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Predictive Model for Patient-Centered Efficacy of Elective Spine Surgery for Degenerative Cervical Disease
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337 P150. The Effect of Smoking Status on Inpatient Pain Scores following Anterior Cervical Discectomy and Fusion Benjamin Mayo, BA1, Dustin H. Massel, BS2, Ankur S. Narain, BA3, Fady Y. Hijji, BS3, Krishna Modi, BS1, William W. Long, BA1, Khaled A. Aboushaala, MD, MS4, Bryce Basques, MD, MHS5, Kern Singh, MD1; 1Rush University Medical Center, Chicago, IL, US; 2 Midwest Orthopaedics at Rush, Chicago, IL, US; 3Department of Orthopaedic Surgery Rush University Medical Center, Chicago, IL, US; 4 Midwest Orthopaedics at Rush University, Oak Park, IL, US; 5Yale School of Medicine, New Haven, CT, US BACKGROUND CONTEXT: Current literature demonstrates patients who smoke experience unfavorable long-term outcomes following anterior cervical discectomy and fusion (ACDF); however, the effect of smoking on inpatient pain and narcotic consumption in the immediate postoperative period has not been previously reported. PURPOSE: To identify the differences in inpatient pain scores and narcotic usage between smokers and non-smokers following ACDF. STUDY DESIGN/SETTING: Retrospective cohort analysis of a prospectively maintained surgical database. PATIENT SAMPLE: A total of 251 patients who underwent a primary 1or 2-level ACDF for degenerative spinal pathology between 2010–2015 by a single surgeon were identified. OUTCOME MEASURES: Demographics, comorbidities, smoking status, surgical outcomes, postoperative narcotic consumption, and inpatient pain scores. METHODS: Patients were stratified by smoking status. Differences in demographics and preoperative characteristics were assessed using a chisquared test and Student’s t-test for categorical and continuous variables, respectively. Multivariate analysis comparing peri- and postoperative outcomes was performed using Poisson regression with robust error variance or linear regression adjusted for patient demographics and preoperative characteristics. RESULTS: A total of 251 patients were included in this analysis, of which 197 (78.5%) were non-smokers, while 47 (21.5%) were smokers. Patient demographics were not different between cohorts. There were no significant differences in operative time, estimated blood loss, or length of hospitalization. Inpatient pain scores and narcotic consumption on postoperative day (POD) 0 and POD 1 were similar between smokers and non-smokers. CONCLUSIONS: The results of this study suggest that smoking status does not affect inpatient pain or narcotic consumption following ACDF. As such, smokers and non-smokers should receive similar postoperative pain management protocols following ACDF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.476
P151. Predictive Model for Patient-Centered Efficacy of Elective Spine Surgery for Degenerative Cervical Disease Ahilan Sivaganesan, MD1, Silky Chotai, MD1, Scott L. Parker, MD2, Matthew J. McGirt, MD3, Clinton J. Devin, MD1; 1Vanderbilt University Medical Center, Nashville, TN, USA; 2Vanderbilt University, Nashville, TN, USA; 3Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA BACKGROUND CONTEXT: Surgery is a valuable therapeutic option for degenerative cervical spine disease, however there is uncertainty as to which patients benefit. PURPOSE: Here we introduce predictive models for disability level, as well as clinically meaningful improvement in disability, one year after cervical spine surgery (CSS). STUDY DESIGN/SETTING: Four hundred thirty patients undergoing CSS were enrolled into a prospective registry. PATIENT SAMPLE: We randomly selected 80% of the patients for model development and then validated the model using the remaining 20%. OUTCOME MEASURES: The following variables were used to power a multiple linear regression model for 12-month Neck Disability Index (NDI):
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demographics, diagnosis, number/location of diseased levels, baseline symptoms and PROs, employment/insurance status, comorbidities, a history of prior surgeries and surgical approach. METHODS: A separate logistic regression was conducted for clinically important improvement in NDI (at least 17.3) at one year. RESULTS: The mean NDI one year after surgery was 25.82, and the mean improvement was 16.33 points. 48% (205) of patients achieved the minimum clinically important difference (MCID) in NDI. Our predictive model for 12-month NDI has an r-squared of 0.60, and in validation, it achieved an r-squared of 0.47. Our predictive model for achieving a MCID in NDI has an area under the curve greater than 0.80 for the development phase and an AUC of 0.77 for the validation phase. CONCLUSIONS: We present validated models that can help predict NDI, and the odds of clinically meaningful improvement, one year after elective surgery for cervical spine disease. The models are accurate and explain a sizeable proportion of the variation in NDI. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.477
P152. Racial Disparity in Total Hospital Length of Stay for Adults undergoing Elective ACDF Parth Kothari, BS1, Nathan J. Lee, BS1, Javier Guzman, MD2, Jeremy Steinberger, MD2, Branko Skovrlj, MD3, Dante M. Leven, DO, PT3, Samuel K. Cho, MD4; 1Mount Sinai School of Medicine, New York, NY, USA; 2New York, NY, USA; 3Mount Sinai School of Medicine, Department of Neurosurgery, New York, NY, USA; 4Icahn School of Medicine at Mount Sinai, New York, NY, USA BACKGROUND CONTEXT: Racial disparities are an important component of healthcare cost inequalities. It is important to become more familiar with racial differences in patients undergoing spine surgery. PURPOSE: To assess racial disparity in adults undergoing elective anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING: Retrospective Cohort Analysis. PATIENT SAMPLE: White, Black or Hispanic patients ≥18 years age who underwent non-emergent ACDF from 2005–2012. OUTCOME MEASURES: Demographics, comorbidities and postoperative complications were measured. METHODS: Patients were identified by CPT (Current Procedural Terminology) code in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database. A univariate analysis was performed to compare demographics, comorbidities, operative and postoperative complications across Hispanics, Blacks and Whites. Multivariate stepwise logistic regression was performed on each complication that demonstrated significant association to race in the univariate comparison. Race and any perioperative variables with p≤.2 were included in the multivariate analyses. White race was set as the reference for the race category. Level of significance was set at p=.05. RESULTS: Hispanics were more likely to be ≥65 years of age than Whites or Blacks (23.08% vs. 16.41% vs. 12.01%)(p=.002). Smoking status was least amongst Hispanic patients (23.56% vs. 33.7 Blacks vs. 33.55% Whites) (p=.002). With regards to comorbidities, Hispanics were observed to have a greater rate of neuromuscular injury (p<.0001) and previous stroke (p=.0001) than White or Black patients undergoing ACDF. Length of stay (LOS)>5 days was more often to be experienced by Black or Hispanic patients than White patients, respectively (11.235 vs. 7.69% vs. 4.96%)(p<.0001). Postoperative blood transfusion was observed at a greater rate in Hispanics (1.44%) than in Blacks (1.04%) or Whites (0.35%) (p=.027). Multivariate for LOS>5 days shows that Black race [Adjusted Odds Ratio (OR)=2.36, p=.002] but not Hispanic race is an independent predictor of prolonged LOS. CONCLUSIONS: Black race (missing word) when using White race as reference is an independent predictor of prolonged LOS in patients undergoing ACDF. Further research may be warranted in this area.
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.
P151. Predictive Model for Patient-Centered Efficacy of Elective Spine Surgery for Degenerative Cervical Disease Ahilan Sivaganesan, MD1, Silky Chotai, MD1, Scott L. Parker, MD2, Matthew J. McGirt, MD3, Clinton J. Devin, MD1; 1Vanderbilt University Medical Center, Nashville, TN, USA; 2Vanderbilt University, Nashville, TN, USA; 3Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA BACKGROUND CONTEXT: Surgery is a valuable therapeutic option for degenerative cervical spine disease, however there is uncertainty as to which patients benefit. PURPOSE: Here we introduce predictive models for disability level, as well as clinically meaningful improvement in disability, one year after cervical spine surgery (CSS). STUDY DESIGN/SETTING: Four hundred thirty patients undergoing CSS were enrolled into a prospective registry. PATIENT SAMPLE: We randomly selected 80% of the patients for model development and then validated the model using the remaining 20%. OUTCOME MEASURES: The following variables were used to power a multiple linear regression model for 12-month Neck Disability Index (NDI):
S317
demographics, diagnosis, number/location of diseased levels, baseline symptoms and PROs, employment/insurance status, comorbidities, a history of prior surgeries and surgical approach. METHODS: A separate logistic regression was conducted for clinically important improvement in NDI (at least 17.3) at one year. RESULTS: The mean NDI one year after surgery was 25.82, and the mean improvement was 16.33 points. 48% (205) of patients achieved the minimum clinically important difference (MCID) in NDI. Our predictive model for 12-month NDI has an r-squared of 0.60, and in validation, it achieved an r-squared of 0.47. Our predictive model for achieving a MCID in NDI has an area under the curve greater than 0.80 for the development phase and an AUC of 0.77 for the validation phase. CONCLUSIONS: We present validated models that can help predict NDI, and the odds of clinically meaningful improvement, one year after elective surgery for cervical spine disease. The models are accurate and explain a sizeable proportion of the variation in NDI. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.477
P152. Racial Disparity in Total Hospital Length of Stay for Adults undergoing Elective ACDF Parth Kothari, BS1, Nathan J. Lee, BS1, Javier Guzman, MD2, Jeremy Steinberger, MD2, Branko Skovrlj, MD3, Dante M. Leven, DO, PT3, Samuel K. Cho, MD4; 1Mount Sinai School of Medicine, New York, NY, USA; 2New York, NY, USA; 3Mount Sinai School of Medicine, Department of Neurosurgery, New York, NY, USA; 4Icahn School of Medicine at Mount Sinai, New York, NY, USA BACKGROUND CONTEXT: Racial disparities are an important component of healthcare cost inequalities. It is important to become more familiar with racial differences in patients undergoing spine surgery. PURPOSE: To assess racial disparity in adults undergoing elective anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING: Retrospective Cohort Analysis. PATIENT SAMPLE: White, Black or Hispanic patients ≥18 years age who underwent non-emergent ACDF from 2005–2012. OUTCOME MEASURES: Demographics, comorbidities and postoperative complications were measured. METHODS: Patients were identified by CPT (Current Procedural Terminology) code in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database. A univariate analysis was performed to compare demographics, comorbidities, operative and postoperative complications across Hispanics, Blacks and Whites. Multivariate stepwise logistic regression was performed on each complication that demonstrated significant association to race in the univariate comparison. Race and any perioperative variables with p≤.2 were included in the multivariate analyses. White race was set as the reference for the race category. Level of significance was set at p=.05. RESULTS: Hispanics were more likely to be ≥65 years of age than Whites or Blacks (23.08% vs. 16.41% vs. 12.01%)(p=.002). Smoking status was least amongst Hispanic patients (23.56% vs. 33.7 Blacks vs. 33.55% Whites) (p=.002). With regards to comorbidities, Hispanics were observed to have a greater rate of neuromuscular injury (p<.0001) and previous stroke (p=.0001) than White or Black patients undergoing ACDF. Length of stay (LOS)>5 days was more often to be experienced by Black or Hispanic patients than White patients, respectively (11.235 vs. 7.69% vs. 4.96%)(p<.0001). Postoperative blood transfusion was observed at a greater rate in Hispanics (1.44%) than in Blacks (1.04%) or Whites (0.35%) (p=.027). Multivariate for LOS>5 days shows that Black race [Adjusted Odds Ratio (OR)=2.36, p=.002] but not Hispanic race is an independent predictor of prolonged LOS. CONCLUSIONS: Black race (missing word) when using White race as reference is an independent predictor of prolonged LOS in patients undergoing ACDF. Further research may be warranted in this area.
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.