikita Lakomkin, BA1, Vadim Goz, MD2, Darrel S. Brodke, MD3, W. Ryan Spiker, MD4; 1 Nashville, TN, US; 2 University of Utah, Salt Lake City, UT, US; 3 University Orthopaedic Center, Salt Lake City, UT, US; 4 University of Utah Orthopaedics, Salt Lake City, UT, US BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) has emerged as a viable alternative to discectomy and fusion in the treatment of degenerative disc disease, offering advantages in range of motion and more rapid return to work. While the number of disc replacements has rapidly increased in recent years, little is known regarding the rates and predictors of suboptimal postoperative outcomes. PURPOSE: The purpose of this study was to identify the incidence and specific causes of readmissions and prolonged length of stay (LOS) following CDA. STUDY DESIGN/SETTING: Analysis of prospectively collected registry data. PATIENT SAMPLE: Patients undergoing cervical disc arthroplasty. OUTCOME MEASURES: Postoperative complications, prolonged LOS, and 30-day readmissions. METHODS: The 2012-2017 National Surgical Quality Improvement Program (NSQIP) database was employed to identify all patients undergoing cervical disc arthroplasty. A variety of variables, including demographics, comorbidities, operative characteristics, postoperative complications, LOS and 30-day readmissions were collected. Patients were considered to experience a prolonged LOS if they remained in the hospital for 2 or more days (>90th percentile). Bivariate statistical analysis followed by multivariable regression modeling was employed to identify significant predictors of readmissions and prolonged LOS. Specific causes of readmissions were identified for all patients who were readmitted within 30 days following surgery. RESULTS: A total of 3,221 patients undergoing CDA were identified. Of these, 472 (14.7%) experienced a prolonged LOS. A total of 36 (1.1%) patients were readmitted within 30 days following surgery. The most common causes of readmission were infectious complications (n=4), followed by orthopedic adverse events, such as vertebral fracture (n=1), displacement of the prosthesis (n=1) and neck pain (n=2). Postoperative superficial wound infection (OR=73.8; p<0.001), ASA classification (OR=2.0; p=0.048) and BMI (OR=1.06; p=0.02) were significant predictors of readmission. Female sex (OR=1.76; p<0.001), diabetes (OR=1.50; p=0.02), postoperative wound dehiscence (OR=13.11; p=0.04), ASA score (OR=1.43; p=0.001) and operative time (OR=1.01; p<0.001) were significantly associated with prolonged LOS. CONCLUSIONS: Wound complications, including superficial wound infection and dehiscence, were significantly associated with prolonged
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LOS and were among the most common causes of readmission following CDA. Meticulous infection prophylaxis, which has been adopted in other areas of orthopedics such as hip and knee arthroplasty, may be beneficial in improving outcomes in this patient population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.539 P115. Evaluation of PROMIS physical function in anterior cervical discectomy and fusion Dil V. Patel, BS1, Joon S. Yoo, BA2, Benjamin Khechen, BA3, Brittany E. Haws, MD1, Sailee S. Karmarkar, BS3, Eric H. Lamoutte, BS3, Kern Singh, MD1; 1 Rush University Medical Center, Chicago, IL, US; 2 Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: As Patient-Reported Outcomes Measurement Information System (PROMIS) becomes increasingly utilized, it is important to assess its validity procedure-specific populations. PURPOSE: This study aims to evaluate the utility of PROMIS physical function (PF) domain as compared to legacy measures of patient reported outcomes (PROs) among patients undergoing an anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 57 patients undergoing a primary, 1-3 level ACDF. OUTCOME MEASURES: PROMIS PF, NDI, VAS Neck and Arm, SF-12. METHODS: Patients undergoing a primary, 1-3 level ACDF were retrospectively identified from a prospectively-maintained surgical registry. PROMIS PF and legacy PRO scores were obtained at preoperative and 6week, 12-week, and 6-month postoperative visits. Legacy PROs included Neck Disability Index (NDI), Short Form-12 (SF-12) physical composite, Visual Analog Scale (VAS) neck pain and VAS arm pain. Postoperative improvements in PROs were assessed using paired t-tests. Correlations between PROMIS and legacy PROs were tested using Pearson correlation coefficient with strength of association interpreted as follows: jrj=0.1-0.3, weak; jrj=0.3-0.5, moderate; jrj=0.5-1.0, strong. RESULTS: A total of 57 ACDF patients were included in this analysis. PROMIS PF scores significantly improved at 12 weeks and 6 months postoperatively, but not at 6 weeks. NDI, VAS neck pain, and VAS arm pain scores demonstrated significant improvement at all postoperative timepoints. SF-12 scores exhibited significant improvement at the 6-month follow up visit. Significant correlations between PROMIS PF and NDI and SF-12 were identified at all preoperative and postoperative timepoints. PROMIS PF exhibited strong correlations with VAS neck pain at postoperative timepoints and a moderate correlation preoperatively. CONCLUSIONS: Patients undergoing a primary 1-3 level ACDF experience significant improvements in PROMIS PF scores at 12-week and 6month postoperative visits, but not at 6-weeks. PROMIS PF exhibits strong correlations to NDI and SF-12 at all preoperative and postoperative timepoints. These results suggest that PROMIS PF accurately measures physical function and may be used in lieu of legacy physical function instruments for patients undergoing ACDF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.540
P116. Swallowing function following anterior cervical discectomy and fusion with and without anterior plating Dil V. Patel, BS1, Joon S. Yoo, BA2, Brittany E. Haws, MD1, Benjamin Khechen, BA3, Arash Sayari, BS, MD1, Eric H. Lamoutte, BS3, Sailee S. Karmarkar, BS3, Kern Singh, MD1; 1 Rush University Medical Center, Chicago, IL, US; 2 Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US
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.