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Patient BMI is an Independent Predictor of 30-Day Hospital Readmission after Elective Spine Surgery
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250
relationship between BMI and complication categories in High-SI and LowSI surgeries. Odds ratios reported as (OR [95% CI]). RESULTS: In High-SI and Low-SI, higher BMI categories were associated with higher baseline Charlson score (CCI), diabetes, and hypertension, but lower smoking rates (p<.001). Controlling for these baseline differences overall complications increased at a BMI threshold of 35 (p=.014). As a linear variable, BMI increased the intra- and perioperative complication risk incrementally. In Low-SI cases, increasing BMI increased risk of any complication (1.019 [1.003,1.034]), particularly: acute renal failure (1.057 [1.026–1.089]), wound complication (1.0043 [1.014–1.073]), and all surgical complications (1.040 [1.028–1.051]<0.001). In High-SI procedures, BMI increased risk of deep infection (1.019 [1.005–1.033]), superficial infection (1.053 [1.026–1.080]), and all surgical complications (1.038 [1.071-1.058]). CONCLUSIONS: The effect of increasing BMI on complication risk appears linear. A threshold BMI of 35 results in a significant increase in complications in lumbar spinal surgery. Depending on invasiveness, different complication characteristics were noted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.099
87. Patient BMI is an Independent Predictor of 30-Day Hospital Readmission after Elective Spine Surgery Owoicho Adogwa, MD, MPH1, Aladine A. Elsamadicy, BS2, Victoria D. Vuong, MSc, BS3, Ankit Mehta, MD4, Raul A. Vasquez-Castellanos, MD5, Joseph S. Cheng, MD, MS6, Isaac O. Karikari, MD7, Carlos A. Bagley, MD8; 1Rush University Medical Center, Chicago, IL, USA; 2Duke School of Medicine, Durham, NC, USA; 3Chicago, IL, USA; 4University of Illinois at Chicago, Chicago, IL, USA; 5Vanderbilt University - Neurosurgery, Nashville, TN, USA; 6Yale University, New Haven, CT, USA; 7Duke University Medical Center, Durham, NC, USA; 8University of Texas Southwestern Medical Center, Dallas, TX, USA BACKGROUND CONTEXT: The Centers for Medicare & Medicaid Services (CMS) estimates the costs of unplanned, preventable readmission to be approximately $17 billion with 80% of hospitals being penalized for high readmission rates. With the growing prevalence of obesity, understanding its impact on 30-day unplanned readmissions and patients’ perception of health status is important for appropriate risk stratification of patients. PURPOSE: The aim of this study is to determine if obesity is an independent risk factor for unplanned 30-day readmissions following elective spine surgery. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: The medical records of 500 patients (nonobese: n=281, obese: n=219) undergoing elective spine surgery at a major academic medical center were reviewed. OUTCOME MEASURES: Unplanned hospital readmission for any reason within 30 days of discharge. METHODS: The medical records of 500 patients (nonobese: n=281, obese: n=219) undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative BMI was measured and assessed on all patients. BMI that was equal to or greater than 30 kg/m2 was classified as obese. Patient demographics, comorbidities, and postoperative complication rates were collected. The primary outcome investigated in this study was unplanned hospital readmission for any reason within 30 days of discharge. The association between preoperative obesity and 30-day readmission rate was assessed via multivariate logistic regression analysis. RESULTS: Baseline characteristics were similar between both cohorts. Operative variables and complication rates were similar between the cohorts. Overall, 8.6% of patients were readmitted within 30 days of discharge, with obese patients experiencing a two-fold increase in 30-day readmission rates (obese: 12.33% vs nonobese: 5.69%, p=.0087). In a multivariate logistic regression analysis, preoperative obesity (BMI ≥30 kg/m2) was found to be
an independent predictor of 30-day readmission after elective spine surgery (p=.008). CONCLUSIONS: Preoperative obesity is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. In a costconscious health care climate, preoperative BMI can identify patients at risk for early-unplanned hospital readmission. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.100
88. The Impact of Radiculopathy on Patient-Reported Outcomes: A Propensity Matched Study on 386 Adult Spinal Deformity Patients with and without Leg Pain Renaud Lafage, MSc1, Justin K. Scheer, BS2, Barthelemy Liabaud, MD1, Frank J. Schwab, MD1, Justin S. Smith, MD, PhD3, Peter G. Passias, MD4, Richard A. Hostin Jr., MD5, Christopher P. Ames, MD6, Gregory M. Mundis Jr., MD7, Douglas C. Burton, MD8, Han Jo Kim, MD1, Shay Bess, MD9, Eric O. Klineberg, MD10, Virginie Lafage, PhD1, International Spine Study Group11; 1Hospital for Special Surgery, New York, NY, USA; 2University of California, San Diego, CA, USA; 3UVA Health System, Charlottesville, VA, USA; 4NYU Medical Center Hospital for Joint Diseases, NY Spine Institute, New York, NY, USA; 5Southwest Scoliosis Institute, Plano, TX, USA; 6University of California, San Francisco, CA, USA; 7Department of Orthopedics, Scripps Clinic Medical Group, La Jolla, CA, USA; 8 University of Kansas Medical Center, Kansas City, KS, USA; 9Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 10 UC Davis School of Medicine, Sacramento, CA, USA; 11Brighton, CO, USA BACKGROUND CONTEXT: Correlations between sagittal radiographic parameters and patient-reported outcomes (PROs) are widely recognized. However, in cases with similar sagittal malalignment, the additional impact of radiculopathy on PROs remains unclear. PURPOSE: This study compared patients with radicular leg pain to propensity matched patients without leg pain at baseline. STUDY DESIGN/SETTING: Retrospective review of prospectively collected database. PATIENT SAMPLE: Adult spinal deformity ASD patients prospectively enrolled in a multicenter patient database. OUTCOME MEASURES: Oswestry Disability Index (ODI), Scoliosis Research Society Score (SRS-22) Total score and by domain, Visual Analog Scale (VAS) leg and back. METHODS: Surgical patients with PROs and radiographic assessment at baseline and 2-year follow-up were included. Patients were stratified based upon the presence or not of leg pain (VAS leg pain>3 [Leg] vs ≤3 [noLeg]) and propensity matched by age, PI-LL and SVA at baseline. Patient demographics, PRO (ODI, SRS22r and VAS back and leg pain) and sagittal alignment were compared between groups at baseline, postop and the change between pre and post. Surgical strategy was also compared. RESULTS: One hundred eighty patients (90 in each group) out of 386 were included. Groups had similar sagittal profile (PI: 56.8° vs 55.2°; PI-LL: 17.6° vs 19.8°; PT: 25.1° vs 25.6°; TPA: 24.6° vs 25.5° and SVA: 73 mm vs 80), age (60.5 vs 59.8) and coronal SRS Schwab Type. At baseline, Leg patients demonstrated a larger ODI (38.8 vs 49.5; p<.001) associated with smaller SRS22r (Pain: 2.6 vs 2.1; p<.001; Total: 2.9 vs 2.6; p=.006) and similar VAS back. Both groups received similar surgery in terms of approach, number / type of osteotomies, interbody fusions and decompression. Fusion length was similar between groups (12.4 vs 11.3). Similar improvement was observed between groups (radiographic: PI-LL, PT, SVA, TPA; PRO: ODI, SRS Total and Pain) with a significant differences in ΔVAS leg (0.8 vs -2.8 p<.001). Postop, there was no difference in radiographic sagittal profile but Leg patients remained with a larger disability (ODI: 23.2 vs 30.3; SRS Pain: 3.6 vs 3.2; VAS leg: 1.7 vs 4; all p<.05).
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.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250
relationship between BMI and complication categories in High-SI and LowSI surgeries. Odds ratios reported as (OR [95% CI]). RESULTS: In High-SI and Low-SI, higher BMI categories were associated with higher baseline Charlson score (CCI), diabetes, and hypertension, but lower smoking rates (p<.001). Controlling for these baseline differences overall complications increased at a BMI threshold of 35 (p=.014). As a linear variable, BMI increased the intra- and perioperative complication risk incrementally. In Low-SI cases, increasing BMI increased risk of any complication (1.019 [1.003,1.034]), particularly: acute renal failure (1.057 [1.026–1.089]), wound complication (1.0043 [1.014–1.073]), and all surgical complications (1.040 [1.028–1.051]<0.001). In High-SI procedures, BMI increased risk of deep infection (1.019 [1.005–1.033]), superficial infection (1.053 [1.026–1.080]), and all surgical complications (1.038 [1.071-1.058]). CONCLUSIONS: The effect of increasing BMI on complication risk appears linear. A threshold BMI of 35 results in a significant increase in complications in lumbar spinal surgery. Depending on invasiveness, different complication characteristics were noted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.099
87. Patient BMI is an Independent Predictor of 30-Day Hospital Readmission after Elective Spine Surgery Owoicho Adogwa, MD, MPH1, Aladine A. Elsamadicy, BS2, Victoria D. Vuong, MSc, BS3, Ankit Mehta, MD4, Raul A. Vasquez-Castellanos, MD5, Joseph S. Cheng, MD, MS6, Isaac O. Karikari, MD7, Carlos A. Bagley, MD8; 1Rush University Medical Center, Chicago, IL, USA; 2Duke School of Medicine, Durham, NC, USA; 3Chicago, IL, USA; 4University of Illinois at Chicago, Chicago, IL, USA; 5Vanderbilt University - Neurosurgery, Nashville, TN, USA; 6Yale University, New Haven, CT, USA; 7Duke University Medical Center, Durham, NC, USA; 8University of Texas Southwestern Medical Center, Dallas, TX, USA BACKGROUND CONTEXT: The Centers for Medicare & Medicaid Services (CMS) estimates the costs of unplanned, preventable readmission to be approximately $17 billion with 80% of hospitals being penalized for high readmission rates. With the growing prevalence of obesity, understanding its impact on 30-day unplanned readmissions and patients’ perception of health status is important for appropriate risk stratification of patients. PURPOSE: The aim of this study is to determine if obesity is an independent risk factor for unplanned 30-day readmissions following elective spine surgery. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: The medical records of 500 patients (nonobese: n=281, obese: n=219) undergoing elective spine surgery at a major academic medical center were reviewed. OUTCOME MEASURES: Unplanned hospital readmission for any reason within 30 days of discharge. METHODS: The medical records of 500 patients (nonobese: n=281, obese: n=219) undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative BMI was measured and assessed on all patients. BMI that was equal to or greater than 30 kg/m2 was classified as obese. Patient demographics, comorbidities, and postoperative complication rates were collected. The primary outcome investigated in this study was unplanned hospital readmission for any reason within 30 days of discharge. The association between preoperative obesity and 30-day readmission rate was assessed via multivariate logistic regression analysis. RESULTS: Baseline characteristics were similar between both cohorts. Operative variables and complication rates were similar between the cohorts. Overall, 8.6% of patients were readmitted within 30 days of discharge, with obese patients experiencing a two-fold increase in 30-day readmission rates (obese: 12.33% vs nonobese: 5.69%, p=.0087). In a multivariate logistic regression analysis, preoperative obesity (BMI ≥30 kg/m2) was found to be
an independent predictor of 30-day readmission after elective spine surgery (p=.008). CONCLUSIONS: Preoperative obesity is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. In a costconscious health care climate, preoperative BMI can identify patients at risk for early-unplanned hospital readmission. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.100
88. The Impact of Radiculopathy on Patient-Reported Outcomes: A Propensity Matched Study on 386 Adult Spinal Deformity Patients with and without Leg Pain Renaud Lafage, MSc1, Justin K. Scheer, BS2, Barthelemy Liabaud, MD1, Frank J. Schwab, MD1, Justin S. Smith, MD, PhD3, Peter G. Passias, MD4, Richard A. Hostin Jr., MD5, Christopher P. Ames, MD6, Gregory M. Mundis Jr., MD7, Douglas C. Burton, MD8, Han Jo Kim, MD1, Shay Bess, MD9, Eric O. Klineberg, MD10, Virginie Lafage, PhD1, International Spine Study Group11; 1Hospital for Special Surgery, New York, NY, USA; 2University of California, San Diego, CA, USA; 3UVA Health System, Charlottesville, VA, USA; 4NYU Medical Center Hospital for Joint Diseases, NY Spine Institute, New York, NY, USA; 5Southwest Scoliosis Institute, Plano, TX, USA; 6University of California, San Francisco, CA, USA; 7Department of Orthopedics, Scripps Clinic Medical Group, La Jolla, CA, USA; 8 University of Kansas Medical Center, Kansas City, KS, USA; 9Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 10 UC Davis School of Medicine, Sacramento, CA, USA; 11Brighton, CO, USA BACKGROUND CONTEXT: Correlations between sagittal radiographic parameters and patient-reported outcomes (PROs) are widely recognized. However, in cases with similar sagittal malalignment, the additional impact of radiculopathy on PROs remains unclear. PURPOSE: This study compared patients with radicular leg pain to propensity matched patients without leg pain at baseline. STUDY DESIGN/SETTING: Retrospective review of prospectively collected database. PATIENT SAMPLE: Adult spinal deformity ASD patients prospectively enrolled in a multicenter patient database. OUTCOME MEASURES: Oswestry Disability Index (ODI), Scoliosis Research Society Score (SRS-22) Total score and by domain, Visual Analog Scale (VAS) leg and back. METHODS: Surgical patients with PROs and radiographic assessment at baseline and 2-year follow-up were included. Patients were stratified based upon the presence or not of leg pain (VAS leg pain>3 [Leg] vs ≤3 [noLeg]) and propensity matched by age, PI-LL and SVA at baseline. Patient demographics, PRO (ODI, SRS22r and VAS back and leg pain) and sagittal alignment were compared between groups at baseline, postop and the change between pre and post. Surgical strategy was also compared. RESULTS: One hundred eighty patients (90 in each group) out of 386 were included. Groups had similar sagittal profile (PI: 56.8° vs 55.2°; PI-LL: 17.6° vs 19.8°; PT: 25.1° vs 25.6°; TPA: 24.6° vs 25.5° and SVA: 73 mm vs 80), age (60.5 vs 59.8) and coronal SRS Schwab Type. At baseline, Leg patients demonstrated a larger ODI (38.8 vs 49.5; p<.001) associated with smaller SRS22r (Pain: 2.6 vs 2.1; p<.001; Total: 2.9 vs 2.6; p=.006) and similar VAS back. Both groups received similar surgery in terms of approach, number / type of osteotomies, interbody fusions and decompression. Fusion length was similar between groups (12.4 vs 11.3). Similar improvement was observed between groups (radiographic: PI-LL, PT, SVA, TPA; PRO: ODI, SRS Total and Pain) with a significant differences in ΔVAS leg (0.8 vs -2.8 p<.001). Postop, there was no difference in radiographic sagittal profile but Leg patients remained with a larger disability (ODI: 23.2 vs 30.3; SRS Pain: 3.6 vs 3.2; VAS leg: 1.7 vs 4; all p<.05).
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.