ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs

Whitmore, Robert G.; Stephen, James H.; Vernick, Coleen; Campbell, Peter G.; Yadla, Sanjay; Ghobrial, George M.; Maltenfort, Mitchell; Ratliff, John K.

doi:10.1016/j.spinee.2013.03.011

Cited by 177 publications

(133 citation statements)

References 30 publications

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“…Although the present study illustrates the effects that age, ASA grade, body habitus, and durotomies can have on hospital costs and length of stay, it reflects solely the immediate perioperative period. It is probable that these individual factors lead to increased complications and readmissions, as recently demonstrated in 2 independent studies conducted by Whitmore et al 18 and Kim et al 8 In addition, this study does not factor in long-term outcomes, which are equally important to consider and review in the subsets when considering reimbursement for surgery, as each cohort will probably still benefit. 1,5,12 The advantages of this study compared with large inpatient samples are the uniformity in practice and the accuracy of data collection.…”

Section: Discussionmentioning

confidence: 95%

Patient-specific factors affecting hospital costs in lumbar spine surgery

Puffer¹,

Planchard²,

Mallory³

et al. 2016

SPI

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OBJECT Health care-related costs after lumbar spine surgery vary depending on procedure type and patient characteristics. Age, body mass index (BMI), number of spinal levels, and presence of comorbidities probably have significant effects on overall costs. The present study assessed the impact of patient characteristics on hospital costs in patients undergoing elective lumbar decompressive spine surgery. METHODS This study was a retrospective review of elective lumbar decompression surgeries, with a focus on specific patient characteristics to determine which factors drive postoperative, hospital-related costs. Records between January 2010 and July 2012 were searched retrospectively. Only elective lumbar decompressions including discectomy or laminectomy were included. Cost data were obtained using a database that allows standardization of a list of hospital costs to the fiscal year 2013–2014. The relationship between cost and patient factors including age, BMI, and American Society of Anesthesiologists (ASA) Physical Status Classification System grade were analyzed using Student t-tests, ANOVA, and multivariate regression analyses. RESULTS There were 1201 patients included in the analysis, with a mean age of 61.6 years. Sixty percent of patients in the study were male. Laminectomies were performed in 557 patients (46%) and discectomies in 644 (54%). Laminectomies led to an increased hospital stay of 1.4 days (p < 0.001) and increased hospital costs by $1523 (p < 0.001) when compared with discectomies. For laminectomies, age, BMI, ASA grade, number of levels, and durotomy all led to significantly increased hospital costs and length of stay on univariate analysis, but ASA grade and presence of a durotomy did not maintain significance on multivariate analysis for hospital costs. For a laminectomy, patient age ≥ 65 years was associated with a 0.6-day increased length of stay and a $945 increase in hospital costs when compared with patient age < 65 years (p < 0.001). A durotomy during a laminectomy increased length of stay by 1.0 day and increased hospital costs by $1382 (p < 0.03). For discectomies, age, ASA grade, and durotomy were significantly associated with increased hospital costs on univariate analysis, but BMI was not. Only age and presence of a durotomy maintained significance on multivariate analysis. There was a significant increase in hospital length of stay in patients undergoing discectomy with increasing age, BMI, ASA grade, and presence of a durotomy on univariate analysis. However, only age and presence of a durotomy maintained significance on multivariate analysis. For discectomies, age ≥ 65 years was associated with a 0.7-day increased length of stay (p < 0.001) and an increase of $931 in postoperative hospital costs (p < 0.01) when compared with age < 65 years. CONCLUSIONS Patient factors such as age, BMI, and comorbidities have significant and measurable effects on the postoperative hospital costs of elective lumbar decompression spinal surgeries. Knowledge of how these factors affect costs will become important as reimbursement models change.

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Section: Discussionmentioning

confidence: 95%

Patient-specific factors affecting hospital costs in lumbar spine surgery

Puffer¹,

Planchard²,

Mallory³

et al. 2016

SPI

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“…In the spine literature, CCI scores have been found to predict mortality, complications, and re-admissions after spine surgery. [29][30][31] It is not surprising that CCI scores are associated with decreased union rates in this study. For example, patients with multiple co-morbidities such as metabolic syndrome often have vascular diseases that may limit neo-angiogenesis and blood flow to a fusion site.…”

Section: Discussionmentioning

confidence: 60%

Outcomes of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusion

et al. 2016

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BackgroundMultiple studies have demonstrated that a significant amount of variability exists in various demineralized bone matrix (DBM) formulations, which casts doubts on its reliability in consistently promoting fusion. Bone marrow aspirate (BMA) is a cellular based graft that contains mesenchymal stem cells (MSCs) and growth factors can confer osteogenic and osteoinductive potential to DBM. The goal of this study was to describe the outcome of DBM enriched with concentrated BMA in patients undergoing combined lumbar interbody and posterolateral fusion.

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“…Moreover, Arrigo et al [18] identified the Charlson comorbidity index (CCI) as a useful predictive tool for complications following spinal metastasis surgery. Also, Whitmore et al [19] reported that the ASA score and the CCI were useful tools in the preoperative assessment. However, surgical invasiveness was not considered, and their ability to predict occurrence of complications was limited.…”

Section: Discussionmentioning

confidence: 99%

Predicting medical complications in spine surgery: evaluation of a novel online risk calculator

et al. 2018

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Purpose The preoperative prediction of medical complications is essential to optimize perioperative management. SpineSage™ is a free of charge online calculator to predict medical complications in spine surgery. The current study utilizes it in patients undergoing spine surgery to assess whether the predicted risks would correlate with the actual complication rate in clinical practice. Methods A total of 273 consecutive patients who underwent spinal surgery were assessed. The risk of medical complications was predicted for each patient, and all medical complications were recorded within 30 days of surgery. Based on their predicted risk of complication, patients were divided into three risk groups (< 15, 15-30, > 30%). Results The predicted overall risk of medical complications was 14.7% and was comparable to the observed complication rate of 16.1%. The predicted risk for major medical complications (3.8%) was also similar to the observed complication rate (3.3%). Detailed analysis of the segmented risk groups suggests a close correlation between predicted and actual complication rates. Receiver operating characteristic analysis revealed an area under the curve of 0.71 (p < 0.001) for the prediction of overall medical complications and 0.85 (p < 0.001) for major complications. Conclusions The online risk calculator predicted both overall and major medical complications. The tool can assist in preoperative planning and counseling of patients.Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key pointsKeywords: Spine surgery, medical risk, medical complications, online calculator, risk assessment 1. Preoperative prediction of medical complications is essential to optimize perioperative management.2. SpineSage™ is a free of charge online calculator to predict medical complications in spine surgery.3. The current study analyzes whether the predicted risks would correlate with the actual complication rate in clinical practice. The median predicted risks and actually observed medical complication rate of all patients and risk groups are presented.

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ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs

Cited by 177 publications

References 30 publications

Patient-specific factors affecting hospital costs in lumbar spine surgery

Patient-specific factors affecting hospital costs in lumbar spine surgery

Outcomes of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusion

Predicting medical complications in spine surgery: evaluation of a novel online risk calculator

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