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The Impact of Resident Involvement in Outcomes for Adults Undergoing Elective Posterior Cervical Fusion
170S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
CONCLUSIONS: Workers’ Compensation patients have a two-fold increased risk of an unsatisfactory outcome compared to noncompensated patients after surgery. This association was consistent when studies were grouped by country or procedure. Compensation status must be considered in all surgical intervention studies. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.199
165. A Comparison of Ocular Radiation Exposure Utilizing Three Types of Leaded Glasses Bradford S. Waddell, MD1, Hunter Waddell, None2, Joseph M. Zavatsky, MD3; 1Ochsner Orthopaedics, New Orleans, LA, US; 2Shreveport, LA, US; 3 Florida Orthopaedic Institute, Temple Terrace, FL, US BACKGROUND CONTEXT: Minimally invasive spine surgery relies on fluoroscopic X-ray. Because ocular radiation is associated with cataract formation, compounded radiation exposure to the surgeon is concerning. Leaded glasses can reduce ocular radiation exposure. PURPOSE: Evaluate the efficacy of three types of leaded eyeglasses during typical views of minimally invasive spine surgery. STUDY DESIGN/SETTING: Anthropomorphic phantoms were used to measure radiation exposure to the surgeon phantom’s eye. Four groups were analyzed: Group 1 – no glasses (None); Group 2 – leaded lenses without lead sides (WOLS); Group 3 – leaded lenses with lead sides (WLS); Group 4 – sport wraparound leaded glasses (Sport). All glasses were 0.75 mm lead equivalent. PATIENT SAMPLE: Patient and surgeon phantoms were used in this project. OUTCOME MEASURES: We averaged the dose of radiation exposure to the eye of the surgeon phantom at each position with head in different positions. Furthermore, we calculated the total radiation dose for all positions combined with each set of glasses. Finally, we calculated the percent reduction in ocular radiation exposure with each set of glasses compared to no glasses. METHODS: Fifteen individual 20-second exposures in the anteroposterior (AP) and lateral V-ray positions with phantom head positions at 0 , 45 and 90 were performed. Radiation dose was measured using a solid-state dosimeter, and average doses were calculated. Student t-test was used to calculate significance. RESULTS: All three glasses (WOLS, WLS, Sport) had significant reductions in ocular radiation versus no glasses at all individual head positions (p!1.31 10-34). Sport had significantly lower ocular radiation dose than WLS at all positions except at 90 AP (p50.001). Sport had significantly lower ocular radiation dose than WOLS in all cases except 0 . AP (p50.0003), 90 AP (p54.46 x 10-10), and 90 lateral (p57.38 1028). WOLS had significantly lower radiation dosage at all positions than WLS except at 45 AP (p50.303). All glasses resulted in a significant reduction in total radiation dose from all head positions over no glasses (p!8.37 10-32). CONCLUSIONS: We demonstrate a significant reduction in ocular radiation exposure with all three types of leaded glasses. We show that leaded glasses with lead sides may have adverse effects by possibly trapping radiation and increasing ocular radiation exposure. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Javier Guzman, BS2, Samuel K. Cho, MD4; 1Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 2Mount Sinai School of Medicine, New York, NY, US; 3New York, NY, US; 4Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Patients admitted to teaching hospitals are exposed to resident surgeons with varying degree of surgical and clinical experience. Previous studies have evaluated the ‘‘July effect,’’ the start of the new academic year at teaching hospitals and its impact on perioperative outcomes. Perception biases exist regarding the perioperative outcomes of posterior cervical fusion (PCF) based on resident surgeon involvement. PURPOSE: To investigate the impact of resident surgeon involvement on perioperative outcomes in patients undergoing PCF. STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012. PATIENT SAMPLE: 524 adult patients. OUTCOME MEASURES: Mortality, complications, length of stay (LOS), readmission, return to operating room (OR). METHODS: Adult patients (O18 years) who underwent PCF (CPT code: 22600) between 2005 and 2012 were identified in the NSQIP database and divided into two groups: those operated by an attending (A) surgeon only and those operated by attending and resident (AþR) surgeon together. Patient demographics and preoperative comorbidity variables were assessed. Outcomes assessed included any complications, return to OR and unplanned readmission. Univariate analysis was performed on demographics, comorbidities and operative variables. Only variables with p!0.2 were evaluated for inclusion in the final step-wise multivariate logistic regression to determine predictors of perioperative outcomes in PCF. Statistical significance was maintained at p!0.05. RESULTS: A total of 524 patients met inclusion criteria; 224 (42.7%) operated by AþR. Patients operated by AþR were more likely to be African American or Other race (p50.001) and American Society of Anesthesiologists (ASA) Class $3 (p50.008); otherwise no significant differences between the two groups existed in terms of patient demographics. No differences between the two groups existed in terms of preoperative comorbidities. In terms of operative variables, patients in the AþR group had greater mean total relative value units (RVU) per procedure (57.3627.1 vs 50.8629.5, p50.009), were more likely to undergo multilevel fusion (p50.0004) and require O4 hours of operative time (p50.001). Patients in the AþR group were more likely to suffer pulmonary complications (p50.03), sepsis/septic shock (p50.04) and necessitate perioperative blood transfusion (p!0.0001). There were no significant differences in total complications (p50.13), neurologic complications (p50.387), wound complications (p50.387) or death (p50.836) between the two groups. Multivariate regression modeling assessing outcomes in PCF found AþR involvement to be an independent risk factor for perioperative transfusion (OR 3.32, 95% CI 1.63-6.76, p50.009) only. CONCLUSIONS: Resident surgeon involvement in adults undergoing PCF did not appear to be associated with worse outcomes and was found to only be an independent risk factor for perioperative transfusion in this patient population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.201
http://dx.doi.org/10.1016/j.spinee.2015.07.200
166. The Impact of Resident Involvement in Outcomes for Adults Undergoing Elective Posterior Cervical Fusion Branko Skovrlj, MD1, Nathan J. Lee, BS2, Parth Kothari, BS2, Jeremy Steinberger, MD3, Dante M. Leven, DO, PT, John I. Shin, BS4,
167. Accuracy of Fluoroscopy versus Computer-Assisted Navigation for the Placement of Anterior Cervical Transpedicle Screws Andrew Patton, MD1, Randal Morris, BS2, Yong-Fang Kuo, PhD2, Ronald W. Lindsey, MD2; 1Galveston, LA, US; 2The University of Texas Medical Branch, Galveston, TX, US
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
CONCLUSIONS: Workers’ Compensation patients have a two-fold increased risk of an unsatisfactory outcome compared to noncompensated patients after surgery. This association was consistent when studies were grouped by country or procedure. Compensation status must be considered in all surgical intervention studies. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.199
165. A Comparison of Ocular Radiation Exposure Utilizing Three Types of Leaded Glasses Bradford S. Waddell, MD1, Hunter Waddell, None2, Joseph M. Zavatsky, MD3; 1Ochsner Orthopaedics, New Orleans, LA, US; 2Shreveport, LA, US; 3 Florida Orthopaedic Institute, Temple Terrace, FL, US BACKGROUND CONTEXT: Minimally invasive spine surgery relies on fluoroscopic X-ray. Because ocular radiation is associated with cataract formation, compounded radiation exposure to the surgeon is concerning. Leaded glasses can reduce ocular radiation exposure. PURPOSE: Evaluate the efficacy of three types of leaded eyeglasses during typical views of minimally invasive spine surgery. STUDY DESIGN/SETTING: Anthropomorphic phantoms were used to measure radiation exposure to the surgeon phantom’s eye. Four groups were analyzed: Group 1 – no glasses (None); Group 2 – leaded lenses without lead sides (WOLS); Group 3 – leaded lenses with lead sides (WLS); Group 4 – sport wraparound leaded glasses (Sport). All glasses were 0.75 mm lead equivalent. PATIENT SAMPLE: Patient and surgeon phantoms were used in this project. OUTCOME MEASURES: We averaged the dose of radiation exposure to the eye of the surgeon phantom at each position with head in different positions. Furthermore, we calculated the total radiation dose for all positions combined with each set of glasses. Finally, we calculated the percent reduction in ocular radiation exposure with each set of glasses compared to no glasses. METHODS: Fifteen individual 20-second exposures in the anteroposterior (AP) and lateral V-ray positions with phantom head positions at 0 , 45 and 90 were performed. Radiation dose was measured using a solid-state dosimeter, and average doses were calculated. Student t-test was used to calculate significance. RESULTS: All three glasses (WOLS, WLS, Sport) had significant reductions in ocular radiation versus no glasses at all individual head positions (p!1.31 10-34). Sport had significantly lower ocular radiation dose than WLS at all positions except at 90 AP (p50.001). Sport had significantly lower ocular radiation dose than WOLS in all cases except 0 . AP (p50.0003), 90 AP (p54.46 x 10-10), and 90 lateral (p57.38 1028). WOLS had significantly lower radiation dosage at all positions than WLS except at 45 AP (p50.303). All glasses resulted in a significant reduction in total radiation dose from all head positions over no glasses (p!8.37 10-32). CONCLUSIONS: We demonstrate a significant reduction in ocular radiation exposure with all three types of leaded glasses. We show that leaded glasses with lead sides may have adverse effects by possibly trapping radiation and increasing ocular radiation exposure. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Javier Guzman, BS2, Samuel K. Cho, MD4; 1Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 2Mount Sinai School of Medicine, New York, NY, US; 3New York, NY, US; 4Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Patients admitted to teaching hospitals are exposed to resident surgeons with varying degree of surgical and clinical experience. Previous studies have evaluated the ‘‘July effect,’’ the start of the new academic year at teaching hospitals and its impact on perioperative outcomes. Perception biases exist regarding the perioperative outcomes of posterior cervical fusion (PCF) based on resident surgeon involvement. PURPOSE: To investigate the impact of resident surgeon involvement on perioperative outcomes in patients undergoing PCF. STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012. PATIENT SAMPLE: 524 adult patients. OUTCOME MEASURES: Mortality, complications, length of stay (LOS), readmission, return to operating room (OR). METHODS: Adult patients (O18 years) who underwent PCF (CPT code: 22600) between 2005 and 2012 were identified in the NSQIP database and divided into two groups: those operated by an attending (A) surgeon only and those operated by attending and resident (AþR) surgeon together. Patient demographics and preoperative comorbidity variables were assessed. Outcomes assessed included any complications, return to OR and unplanned readmission. Univariate analysis was performed on demographics, comorbidities and operative variables. Only variables with p!0.2 were evaluated for inclusion in the final step-wise multivariate logistic regression to determine predictors of perioperative outcomes in PCF. Statistical significance was maintained at p!0.05. RESULTS: A total of 524 patients met inclusion criteria; 224 (42.7%) operated by AþR. Patients operated by AþR were more likely to be African American or Other race (p50.001) and American Society of Anesthesiologists (ASA) Class $3 (p50.008); otherwise no significant differences between the two groups existed in terms of patient demographics. No differences between the two groups existed in terms of preoperative comorbidities. In terms of operative variables, patients in the AþR group had greater mean total relative value units (RVU) per procedure (57.3627.1 vs 50.8629.5, p50.009), were more likely to undergo multilevel fusion (p50.0004) and require O4 hours of operative time (p50.001). Patients in the AþR group were more likely to suffer pulmonary complications (p50.03), sepsis/septic shock (p50.04) and necessitate perioperative blood transfusion (p!0.0001). There were no significant differences in total complications (p50.13), neurologic complications (p50.387), wound complications (p50.387) or death (p50.836) between the two groups. Multivariate regression modeling assessing outcomes in PCF found AþR involvement to be an independent risk factor for perioperative transfusion (OR 3.32, 95% CI 1.63-6.76, p50.009) only. CONCLUSIONS: Resident surgeon involvement in adults undergoing PCF did not appear to be associated with worse outcomes and was found to only be an independent risk factor for perioperative transfusion in this patient population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.201
http://dx.doi.org/10.1016/j.spinee.2015.07.200
166. The Impact of Resident Involvement in Outcomes for Adults Undergoing Elective Posterior Cervical Fusion Branko Skovrlj, MD1, Nathan J. Lee, BS2, Parth Kothari, BS2, Jeremy Steinberger, MD3, Dante M. Leven, DO, PT, John I. Shin, BS4,
167. Accuracy of Fluoroscopy versus Computer-Assisted Navigation for the Placement of Anterior Cervical Transpedicle Screws Andrew Patton, MD1, Randal Morris, BS2, Yong-Fang Kuo, PhD2, Ronald W. Lindsey, MD2; 1Galveston, LA, US; 2The University of Texas Medical Branch, Galveston, TX, US
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.