Background: Disparities among social determinants of health (SDoH) can impact overall well-being and surgical outcomes. The purpose of this study was to identify SDoH for patients who underwent lumbar spine surgery and evaluate their relationship to the postoperative outcomes of length of stay (LOS), discharge disposition, and readmissions. Methods: We conducted a retrospective observational study of patients who underwent lumbar spine surgery from July 2017 to January 2021. We used a self-reported SDoH survey in conjunction with the electronic medical record to gather patient information. Multivariate analysis was used to evaluate the relationships between patient demographics, SDoH, and postoperative outcomes. Results: A total of 951 patients underwent lumbar spine surgery: 484 (50.9%) had decompressive laminectomy alone without fusion, and 467 (49.1%) had decompressive laminectomy with instrumented posterolateral fusion. When controlling for age, American Society of Anesthesiologists physical status classification, and surgery type, the SDoH of being currently married or having a life partner was associated with shorter LOS and decreased likelihood of discharge to a skilled nursing facility. Financial strain was associated with longer LOS, while attending church was associated with a decreased likelihood of 30-day emergency department (ED) return. Conclusion:This study identified various SDoH that may influence postoperative lumbar spine surgery outcomes of LOS, discharge disposition, 30-day ED return, and 30-day readmission. Patients at risk for suboptimal outcomes appear to be those with lower financial resources, less in-home support, and lower social connectivity. Routine screening of SDoH may enable care teams to effectively allocate resources for at-risk patients.
Background: Depression and anxiety are common within spine patient populations. The demand for surgical management of degenerative spine conditions and the prevalence of mental disorders are expected to increase as the general population ages. Concurrently, there is increasing pressure to demonstrate high-value care through improved perioperative outcome metrics and patient-reported outcome instruments. The purpose of this study was to evaluate the impact of common mental disorders on perioperative markers of high resource utilization and patient-reported outcomes measurement information system physical function (PROMIS-PF) following thoracolumbar (TL) spine surgery.Methods: A retrospective review of patients undergoing TL decompression alone or with fusion at a single institution. Data were collected using an administrative database for patient demographics. Outcomes of interest included length of stay, discharge disposition, 90-day return to the emergency department (ED), 90-day hospital readmission, 1-year complication rate, 1-year revision surgery rate, 1-year residual radiculopathy, and PROMIS-PF scores recorded preoperatively, at 0 to 1, 1 to 3, 3 to 6, and 6 to 12 months postoperatively. Univariate analysis and multiple linear regression were utilized to analyze results.Results: A total of 596 patients were included in this study, of whom 205 (34%) had a history of depression or anxiety. Compared with patients with no history of a mental disorder, patients with depression or anxiety who underwent TL decompression alone had higher rates of 90-day ED visits (P = 0.019), 90-day readmissions (P = 0.031), and complications at 1 year (P = 0.012). After risk adjustment, the diagnosis of depression or anxiety had no significant effect on PROMIS-PF improvement from the preoperative to postoperative period.Conclusion: Our study suggests that a history of depression or anxiety is common among patients undergoing spine surgery but has no significant impact on PROMIS-PF improvement. Because some patients with depression or anxiety may be at higher risk of postoperative resource utilization, further study and effort are warranted to support at-risk groups and improve overall care value.Clinical Relevance: Although patients with depression or anxiety are at risk for increased resource utilization after TL decompression or fusion, they can experience similar levels of functional improvement as patients without these conditions. Therefore depression or anxiety should not be considered contraindications to surgery, but additional attention should be paid to this population during the postoperative recovery period.
Topical hemostatic agents are commonly used in a wide variety of surgical procedures to assist in hemostasis. However, the use of these agents is not without risk as many contain biologically active agents derived from human and animal products that have the potential to cause adverse reactions. This case report covers a 44-year-old man with a history of alpha-gal syndrome who was scheduled for an open reduction and internal fixation of a left distal radius fracture. Alphagal syndrome is characterized by an IgE-mediated type 1 hypersensitivity reaction to a mammalian oligosaccharide epitope. Patients with this condition have a history of a past tick bite and subsequent development of an allergic reaction to mammalian protein products, most notably red meat. The patient had concerns about products used during surgery and potential reactions based on his allergy. The intent of this case report is to promote physician awareness of the widespread use of mammalian products in surgical hemostatic agents and potential immunogenic reactions. By increasing awareness of the alpha-gal syndrome, the goal is that medical device companies will actively disclose product components that could potentiate these adverse reactions and continue to develop alternative agents.
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