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Impact of Intraoperative Monitoring During Elective Complex Spinal Fusions (≥4 Levels) on 30-Day Complication and Readmission Rates: A Single-Institutional Study of 643 Adult Patients with Spinal Deformity.

Authors :
Elsamadicy AA
Adogwa O
Lydon E
Reddy G
Kaakati R
Sergesketter A
Gottfried ON
Karikari IO
Source :
World neurosurgery [World Neurosurg] 2017 May; Vol. 101, pp. 283-288. Date of Electronic Publication: 2017 Feb 09.
Publication Year :
2017

Abstract

Objective: The aim of this study is to determine if there are differences in 30-day postoperative complication and readmission rates between patients with spinal deformity undergoing complex spinal fusion with and without intraoperative monitoring (IOM).<br />Methods: The medical records of 643 adult patients with spine deformity undergoing elective complex spinal fusion (≥4 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 122 cases (19%) that involved IOM including electromyography, somatosensory evoked potential, and/or transcranial motor evoked potential and 521 (81%) that did not (IOM, n = 122; no-IOM, n = 521). The primary outcome investigated was the rate of 30-day postoperative complications and readmission.<br />Results: Patient demographics and comorbidities were similar between both groups, including age, gender, body mass index, and smoking status. IOM cases had significantly increased operative time (IOM, 360.9 ± 153.8 minutes vs. no-IOM, 290.3 ± 127.1 minutes; P < 0.0001), with no differences in the incidences of spinal cord injury, nerve injury, and durotomy. Both cohorts had similar postoperative complications and length of hospital stay, with the no-IOM cohort having a greater incidence of intensive care unit transfer (no-IOM, 27.1% vs. IOM, 16.1%, P = 0.015). There was no significant difference in 30-day readmission between the cohorts (IOM, 8.2% vs. no-IOM, 12.3%; P = 0.27) or differences in sensorimotor deficits. Although the overall 30-day complication rate trended to be higher in the no-IOM cohort, these factors were not attributed to IOM use.<br />Conclusions: Our study suggests that the use of IOM may not have a significant impact on overall surgical outcomes and 30-day readmission rates.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1878-8769
Volume :
101
Database :
MEDLINE
Journal :
World neurosurgery
Publication Type :
Academic Journal
Accession number :
28192259
Full Text :
https://doi.org/10.1016/j.wneu.2017.02.002