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Background: As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity. Methods: A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications. Results: There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock. Conclusions: Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery. Clinical Relevance: In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications--notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery. Level of Evidence: 1. [ABSTRACT FROM AUTHOR]

Background: Patients with ankylosing spondylitis (AS) experience abnormal spinopelvic motion due to chronic inflammation of the axial skeleton, predisposing them to impingement and dislocation. The purpose of this study was to evaluate total hip arthroplasty (THA) dislocation rates in AS patients and evaluate the effects of age and gender on dislocation risk. Methods: Patients who underwent primary THA from 2005 to 2014 were identified using the PearlDiver database. AS patients were compared to age- and gender-matched controls without AS. Patients with a history of spine pathology or spine surgery were excluded. Univariate analyses were performed based on age and sex to evaluate dislocation rates at 90 days, 6 months, 1 year, and 5 years postoperatively. Results: A total of 2792 THA patients (59.6% male) with AS were identified and compared to an age- and gender-matched control group of 5582 THA patients (59.5% male) without AS or known spine pathology. At final follow-up, there were 96 dislocations (3.4%) in the AS group and 138 (2.5%) dislocations in the control group (OR 1.40; 95% CI, 1.08–1.83; p = 0.0118). AS patients ⩾70 years old had higher dislocation rates at all time points (OR range, 1.75–2.09; p < 0.05) compared to controls. At 5-year follow-up, dislocation-free survivorship was 95.7% (95% CI, 94.5–96.9%) for AS patients ⩾70 years old compared to 97.3% (95% CI, 96.6–98.0%) for patients ⩾70 years old without AS. Conclusions: Older AS patients have higher dislocation rates following THA. This effect is likely related to decreased spinopelvic motion in the sagittal plane, predisposing patients to impinge and dislocate. [ABSTRACT FROM AUTHOR]

Purpose: To describe the incidence of complications associated with cervical spine surgery and post-operative physical therapy (PT), and to identify if the timing of initiation of post-operative PT impacts the incidence rates. Methods: MOrtho PearlDiver database was queried using billing codes to identify patients who had undergone Anterior Cervical Discectomy and Fusion (ACDF), Posterior Cervical Fusion (PCF), or Cervical Foraminotomy and post-operative PT from 2010–2019. For each surgical procedure, patients were divided into three 12-week increments for post-operative PT (starting at post-operative weeks 2, 8, 12) and then matched based upon age, gender, and Charlson Comorbidity Index score. Each group was queried to determine complication rates and chi-square analysis with adjusted odds ratios, 95% confidence intervals, and p-values were used. Results: Following matching, 3,609 patients who underwent cervical spine surgery at one or more levels and had post-operative PT (ACDF:1784, PCF:1593, and cervical foraminotomy:232). The most frequent complications were new onset cervicalgia (2–14 weeks, 8–20 weeks, 12–24 weeks): ACDF (15.0%, 14.0%, 13.0%), PCF (18.8%, 18.0%, 19.9%), cervical foraminotomy (16.8%, 16.4%, 19.4%); revision: ADCF (7.9%, 8.2%, 7.4%), PCF (9.3%, 10.6%, 10.2%), cervical foraminotomy (11.6%, 10.8% and 13.4%); wound infection: ACDF (3.3%, 3.4%, 3.1%), PCF (8.3%, 8.0%,7.7%), cervical foraminotomy (5.2%, 6.5%, < 4.7%). None of the comparisons were statistically significant. Conclusion: The most common post-operative complications included new onset cervicalgia, revision and wound infection. Complications rates were not impacted by the timing of initiation of PT whether at 2, 8, or 12 weeks post-operatively. [ABSTRACT FROM AUTHOR]

Purpose: Lumbar fusion is widely used to treat degenerative and traumatic conditions of the spine, with various perioperative complications. This study compared lumbar fusion complications in patients with and without chronic hyperlipidemia.Methods: Using the MSpine division of the PearlDiver database, patients with or without chronic hyperlipidemia who underwent lumbar fusions were identified. The appropriate Current Procedural Terminology (CPT) codes identified patients with single- or multi-level lumbar spinal fusion surgeries. International Classification of Diseases (ICD-9 and ICD-10) codes identified patients with chronic hyperlipidemia. The surgical and medical complications were obtained utilizing the appropriate ICD-9, ICD-10, and CPT codes. Propensity score matching analysis was used to control for confounding factors. Chi-square test was applied to compare the incidence of complications among different groups.Results: In single-level fusion group, patients with hyperlipidemia had a higher incidence of wound complications (P < 0.001), surgical site infection (P < 0.001), failed back syndrome (P < 0.001), hardware removal (P < 0.001), deep venous thrombosis/pulmonary embolism (P = 0.031), myocardial infarction (P < 0.001) cerebrovascular accident (P < 0.001), renal failure (P < 0.001), sepsis (P < 0.001), and urinary tract infection/incontinence (P < 0.001). In multi-level fusion group, patients with hyperlipidemia had a higher incidence of nerve root injury (P = 0.034), wound complications (P < 0.001), surgical site infection (P < 0.001), failed back syndrome (P < 0.001), hardware removal (P < 0.001), revision (P = 0.002), myocardial infarction (P < 0.001), renal failure (P < 0.001), and urinary tract infection/incontinence (P < 0.001).Conclusion: Following lumbar fusion, patients with chronic hyperlipidemia have an increased risk of perioperative complications, including wound complications, surgical site infection, failed back surgery syndrome, hardware removal, myocardial infarction, renal failure, and urinary tract infection/incontinence. [ABSTRACT FROM AUTHOR]

Purpose: Two main surgical approaches are available for fusing the sacroiliac joint (SIJ): an open or minimally invasive (MIS) approach. The purpose of this study was to analyze the associated total hospital charges and postoperative complications of the MIS and open approach. Methods: Using the 2016 and 2017 National Readmission Database, we conducted a retrospective cohort analysis of 2521 patients who received a SIJ fusion with an open (N = 1990) or MIS (N = 531) approach for diagnosed sacrum pain, sacroiliitis, sacral instability, or spondylosis. Each cohort was analyzed for postoperative complications. Results: We identified 604 patients diagnosed with sacrum pain, 1142 with sacroiliitis, 315 with spondylosis, and 288 with sacral instability. Patients who received the open approach for sacrum pain had significantly higher rates of novel post-procedural pain (p = 0.045) and novel lumbar pathology (p = 0.015) within 30 days. On 30-day follow-up, patients with sacroiliitis treated with open SIJ fusion had significantly higher rates of novel postprocedural pain compared to those treated with MIS fusion (p = 0.045). Patients who received the open approach for spondylosis resulted in significantly higher rates of non-elective readmission within 30 days compared to the MIS approach (p < 0.0001). In addition, the open technique for spondylosis resulted in significantly higher rates of non-elective readmissions for infection within 30 days (p = 0.014). On 30-day follow-up, patients with sacral instability treated with open SIJ fusion had significantly higher rates of UTI (p = 0.045). Conclusion: Our study suggests that there exist unique postoperative complications that arise after SIJ fusion specific to preoperative diagnosis and surgical approach. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates the influence of patient frailty status on postoperative complications in those receiving single-level lumbar fusion surgery. Methods: The nationwide readmission database was retrospectively queried between 2016 and 2017 for all patients receiving single-level lumbar fusion surgery. Readmissions were analyzed at 30, 90, and 180 days from primary discharge. Demographics, frailty status, and relevant complications were queried at index admission and all readmission intervals. Complications of interest included infection, urinary tract infection (UTI), posthemorrhagic anemia, inpatient length of stay (LOS), and adjusted all-payer costs. Nearest-neighbor propensity score matching for demographics was implemented to identify non-frail control patients with similar diagnoses and procedures. The analysis used nonparametric Mann–Whitney U testing and odds ratios. Results: Comparing propensity-matched cohorts revealed significantly greater LOS and total all-payer inpatient costs in frail patients than non-frail patients with comparable demographics and comorbidities (p < 0.0001 for both). Furthermore, frail patients encountered higher rates of UTI (OR: 3.97, 95%CI: 3.21–4.95, p < 0.0001), infection (OR: 6.87, 95%CI: 4.55–10.86, p < 0.0001), and posthemorrhagic anemia (OR: 1.94, 95%CI: 1.71–2.19, p < 0.0001) immediately following surgery. Frail patients had significantly higher rates of 30-day (OR: 1.24, 95%CI: 1.02–1.51, p = 0.035), 90-day (OR: 1.38, 95%CI: 1.17–1.63, p < 0.001), and 180-day (OR: 1.55, 95%CI: 1.30–1.85, p < 0.0001) readmissions. Lastly, frail patients had higher rates of infection at 30-day (OR: 1.61, 95%CI: 1.05–2.46, p = 0.027) and 90-day (OR: 1.51, 95%CI: 1.07–2.16, p = 0.020) readmission intervals. Conclusions: Patient frailty status may serve as an important predictor of postoperative outcomes in patients receiving single-level lumbar fusion surgery. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the effects of bisphosphonates on complications following posterior lumbar fusion (PLF) with a large database study. Methods: The PearlDiver Patient Record Database was queried to identify adult patients who had undergone posterior lumbar fusion (PLF). Those patient cohorts were divided based on a diagnosis of osteoporosis prior to surgery and bisphosphonate usage. This yielded three groups: Osteo+Bisph+, Osteo+Bisph−, and Osteo−Bisph−. The primary outcome of the present study was revision rates at 6 months and 1 year following surgery. Incidence of postoperative complications was analyzed, and statistical analysis was conducted using Pearson chi-square analysis. Results: Patients taking bisphosphonates did not have significantly different rates of revision surgery at 6 months and 1 year, instrumentation complications, or post-vertebral fractures than patients not taking bisphosphonates. Additionally, osteoporotic patients did not have significantly different rates of these complications than patients without osteoporosis. Conclusion: Bisphosphonate usage did not significantly affect the rates of postoperative complications following posterior lumbar fusion. Further research is required to fully elucidate the effects of bisphosphonates on outcomes and complications following spine surgery. [ABSTRACT FROM AUTHOR]

Study Design: Systematic literature review Objective: To critically analyze the literature and describe the complications associated with the use of allograft in 1- or 2- level anterior cervical discectomy and fusion (ACDF) Methods: A systematic search of PubMed/MEDLINE, EMBASE, and ClinicalTrials.gov databases was conducted for literature published between January 2000 and August 2020 reporting complications associated with the use of allograft in 1- or 2- level ACDF. Results: From 584 potentially relevant citations, 21 met the inclusion criteria (4 randomized controlled trials (RCT), 4 prospective, and 13 retrospective studies). The patient number varied between 26 and 463 in comparative studies (RCT and non-RCT) and between 29 and 345 in non-comparative studies. Fusion rate was reported in 14 studies and ranged between 68.5-100%. The most frequently reported complication was post-operative dysphagia or dysphonia, with incidences ranging between.5% and 14.4%. Revision surgery was the second most reported complication (14 studies) and ranged between 0% and 10.3%. Wound-related complications were reported in 6 studies and ranged between 0% and 22.8%. Conclusion: The overall reporting of complications was low with very few comparative studies. Reported complications with allografts are within the range of other osteobiologics and autografts and in most cases may not attributable to the use of osteobiologics and may be complications of the procedure itself. Comparative studies with a more robust methodology analyzing complications with allograft and other osteobiologics are needed to inform current practice with strong recommendations. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the relative incidence of postoperative complications in 25-hydroxyvitamin D (25D)-deficient and -sufficient patients undergoing total knee arthroplasty (TKA). Patients who were either serum 25D deficient (25D <20 ng/mL) or 25D sufficient (25D ≥20 ng/mL) 90 days prior to primary TKA from 2007 to 2016 were identified using the Humana administrative claims registry. The incidence of postoperative medical and surgical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Risk-adjusted odds ratios (ORs) were calculated using multivariate logistic regression with age, sex, and Charlson Comorbidity Index as covariates. In total, 868 of 6593 patients who underwent TKA from 2007 to 2016 were 25D deficient, corresponding to a 13.2% prevalence rate. On adjustment for age, sex, and Charlson Comorbidity Index, 25D-deficient patients had a higher incidence of postoperative stiffness requiring manipulation under anesthesia (OR, 1.69; 95% confidence interval [CI], 1.39-2.04; P<.001), surgical site infection requiring irrigation and debridement (OR, 1.76; 95% CI, 1.25-2.48; P=.001), and prosthesis explantation (OR, 2.97; 95% CI, 2.04-4.31; P<.001) at 1 year. Patients who were 25D deficient also had higher rates of postoperative deep venous thrombosis (OR, 1.80; 95% CI, 1.36-2.38; P<.001), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.15; P<.001), and cerebrovascular accident (OR, 1.73; 95% CI, 1.17-2.57; P=.006). Thus, serum 25D levels below 20 ng/mL are associated with a higher incidence of postoperative complications and may be a perioperative modifiable risk factor in TKA. [Orthopedics. 2018; 41(4):e489-e495.]. [ABSTRACT FROM AUTHOR]

Outpatient arthroplasty is an appealing option among select patient populations as a mechanism for reducing health care expenditure. The purpose of this study was to determine the nationwide trends and complication profile of outpatient total shoulder arthroplasty (TSA). The authors reviewed a national administrative claims database to identify patients undergoing TSA as outpatients and inpatients from 2007 to 2016. The incidence of perioperative surgical and medical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes. Multivariate logistic regression adjusted for age, sex, and Charlson Comorbidity Index was used to calculate odds ratios of complications among outpatients relative to inpatients undergoing TSA. The query identified 1555 patients who underwent outpatient TSA and 15,987 patients who underwent inpatient TSA. The median age was in the 70 to 74 years age group in both the outpatient and the inpatient cohorts, and the age distribution was comparable between the 2 cohorts (P=.287). The incidence of both outpatient (P<.001) and inpatient (P<.001) TSA increased during the study period. On adjustment for age, sex, and comorbidities, patients undergoing outpatient TSA had significantly lower rates of stiffness requiring manipulation under anesthesia (outpatient, 1.09%; inpatient, 2.35%; odds ratio, 0.52; 95% confidence interval, 0.38-0.71; P<.001) and higher rates of postoperative surgical site infections requiring reoperation (outpatient, 0.90%; inpatient, 0.65%; odds ratio, 1.65; 95% confidence interval, 1.15-2.35; P<.001) at 1 year. Rates of all other postoperative complications were comparable. Ambulatory TSA is increasing in incidence nationwide and is associated with an overall favorable postoperative complication profile. [Orthopedics. 2018; 41(3):e400-e409.]. [ABSTRACT FROM AUTHOR]

Background: As concerns regarding health-care expenditure in the U.S. remain at the national forefront, outpatient arthroplasty is an appealing option for carefully selected patient populations. The purpose of this study was to determine the nationwide trends and complication rates associated with outpatient total knee arthroplasty (TKA) in comparison with standard inpatient TKA.Methods: We performed a retrospective review of the Humana subset of the PearlDiver Patient Record Database to identify patients who had undergone TKA (Current Procedural Terminology [CPT] code 27447) as either outpatients or inpatients from 2007 to 2015. The incidence of perioperative medical and surgical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision (ICD-9) and CPT codes. Multivariate logistic regression analysis adjusted for age, sex, and Charlson Comorbidity Index (CCI) was used to calculate odds ratios (ORs) of complications among outpatients relative to inpatients treated with TKA.Results: Cohorts of 4,391 patients who underwent outpatient TKA and 128,951 patients who underwent inpatient TKA were identified. The median age was in the 70 to 74-year age group in both cohorts. The incidence of outpatient TKA increased across the study period (R = 0.60, p = 0.015). After adjustment for age, sex, and CCI, outpatient TKAs were found to more likely be followed by tibial and/or femoral component revision due to a noninfectious cause (OR = 1.22, 95% confidence interval [CI] = 1.01 to 1.47; p = 0.039), explantation of the prosthesis (OR = 1.35, CI = 1.07 to 1.72; p = 0.013), irrigation and debridement (OR = 1.50, CI = 1.28 to 1.77; p < 0.001), and stiffness requiring manipulation under anesthesia (OR = 1.28, CI = 1.17 to 1.40; p < 0.001) within 1 year. Outpatient TKA was also more frequently associated with postoperative deep vein thrombosis (OR = 1.42, CI = 1.25 to 1.63; p < 0.001) and acute renal failure (OR = 1.13, CI = 1.01 to 1.25; p = 0.026).Conclusions: With the potential to minimize arthroplasty costs among healthy patients, outpatient TKA is an increasingly popular option. Nationwide data from a private insurance database demonstrated a higher risk of perioperative surgical and medical complications including component failure, surgical site infection, knee stiffness, and deep vein thrombosis.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose: Prior studies have reported high complication rates with acromioclavicular joint reconstruction (ACJR). However, many of these reports have suffered from small sample sizes and inclusion of older surgical techniques. The purpose of this study was to determine the rates of early complications requiring reoperation in patients treated with ACJR.Methods: From 2007 to 2011, patients who were treated with ACJR were identified using the PearlDiver database, a large insurance database in the USA. The following reoperations were then queried from this patient cohort: irrigation and debridement within 30 days of index surgery, manipulation under anaesthesia (MUA) of the shoulder joint within 3 months of index surgery, and revision ACJR, distal clavicle excision, and removal of hardware within 6 months of index surgery.Results: In total, 2106 patients treated with ACJR were identified. The reoperation rates for irrigation and debridement, MUA, revision ACJR, distal clavicle excision, and removal of hardware were 2.6, 1.3, 4.2, 2.8, and 6.2 %, respectively. Patients ≥35 years of age and females more likely to undergo a reoperation after ACJR. Specifically, patients ≥35 years of age were more likely to undergo MUA and revision ACJR, while patients ≥50 years of age were more likely to undergo an irrigation and debridement. Females were more likely than males to undergo revision ACJR and distal clavicle excision.Conclusions: Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement. By analysing a large cohort of patients across multiple centres and providers, this study provides valuable insight into the recent complication profiles of ACJR, allowing surgeons to appropriately counsel patients on the risks of these procedures.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

The article discusses a study which explored the incidence of acute infections after arthroscopic shoulder surgery and compared infection rates by age group, sex, geographic region, and specific procedures. The results showed that the overall infection rate for all arthroscopic shoulder procedures was 0.27 %. The study also found that the incidence was highest in elderly patients, in the South, and for rotator cuff repair, and lowest in young patients, in the Midwest, and for capsulorrhaphy.

The article presents a study which identifies the complications in patients following the use of bone morphogenetic proteins (BMP) in spinal fusion surgery. The study conducted a systemic review of literatures published from 1990 to June 2009 in the Cochrane Collaboration Library, EMBASE and MEDLINE. Results show that multiple complications including resorption, subsidence and dysphagia are associated following the use of recombinant BMP-2 in lumbar and cervical spinal fusion surgery.

The number of spinal procedures utilizing metallic implants has significantly increased in the past decade. Unfortunately, a small percentage of the cases are complicated by spinal infections in the setting of instrumentation. The clinical, laboratory, and radiographic assessment of this difficult patient population can be quite challenging to even the astute clinician. Traditional radiographic techniques including CT scan and MRI are significantly less useful in this situation secondary to the confusing postoperative changes and the presence of internal fixation. In this article, we review the nuclear medicine imaging modalities which can be used to assist in the diagnosis and management of patients with postoperative spinal infections with metallic implants. These include 99Technetiumm-methylene diphosphonate (99Tcm-MDP) scan, SPECT scan, three-phase bone scan, 67Gallium citrate scan, 111Indium oxine labeled leukocytes scan, 18-F-Fluoro-deoxy-d-glucose (FDG) labeled PET scanning, as well as combinations of the different modalities. Combinations of the radiopharmaceutical isotope scans and the new FDG PET scan appear to demonstrate the most optimal sensitivity and specificity for infection detection in this patient population. [ABSTRACT FROM AUTHOR]

Background: A primary concern after posterior lumbar spine arthrodesis is the potential for adjacent segment degeneration cephalad or caudad to the fusion segment. There is controversy regarding the subsequent degeneration of adjacent segments, and we are aware of no long-term studies that have analyzed both cephalad and caudad degeneration following posterior arthrodesis. A retrospective investigation was performed to determine the rates of degeneration and survival of the motion segments adjacent to the site of a posterior lumbar fusion. Methods: Two hundred and fifteen patients who had undergone posterior lumbar arthrodesis were included in this study. The study group included 126 female patients and eighty-nine male patients. The average duration of follow-up was 6.7 years. Radiographs were analyzed with regard to arthritic degeneration at the adjacent levels both preoperatively and at the time of the last follow-up visit. Disc spaces were graded on a 4-point arthritic degeneration scale. Correlation analysis was used to determine the contribution of independent variables to the rate of degeneration. Survivorship analysis was performed to describe the degeneration of the adjacent motion segments. Results: Fifty-nine (27.4%) of the 215 patients had evidence of degeneration at the adjacent levels and elected to have an additional decompression (fifteen patients) or arthrodesis (forty-four patients). Kaplan-Meier analysis predicted a disease-free survival rate of 83.5% (95% confidence interval, 77.5% to 89.5%) at five years and of 63.9% (95% confidence interval, 54.0% to 73.8%) at ten years after the index operation. Although there was a trend toward progression of the arthritic grade at the adjacent disc levels, there was no significant correlation, with the numbers available, between the preoperative arthritic grade and the need for additional surgery. Conclusions: The rate of symptomatic degeneration at an adjacent segment warranting either decompression or arthrodesis was predicted to be 16.5% at five years and 36.1% at ten years. There appeared to be no correlation with the length of fusion or the preoperative arthritic degeneration of the adjacent segment. Level of Evidence: Prognostic study, Level IV (case series). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study.Objective: The aim of this study was to compare different aspects of fusion surgery in patients with osteoporosis with regard to graft subtype and surgical approach.Summary Of Background Data: Osteoporosis and chronic lower back pain are common in elderly populations and significantly increase the risk of compression fractures within the spine.Methods: Using the 2016-2017 National Readmission Database we identified 11,086 osteoporotic patients who received lumbar fusion using ICD-10 coding. Information regarding biologic graft type and surgical approach was collected. Patients were stratified by number of levels fused. Perioperative complications were collected at 30-, 90-, and 180-day follow-up intervals. Statistical analysis included univariate testing and multivariate regression modeling, controlling for patient demographics and comorbidities.Results: Patients receiving single-level fusion with autologous grafts had higher rates of hardware failure (P = 0.00014) at 30-day follow-up and 90-day follow-up (P < 0.0001) and higher rates of lumbar vertebral fractures at 90-day follow-up (P = 0.045) compared to those treated with nonautologous grafts. Patients receiving lumbar fusion with anterior and posterior approaches had no difference in readmission or infection rates, but the anterior approach was associated with a higher cost.Conclusion: In this study, osteoporotic patients treated with autologous grafts had higher rates of complications compared to those treated with nonautologous grafts. Anterior and posterior approaches had similar complication rates; however, the anterior approach was associated with a higher total cost.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background Context: Posterior cervical foraminotomy (PCF) is a relatively safe procedure for the treatment of cervical radiculopathy. Though most often performed as an inpatient procedure, there is an increasing number of patients treated in an outpatient setting.Purpose: This study aimed to compare the perioperative complication rates associated with inpatient and outpatient single-level PCF.Study Design/setting: Retrospective database study.Patient Sample: Patients with cervical radiculopathy who underwent inpatient or outpatient single-level PCF between 2007 to the first quarter of 2016.Outcome Measures: Charlson Comorbidity Index (CCI) was used as a broad measure of comorbidity. Surgical complications included cervical nerve root injury, dural tear, wound complications, infection, dysphagia, cervicalgia, and revision surgery. Medical complications included pulmonary embolism and lower limb deep vein thrombosis, acute myocardial infarction, acute respiratory failure, pneumonia, sepsis, and urinary complications.Methods: This study was a retrospective review of patients who received single-level PCF from 2007 to the first quarter of 2016 as either outpatients or inpatients using the Humana subset of the PearlDiver Patient Record Database. The incidence of perioperative medical and surgical complications was queried using relevant International Classification of Diseases (ICD-9-CM and ICD-10-CM) and Current Procedural Terminology codes. Multivariate logistic regression analysis, adjusted for age, gender, and CCI, was performed to calculate odds ratios (ORs) of complications among inpatients relative to outpatients treated with PCF. Propensity score matching was done, and comparisons were made for postoperative complications.Results: Throughout the time period, 1,469 and 1,192 patients received inpatient and outpatient single-level PCF, respectively. The mean CCIs±standard deviation of inpatient and outpatient groups undergoing PCF were 2.83±3.11 and 1.46±2.21, respectively (p<.001). After propensity score matching, patients who received PCF in an inpatient setting showed significantly higher rates of wound complications (OR=1.53, 95% confidence interval [CI]=1.04-2.23; p=.029), infection (OR=1.91, CI=1.15-3.15; p=.012), acute respiratory failure (OR=2.50, CI=1.23-5.08; p=.011), and urinary tract infections and incontinence (OR=2.11, CI=1.32-3.38; p=.002).Conclusions: Outpatient single-level PCF was associated with a lower rate of perioperative medical and surgical complications. The PCF in the outpatient setting can potentially be a safe procedure for the treatment of cervical radiculopathy with appropriate patient selection. [ABSTRACT FROM AUTHOR]

Background Context: Previous studies have found an association between mental illness and poor outcomes in spine surgery, but little is known about the effects of depression and/or anxiety on the adult spinal deformity population. In addition, most relevant studies exclusively focused on the lumbar spine and had relatively small patient sizes.Purpose: The aim of this study was to investigate whether adult spinal deformity patients with depression and/or anxiety have an increased risk of postoperative complications and reoperation following posterior thoracolumbar spinal surgery.Study Design/setting: Retrospective database study.Methods: Adult patients (over 18 years of age) with a diagnosis of spinal deformity undergoing any reconstructive thoracic or thoracolumbar spinal procedure with a posterior approach between 2007 and 2015 Q2 were identified using Current Procedural Terminology codes to query the Pearl Diver patient record database (Pearl Diver Technologies, West Conshohocken, PA, USA). The database includes records of approximately 18 million patients across the United States having Humana insurance. Further selection of patients with depression and/or anxiety and their associated postoperative complications were identified using ICD-9 and ICD-10 diagnosis codes (International Classification of Diseases 9th-10th edition). The mental illness cohort was matched to a control group according to age, sex, and Charlson Comorbidity Index. Patient data was analyzed for reoperation rates and incidence of common postoperative complications.Results: Multilevel posterolateral fusion was the most common included posterior thoracic reconstructive surgery. The mental illness cohort (n = 327) had significantly increased rates of infection (odds ratio [OR] = 1.743, p = .022) and respiratory complications (OR = 1.492, p = .02) at the 90-day postoperative period. The rates of incision and drainage (OR = 1.379, p = .475) and pneumonia (OR = 1.22, p = .573) were increased in the mental illness cohort at the 90-day postoperative period, but not significantly. There were no significant differences in complication and reoperation rates at 1-year postoperatively.Conclusions: Patients with spinal deformity and pre-existing depression and/or anxiety treated with a posterior thoracolumbar reconstructive spinal surgery had significantly elevated risk of postoperative infections and respiratory complications when compared with the control group. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective case-control study.Objective: The aim of this study was to determine the nationwide trends and complication rates associated with outpatient posterior lumbar fusion (PLF).Summary Of Background Data: Outpatient lumbar spine fusion is now possible secondary to minimally invasive techniques that allow for reduced hospital stays and analgesic requirements. Limited data are currently available regarding the clinical outcome of outpatient lumbar fusion.Methods: The Humana administrative claims database was queried for patients who underwent one to two-level PLF (CPT-22612 or CPT-22633 AND ICD-9-816.2) as either outpatients or inpatients from Q1 2007 to Q2 2015. The incidence of perioperative medical and surgical complications was determined by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate odds ratios (ORs) of complications among outpatients relative to inpatients undergoing PLF.Results: Cohorts of 770 patients who underwent outpatient PLF and 26,826 patients who underwent inpatient PLF were identified. The median age was in the 65 to 69 years age group for both cohorts. The annual relative incidence of outpatient PLF remained stable across the study period (R = 0.03, P = 0.646). Adjusting for age, gender, and comorbidities, patients undergoing outpatient PLF had higher likelihood of revision/extension of posterior fusion [(OR 2.33, confidence interval (CI) 2.06-2.63, P < 0.001], anterior fusion (OR 1.64, CI 1.31-2.04, P < 0.001), and decompressive laminectomy (OR 2.01, CI 1.74-2.33, P < 0.001) within 1 year. Risk-adjusted rates of all other postoperative surgical and medical complications were statistically comparable.Conclusion: Outpatient lumbar fusion is uncommonly performed in the United States. Data collected from a national private insurance database demonstrate a greater risk of postoperative surgical complications including revision anterior and posterior fusion and decompressive laminectomy. Surgeons should be cautious in performing PLF in the outpatient setting, as the risk of revision surgery may increase in these cases.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background Context: With the changing landscape of health care, outpatient spine surgery is being more commonly performed to reduce cost and to improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population.Purpose: The objective of this study was to determine the nationwide trends and relative complication rates associated with outpatient ACDF.Study Design/setting: This is a large-scale retrospective case control study.Patient Sample: The patient sample included Humana-insured patients who underwent one- to two-level ACDF as either outpatients or inpatients from 2011 to 2016 OUTCOME MEASURES: The outcome measures included incidence and the adjusted odds ratio (OR) of postoperative medical and surgical complications within 1 year of the index surgery.Materials and Methods: A retrospective review was performed of the PearlDiver Humana insurance records database to identify patients undergoing one- to two-level ACDF (Current Procedural Terminology [CPT]-22551 and International Classification of Diseases [ICD]-9-816.2) as either outpatients or inpatients from 2011 to 2016. The incidence of perioperative medical and surgical complications was determined by querying for relevant ICD and CPT codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate ORs of complications among outpatients relative to inpatients undergoing ACDF.Results: Cohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the 65-69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=.04). Adjusting for age, gender, and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, confidence interval [CI] 1.27-1.96, p<.001) and 1 year (OR 1.79, CI 1.51-2.13, p<.001) postoperatively. Outpatient ACDF was also associated with a higher likelihood of revision anterior fusion at 1 year postoperatively (OR 1.46, CI 1.26-1.70, p<.001). Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient ACDF (OR 1.25, CI 1.06-1.49, p=.010). Adjusted rates of all other queried surgical and medical complications were comparable.Conclusions: Outpatient ACDF is increasing in frequency nationwide over the past several years. Nationwide data demonstrate a greater risk of perioperative surgical complications, including revision anterior and posterior fusion, as well as a higher risk of postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks. [ABSTRACT FROM AUTHOR]

Study Design: Secondary analysis of data from a prospective multicenter observational study.Objective: The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery.Summary Of Background Data: SSI is a morbid and expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI following spine surgery. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study.Methods: Patients undergoing elective spine surgery over a period of 4 years at seven spine surgery centers across the United States were included in the study. Patients were dichotomized on the basis of whether intrawound vancomycin was applied. Outcomes were occurrence of SSI within postoperative 30 days and SSI that required return to the operating room (OR). Multivariable random-effect log-binomial regression analyses were conducted to determine the relative risk of having an SSI and an SSI with return to OR.Results: .: A total of 2056 patients were included in the analysis. Intrawound vancomycin was utilized in 47% (n = 966) of patients. The prevalence of SSI was higher in patients with no vancomycin use (5.1%) than those with use of intrawound vancomycin (2.2%). The risk of SSI was higher in patients in whom intrawound vancomycin was not used (relative risk (RR) -2.5, P < 0.001), increased number of levels exposed (RR -1.1, P = 0.01), and those admitted postoperatively to intensive care unit (ICU) (RR -2.1, P = 0.005). Patients in whom intrawound vancomycin was not used (RR -5.9, P < 0.001), increased number of levels were exposed (RR-1.1, P = 0.001), and postoperative ICU admission (RR -3.3, P < 0.001) were significant risk factors for SSI requiring a return to the OR.Conclusion: The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background Context: Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery.Purpose: The study aimed to describe a perfusion-based cadaveric simulation model with cerebrospinal fluid (CSF) reconstitution and to compare spine dural repair techniques.Study Design/setting: The study is set in a fresh tissue dissection laboratory.Sample Size: The sample includes eight fresh human cadavers.Outcome Measures: A watertight closure was achieved when pressurized saline up to 40 mm Hg did not cause further CSF leakage beyond the suture lines.Methods: Fresh human cadaveric specimens underwent cannulation of the intradural cervical spine for intrathecal reconstitution of the CSF system. The cervicothoracic dura was then exposed from C7-T12 via laminectomy. The entire dura was then opened in six cadavers (ALLSPINE) and closed with 6-0 Prolene (n=3) or 4-0 Nurolon (n=3), and pressurized with saline via a perfusion system to 60 mm Hg to check for leakage. In two cadavers (INCISION), six separate 2-cm incisions were made and closed with either 6-0 Prolene or 4-0 Nurolon, and then pressurized. A hydrogel sealant was then added and the closure was pressurized again to check for further leakage.Results: Spinal laminectomy with repair of intentional durotomy was successfully performed in eight cadavers. The operative microscope was used in all cases, and the model provided a realistic experience of spinal durotomy repair. For ALLSPINE cadavers (mean: 240 mm dura/cadaver repaired), the mean pressure threshold for CSF leakage was observed at 66.7 (±2.9) mm Hg in the 6-0 Prolene group and at 43.3 (±14.4) mm Hg in the 4-0 Nurolon group (p>.05). For INCISION cadavers, the mean pressure threshold for CSF leakage without hydrogel sealant was significantly higher in 6-0 Prolene group than in the 4-0 Nurolon group (6-0 Prolene: 80.0±4.5 mm Hg vs. 4-0 Nurolon: 32.5±2.7 mm Hg; p<.01). The mean pressure threshold for CSF leakage with the hydrogel sealants was not significantly different (6-0 Prolene: 100.0±0.0 mm Hg vs. 4-0 Nurolon: 70.0±33.1 mm Hg). The use of a hydrogel sealant significantly increased the pressure thresholds for possible CSF leakage in both the 6-0 Prolene group (p=.01) and the 4-0 Nurolon group (p<.01) when compared with mean pressures without the hydrogel sealant.Conclusions: We described the feasibility of using a novel cadaveric model for both the study and training of watertight dural closure techniques. 6-0 Prolene was observed to be superior to 4-0 Nurolon for watertight dural closure without a hydrogel sealant. The use of a hydrogel sealant significantly improved watertight dural closures for both 6-0 Prolene and 4-0 Nurolon groups in the cadaveric model. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective database study.Objective: The goal of this study was to (1) evaluate the trends in the use of intraoperative neuromonitoring (ION) for anterior cervical discectomy and fusion (ACDF) surgery in the United States and (2) assess the incidence of neurological injuries after ACDFs with and without ION.Summary Of Background Data: Somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) are the commonly used ION modalities for ACDFs. Controversy exists on the routine use of ION for ACDFs and there is limited literature on national practice patterns of its use.Methods: A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of spondylotic myelopathy and radiculopathy that underwent ACDF from 2007 to 2014. The type of ION modality used and the rates of neurological injury after surgery were assessed.Results: During the study period, 15,395 patients underwent an ACDF. Overall, ION was used in 2627 (17.1%) of these cases. There was a decrease in the use of ION for ACDFs from 22.8% in 2007 to 4.3% use in 2014 (P < 0.0001). The ION modalities used for these ACDFs were quite variable: SSEPs only (48.7%), MMEPs only (5.3%), and combined SSEPs and MMEPs (46.1%). Neurological injuries occurred in 0.23% and 0.27% of patients with and without ION, respectively (P = 0.84). Younger age was associated with a higher utility of ION (<45: 20.3%, 45-54: 19.3%, 55-64: 16.6%, 65-74: 14.3%, and >75: 13.6%, P < 0.0001). Significant regional variability was observed in the utility of ION for ACDFs across the country (West; 21.9%, Midwest; 12.9% (P < 0.0001).Conclusion: There has been a significant decrease in the use of ION for ACDFs. Furthermore, there was significant age and regional variability in the use of ION for ACDFs. Use of ION does not further prevent the rate of postoperative neurological complications for ACDFs as compared with the cases without ION. The utility of routine ION for ACDFs is questionable.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background Context: Minimally invasive sacroiliac (SI) joint fusion has become increasingly relevant in recent years as a treatment for SI joint pathology. Previous studies have found minimally invasive SI fusion to be an effective and safe treatment option for chronic SI joint pain. However, these studies have been primarily single-center, case-based, or manufacturer-sponsored investigations, and as such their findings are limited to their sample populations.Purpose: The aim of this study was to investigate the safety of minimally invasive SI fusion using a large nationwide sample group to more accurately identify complication rates of this increasingly popular procedure.Study Design/setting: This is a retrospective database study.Patient Sample: The sample includes patients within the orthopedic subset of Humana database who underwent minimally invasive SI fusion between 2007 and 2014.Outcome Measures: Complications and novel lumbar and nerve pathology were the outcome measures.Methods: Patients undergoing minimally invasive SI fusion from 2007 to 2014 were identified using the Pearl Diver patient record database (Pearl Diver Technologies, West Conshohocken, PA, USA) from the nationwide private insurance provider Humana Inc. This approach provided access to records of over 18 million patients in every major geographic region of the country. Using the ICD-9 diagnosis codes (International Classification of Diseases 9th edition), data from patient records were analyzed to reveal incidence of postoperative infection, pain, osteomyelitis, joint derangement, urinary tract infection, and novel lumbar and nervous system pathology.Results: Four hundred sixty-nine patients (305 female; 164 male) within the Humana insurance database received minimally invasive SI fusion between 2007 and 2014. Data from these patients showed a substantial increase in the use of the procedure over this 7-year period. Among these patients, an overall complication rate of 13.2% (n=62) was seen at 90 days postoperatively and 16.4% (n=77) at 6 months. The number of patients receiving a first time diagnosis of lumbar pathology following minimally invasive SI fusion in the sample population was also analyzed. The incidence of novel lumbar pathology in this population was 3.6% (n=17) at 90 days postoperatively and 5.3% (n=25) at 6 months. Men experienced diagnoses of novel lumbar pathology at higher rates than women within both 90 days (men=6.7%; women≤3.3%) and 6 months (men=9.1%; women≤3.3%) of the procedure (p<.01).Conclusions: The results of this study show that minimally invasive SI joint fusion could possibly carry higher risks of complications than previously stated. These findings are useful for physicians and patients when considering treatment for chronic SI joint pain. [ABSTRACT FROM AUTHOR]

The concept of frailty has become increasingly recognized, and while patients with cancer are at increased risk for frailty, its influence on perioperative outcomes in metastatic spine tumors is uncertain. Furthermore, the impact of frailty can be confounded by comorbidities or metastatic disease burden. The purpose of this study was to evaluate the influence of frailty and comorbidities on adverse outcomes in the surgical management of metastatic spine disease. Retrospective Cohort Study. A total of 7,772 patients underwent spinal fusion with spinal metastasis within the Nationwide Readmissions Database (NRD). Mortality, medical complications, surgical complications, increased length of stay (LOS), nonroutine discharge and increased costs. A validated binary frailty index (Johns Hopkins Adjusted Clinical Groups) was used to identify frail and non-frail groups, and propensity score-matched analysis (including demographics, comorbidities, surgical and tumor characteristics) was performed. Sub- group analysis of levels involved was performed for cervical, thoracic, lumbar and junctional spine. Outcomes analyzed included mortality, complications, length of stay (LOS), nonroutine discharges and costs. Multivariable-regression techniques were used to develop predictive models for outcomes using frailty and the Elixhauser Comorbidity Index (ECI). A total of 7,772 patients underwent spinal fusion with spinal metastasis, of which 1,974 (25.4%) patients were identified as frail. Following propensity score matching for frail (n= 1,974) and not-frail (n=1,975) groups, frailty demonstrated significantly greater medical complications (OR=1.58; 95% CI 1.33-1.86), surgical complications (OR=1.46; 95% CI 1.15-1.85), LOS (OR=2.65; 95% CI 2.09-3.37), nonroutine discharges (OR=1.79; 95% CI 1.46-2.20) and costs (OR=1.68; 95% CI 1.32-2.14). Differences in mortality were only observed in subgroup analysis and were greater in frail junctional and lumbar spine subgroups. Models using ECI alone (AUC= 0.636-0.788) demonstrated greater predictive ability compared to those using frailty alone (AUC=0.633-0.752). However, frailty combined with ECI improved the prediction of increased LOS (AUC=0.811), cost (AUC=0.768), medical complications (AUC=0.723) and nonroutine discharges (AUC=0.718). Predictive modeling of frailty in subgroups demonstrated the greatest performance for mortality (AUC=0.750) in the lumbar spine, otherwise performed similarly for LOS, costs, complications, and discharge across subgroups. A high prevalence of frailty existed in the current patient cohort. Frailty contributed to worse short-term adverse outcomes and could be more influential in the lumbar and junctional spine due to higher risk of deconditioning in the postoperative period. Predictions for short-term outcomes can be improved by adding frailty to comorbidity indices, suggesting a more comprehensive preoperative risk stratification should include frailty. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Lumbar fusions are commonly used surgical techniques for the treatment of instability and degenerative disc disease. Few studies have examined if the non-opioid analgesics Gabapentin and Pregabalin can effectively manage postoperative pain following common lumbar fusion procedures. This study aims to examine postoperative complications associated with the use of non-opioid analgesics (ie, Gabapentin or Pregabalin) for postoperative pain management following anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or transforaminal lumbar interbody fusion (TLIF). Retrospective database review. Patient cohort identified using MSpine national database that includes patients of all payer types who received fusion procedures. Complications examined included the following: neurologic, GI, respiratory, DVT and pulmonary embolism, pruritus, mental disorders, urinary incontinence and postoperative pain. The MSpine national database was queried with relevant Current Procedural Terminology (CPT) codes for patients who underwent an ALIF, PLIF, or TLIF between 2010 to 2019. Patients were organized into anterior approach and posterior approach groups and further queried using National Drug Codes (NDC) to form cohorts of patients who received (i) exclusively opioids, or (ii) a mix regimen, for postoperative pain management. A search of relevant International Classification of Diseases (ICD-9 and ICD-10) codes identified the postoperative surgical and medical complications. Propensity score matching for age, gender, and Charlson Comorbidity Index was performed to control for potential confounding factors. Odds ratios and CI will be used to compare postoperative complication rates between the various groups. The anterior_opioids group included 22,581 patients (45.5% male and 54.5% female) and the anterior_mix group included 2,192 patients (37.2% male and 62.8% female). The posterior_opioids group included 22,279 patients (48.0% male and 52.0% female) and the posterior_mix group included 2,677 patients (39.4% male and 60.6% female). After propensity score matching, the anterior groups and posterior groups were 2,182 and 2,671 patients, respectively. The incidence of postoperative pain at 6 weeks was higher in anteriormix (6.0%) than anterior_opioids (3.9%); similarly, this incidence was higher in posterior_mix (8.6%) than posterior_opioids (5.6%). The incidence of mental disorders at 3 weeks was higher in anterior_opioids (6.9%) than anterior_mix (5.8%), while the incidence of GI complications at 3 weeks was lower in anterior_opioids (3.1%) than anterior_mix (3.8%). Respiratory complications at 3 weeks were higher in posterior_mix (2.5%) than posterior_opioids (1.9%). Furthermore, neurologic complications at 3 weeks were higher in posterior_mix (2.3%) than posterior_opioids (1.9%). Patients receiving opioids and Gabapentin or Pregabalin for postoperative pain management following ALIF had higher incidence of postoperative pain and GI complications, but lower incidence of mental disorders, compared to patients who received opioids. Patients who received a mixed regimen for postoperative pain management following PLIF or TLIF were associated with a higher incidence of postoperative pain, respiratory, and neurologic complications. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Cervical radiculopathy refers to irritation of nerve roots exiting the cervical spine due to degenerative changes of the facet joints or intervertebral discs. Surgical management may include an anterior or posterior approach. Posterior decompression has been favored due to avoidance of anterior neck structure injury, adjacent segment disease and graft subsidence. Since posterior cervical foraminotomy (PCF) is a relatively safe procedure compared to anterior cervical discectomy and fusion, PCF has gained interest in an outpatient setting. To compare the perioperative surgical and medical complications associated with inpatient and outpatient single-level PCF. Retrospective database. Patients with cervical radiculopathy who had undergone inpatient or outpatient single-level PCF between 2007 to the first quarter of 2016. Charlson Comorbidity Index (CCI) was used as a broad measure of comorbidity. Surgical complications included cervical nerve root injury, dural tear, wound complications, infection, dysphagia, cervicalgia, CSF leakage and revision surgery. Medical complications included pulmonary embolism and lower limb deep vein thrombosis, acute myocardial infarction, acute respiratory failure, pneumonia, sepsis and urinary complications. The Humana subset of the PearlDiver Patient Record Database was queried to identify patients who had undergone inpatient or outpatient single-level PCF using CPT codes. The incidence of perioperative medical and surgical complications was queried for by using relevant ICD-9, ICD-10 and CPT codes. CCI was compared between the two groups using the 2-tailed Student-t test. Multivariate logistic regression analysis, adjusted for age, sex and CCIwas performed to calculate adjusted odds ratios (ORs), 95% confidence interval and significance level for each complication category, with the inpatient cohort treated as the exposed group. Throughout the time period, 1,469 and 1,192 patients received inpatient and outpatient single-level PCF, respectively. In both cohorts, the mean age was 65 to 69-year age group. The mean CCIs ± SD of inpatient and outpatient groups were 2.83±3.11 and 1.46±2.21, respectively (P <0.001). Patients who received inpatient PCF showed significantly higher rates of wound complications (Odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.16 to 2.62; P=0.015), dysphagia (OR=2.36, CI=1.07 to 5.98; P=0.047), acute respiratory failure (OR=5.17, CI=2.46 to 12.70; P <0.001), sepsis (OR=4.90, CI=1.87 to 16.94; P=0.004), and urinary tract infections and incontinence (OR=1.96, CI = 1.30 to 3.01; P=0.002). Compared to inpatient single-level PCF, outpatient PCF is associated with a lower risk of perioperative surgical and medical complications, including wound complications, dysphagia, acute respiratory failure, sepsis, urinary tract infection and urinary incontinence. PCF in outpatients is a safe procedure for the treatment of cervical radiculopathy with an appropriate patient selection. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Neurologic complications of cervical spine surgery include C5 palsy, monoplegia, paraplegia and quadriplegia and can have significant impact on quality of life. C5 palsy has a reported incidence of 0-30% with few well-established risk factors. Postoperative cervical spine iatrogenic monoplegia, paraplegia and quadriplegia have little literature supporting their incidence. The Charlson Comorbidity Index is a measure of comorbidity in patients that is associated with surgical outcomes. The objective of this study was to identify the incidence and risk factors for severe neurological complications including C5 palsy after cervical spine surgery using a nationwide patient database. Retrospective database study. Patients from the Humana national database who underwent cervical spine surgery between 2007 and 2016. Neurological complications, CCI, patient demographics. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10), and Current Procedural Terminology (CPT) codes were used to identify and evaluate patients from the Humana national database for neurological complications following posterior fusion cervical spine surgery, anterior fusion cervical spine surgery, laminectomy/laminotomy of the cervical spine, and artificial disc replacement of the cervical spine. Neurological complications were evaluated over a 14-day postoperative period. Using Chi-squared testing, complication incidences and relative risk ratios were calculated with respect to type of cervical spine surgery, CCI, patient age, and patient sex. A total of 45,373 patients from the Humana database fit the inclusion criteria for cervical spine surgery. Of these, 732 (1.61%) patients experienced a neurological complication within 14 days after cervical spine surgery. C5 palsy had an incidence of 0.06% across all cervical spine surgeries (29 of 45,373 patients). A CCI >3 had a 5.44 times relative risk for any neurological complication (RR: 5.44; 95% CI: 4.70 - 6.30; p<<0.001) and a 2.85 times relative risk of C5 palsy complications (RR: 2.85; 95% CI: 1.37 - 5.92; p <0.05). The incidence of neurological complications varied by surgery: posterior fusion (4.56%), anterior fusion (1.10%), laminotomy (1.84%) and artificial disc replacement (1.08%). Compared to female patients, male patients had a 1.43x increased risk of neurological complications (RR: 1.43; 95% CI: 1.23-1.65; p<<0.001), but not C5 palsy (RR: 1.23, 95% CI: 0.59-2.56, p=0.57314). Patients 90 years of age and over had the highest incidence of neurological complications (10.26%). Incidence of neurological complications followed a linear increase as age increased. Patients who underwent cervical spine surgery and had a CCI > 3 were at a significantly increased relative risk for neurological complications including C5 palsy within 14 days after surgery. Compared to female patients, male patients had a statistically significant increased incidence in neurological complications, but no significant increase in incidence for C5 palsy. Posterior fusion cervical spine surgery had the highest incidence of neurological complications. Age was correlated with greater incidence of neurological complications. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Outpatient lumbar spine fusion is now possible secondary to minimally invasive techniques that allow for reduced hospital stays and analgesic requirements. Data is currently limited regarding the clinical outcome of outpatient lumbar fusion. PURPOSE The purpose of this study is to determine the nationwide trends and complication rates associated with outpatient posterior lumbar fusion (PLF). STUDY DESIGN/SETTING This is a retrospective case control study utilizing the Humana subset of the PearlDiver insurance records database. PATIENT SAMPLE The patient sample consisted of patients who underwent one-two level PLF (CPT-22612 or CPT-22633 AND ICD-9-816.2) as either outpatients or inpatients from Q1 2007 to Q2 2015. OUTCOME MEASURES Perioperative medical and surgical complications were identified by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. METHODS The incidence of perioperative medical and surgical complications was determined after the database query was performed. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate odds ratios (OR) of complications among outpatients relative to inpatients undergoing PLF. RESULTS Cohorts of 770 patients who underwent outpatient PLF and 26,826 patients who underwent inpatient PLF were identified. The median age was in the age 65-69 age group for both cohorts. The annual relative incidence of outpatient PLF remained stable across the study period (R2=0.03, p=.646). Adjusting for age, gender, and comorbidities, patients undergoing outpatient PLF had higher likelihood of revision/extension of posterior fusion (OR 2.33, CI 2.06–2.63, p<.001), anterior fusion (OR 1.64, CI 1.31–2.04, p<.001), and decompressive laminectomy (OR 2.01, CI 1.74–2.33, p<.001) within one year. Risk adjusted rates of all other postoperative surgical and medical complications were statistically comparable. CONCLUSIONS Outpatient lumbar fusion is uncommonly performed in the United States. Data collected from a national private insurance database demonstrate a greater risk of postoperative surgical complications including revision anterior and posterior fusion and decompressive laminectomy. Surgeons should be cautious in performing posterior lumbar fusion in the outpatient setting as the risk of revision surgery may increase in these cases. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT With the changing landscape of health care, outpatient spine surgery is more commonly performed to reduce cost and improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the mo st common spine surgeries performed and demand is expected to increase with an aging population. PURPOSE The purpose of this study was to determine the nationwide trends and complication rates associated with outpatient ACDF as compared to inpatient ACDF. STUDY DESIGN/SETTING This study is a retrospective review utilizing the Humana subset of the PearlDiver insurance records database. PATIENT SAMPLE The patient sample consisted of patients undergoing single level ACDF (CPT-22551 AND ICD-9-816.2) as either outpatients or inpatients from 2011 to 2016. OUTCOME MEASURES Perioperative medical and surgical complications were identified by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. METHODS The incidence of perioperative medical and surgical complications was determined after the database query was performed. Multivariate logistic regression adjusting for age, gender and Charlson Comorbidity Index was used to calculate odds ratios (OR) of complications among outpatients relative to inpatients undergoing ACDF. RESULTS Cohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the age 65-69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=.04). Adjusting for age, gender and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, CI 1.27–1.96, p<.001) and one year postoperatively (OR 1.79, CI 1.51–2.13, p<.001). Outpatient ACDF patients were also more likely to undergo revision anterior fusion surgery with extension at one year postoperatively (OR 1.46, CI 1.26–1.70, p<.001). Rates of hardware removal, surgical wound exploration, dural tears, and neurological injury were statistically comparable. Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient (OR 1.25, CI 1.06–1.49, p=.010), while the rates of major thromboembolic, respiratory, and cardiovascular events were statistically comparable. CONCLUSIONS Outpatient spine surgery is growing increasingly popular due to changes in health care delivery and greater attention to cost reduction and improved efficiency. Data collected from a national private insurance database demonstrates greater risk of perioperative surgical complications associated with outpatient ACDF, including revision anterior and posterior fusion, as well as higher risk for postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Although posterior decompression is the most common approach for surgical treatment of degenerative thoracic spine disease, anterior approach is gaining interest due to its advantage in disc visualization. Considering the substantial similarity in neurologic outcomes following the two approaches, complication rates seem to be the key determinants in resolving the controversy over the optimal approach. PURPOSE To compare the complication rates between anterior and posterior decompression for degenerative thoracic spine disease. STUDY DESIGN/SETTING Retrospective database. PATIENT SAMPLE Patients with degenerative thoracic spine disease who had undergone anterior or posterior decompression between 2007 and 2015. OUTCOME MEASURES Charlson Comorbidity Index (CCI) as a broad measure of comorbidity; Intra-operative complications, including accidental organ puncture or laceration, hemorrhage and dural laceration; and major medical complications on the day of surgery, one month and three months after the surgery, including cardiovascular, central nervous system, infectious, respiratory and wound complications as well as organ failure and minor complications. METHODS A private insurance database (Humana) containing the medical records of over 68 million patients in United States was queried using the PearlDiver Patient Records Database (PearlDiver Technologies, Colorado Springs, CO, USA). Patients who had undergone anterior or posterior thoracic decompression were identified using the Current Procedural Terminology codes. Subsequently, records were screened for patients with degenerative diagnoses using the International Classification of Diseases 9th edition codes, and patients diagnosed with spinal neoplasm, trauma, fracture and infection were excluded. CCI was compared between groups using the Mann-Whitney U test. Incidence rates of complications were compared between the two approaches using the Chi-square statistics, and crude odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS A total of 1,495 patients were included in this study, consisting of 1,030 patients in the posterior group and 465 patients in the anterior group. CCI was significantly higher in the posterior group (Md=2, IQR: 1-4) compared to the anterior group (Md=2, IQR: 2-2, p<.001). Two groups were comparable in terms of cardiovascular, central nervous system, infectious and wound complications, as well as major organ failure. However, patients in the anterior group were more likely to develop intra-operative complications (6.45% vs. 3.40%, OR=1.88, 95% CI: 1.14-3.10, p<.05) and respiratory complications on the day of surgery (13.98% vs. 9.51%, OR=1.55, 95% CI: 1.11-2.16, p<.05), during the first month (23.66% vs. 16.31%, OR=1.59, 95% CI: 1.21-2.08, p<.01) and within three months after surgery (24.95% vs. 18.45%, OR=1.47, 95% CI: 1.13-1.91, p<.01). Furthermore, patients in this group were more likely to develop minor complications on the day of surgery (5.81% vs. 2.62%, OR=2.29, 95% CI: 1.33-3.95, p<.01), within one month (9.89% vs. 6.21%, OR=1.66, 95% CI: 1.12-2.46, p<.05) and three months after surgery (10.97% vs. 7.48%, OR=1.52, 95% CI: 1.05-2.21, p<.05). CONCLUSIONS Despite having a lower overall comorbidity score, patients with degenerative thoracic spine diseases undergoing anterior decompression were more likely to develop intraoperative, respiratory and minor complications when compared to the posterior approach. High rates of respiratory complications following the anterior approach underline the importance of special respiratory care for these patients. Future studies may focus on predictive factors of respiratory compromise following thoracic decompression, aiming to identify the patients at risk who may benefit from posterior decompression. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]