Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Ramos, Rafael De la Garza; Nakhla, Jonathan; Nasser, Rani; Schulz, Jacob F.; Purvis, Taylor E.; Sciubba, Daniel M.; Kinon, Merritt D.; Yassari, Reza

doi:10.3171/2017.7.focus17342

Cited by 36 publications

(29 citation statements)

References 20 publications

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“…Prior studies have suggested that obese patients are at higher risk due to their larger surface area, which may increase the potential dead space and require greater force during intraoperative retraction, which may lead to tissue necrosis. [40][41][42][43] Prevention strategies for reducing the risk of postoperative wound infection include bacterial screening, the administration of preincision antibiotics, and meticulous sterile technique. The CMS has implemented various initiatives aimed at reducing the incidence of preventable surgical complications, including surgical site infection, by suggesting that it will no longer pay the additional cost associated with adverse events.…”

Section: Discussionmentioning

confidence: 99%

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

Lee¹,

Fields²,

Boddapati³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEWith the continued evolution of bundled payment plans, there has been a greater focus within orthopedic surgery on quality metrics up to 90 days of care. Although the Centers for Medicare and Medicaid Services does not currently penalize hospitals based on their pediatric readmission rates, it is important to understand the drivers for unplanned readmission to improve the quality of care and reduce costs.METHODSThe National Readmission Database provides a nationally representative sample of all discharges from US hospitals and allows follow-up across hospitals up to 1 calendar year. Adolescents (age 10–18 years) who underwent idiopathic scoliosis surgery from 2012 to 2015 were included. Patients were separated into those with and those without readmission within 30 days or between 31 and 90 days. Demographics, operative conditions, hospital factors, and surgical outcomes were compared using the chi-square test and t-test. Independent predictors for readmissions were identified using stepwise multivariate logistic regression.RESULTSA total of 30,677 patients underwent adolescent idiopathic scoliosis surgery from 2012 to 2015. The rates of 30- and 90-day readmissions were 2.9% and 1.4%, respectively. The mean costs associated with the index admission and 30- and 90-day readmissions were $60,680, $23,567, and $16,916, respectively. Common risk factors for readmissions included length of stay > 5 days, obesity, neurological disorders, and chronic use of antiplatelets or anticoagulants. The index admission complications associated with readmissions were unintended durotomy, syndrome of inappropriate antidiuretic hormone, and superior mesenteric artery syndrome. Hospital factors, discharge disposition, and operative conditions appeared to be less important for readmission risk. The top reasons for 30-day and 90-day readmissions were wound infection (34.7%) and implant complications (17.3%), respectively. Readmissions requiring a reoperation were significantly higher for those that occurred between 31 and 90 days after the index readmission.CONCLUSIONSReadmission rates were low for both 30- and 90-day readmissions for adolescent idiopathic scoliosis surgery patients. Nevertheless, readmissions are costly and appear to be associated with potentially modifiable risk factors, although some risk factors remain potentially unavoidable.

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Section: Discussionmentioning

confidence: 99%

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

Lee¹,

Fields²,

Boddapati³

et al. 2021

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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“…Within the general spine literature, obesity has been widely associated with increased complication incidence. [34][35][36][37][38][39][40] Regarding surgical complications specifically, multiple studies have demonstrated an association between obesity and the incidence of surgical site infections. 35,38,39,41,42 The increased risk for surgical site infections in obese patients has been attributed to the increased risk of fat necrosis in this population, serving as a nidus for infection.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Medical and Surgical Complications After Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2020

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Background: The prevention of perioperative and postoperative complications is necessary to avoid poor postoperative outcomes and increased costs. Previous investigations have identified risk factors for complications after various spine procedures, but no such study exists in a population solely undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The purpose of this study is to determine risk factors for the development of complications up to 2 years after MIS TLIF procedures. Methods: Patients who underwent primary, single-level MIS TLIF from 2007 to 2016 were retrospectively reviewed. The incidence of medical and surgical complications up to 2 years postoperatively was determined. Patients were categorized according to demographic, comorbidity, and procedural characteristics. Bivariate Poisson regression with robust error variance was used to determine if an association existed between patient characteristics and complication incidence. A final multivariate model including all patient characteristics as controls was created using backwards, stepwise regression until only those variables with P , .05 remained. Results: 390 patients were analyzed. Upon bivariate analysis, age .50 years (P ¼ .025), diabetes mellitus (P ¼ .001), and operative duration .105 minutes (P ¼ .016) were associated with increased medical complication rates. Regarding surgical complications, age 50 years (P , .001), obesity (P ¼ .012), and diabetes mellitus (P ¼ .042) were identified as risk factors on bivariate analysis. Upon final multivariate analysis, operative time .105 minutes (P ¼ .009) and diabetes mellitus (P ¼ .001) were independent risk factors for medical complications. Independent risk factors for surgical complications on multivariate analysis included age 50 years (P , .001), diabetes mellitus (P ¼ .002), and obesity (P ¼ .030). Conclusions: Diabetic patients and those who underwent longer operations were at increased risk of medical complications, while younger patients, obese patients and those also with diabetes mellitus were at increased risk of surgical complications up to 2 years after MIS TLIF. Practitioners can use this information to identify patients who require preventative care before their procedure or increased postoperative vigilance and monitoring after single-level MIS TLIF.

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“…NSQIP-P has been used to describe adverse events following common pediatric orthopedic procedures in order to identify procedures and patient characteristics associated with an increased risk of postoperative complications [26]. Other studies have considered outcomes after specific orthopedic procedures [27][28][29], most frequently involving the spine [30][31][32][33], as well as outcomes in orthopedic patients with specific risk factors such as obesity, congenital heart disease, or cerebral palsy [34][35][36]. To our knowledge, NSQIP-P has not been used to characterize outcomes after pediatric orthopedic oncology procedures.…”

Section: Introductionmentioning

confidence: 99%

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Gallaway

Ahn

Callan

2020

Sarcoma

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Background. Pediatric bone and soft tissue sarcomas are rare; therefore, national registries are essential tools for orthopedic oncology research. Past studies provide excellent data on long-term prognosis and survival trends but fail to examine treatment-specific morbidity. The aim of this study is to use a national registry to describe patient demographics, comorbidities, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas. Methods. A retrospective review of patients in the American College of Surgeons National Surgical Quality Improvement Program—Pediatrics database (NSQIP-P) was performed. The cohort was partitioned by tumor origin (bone versus soft tissue) and tumor location (axial versus appendicular). Results. One-hundred ninety-two patients were identified. Bone sarcomas were more common (71.9%) and predominately appendicular (62.3%), while soft tissue sarcomas were predominately axial (77.8%). The overall complication rate was 8.9%. The most frequent etiologies were wound dehiscence (3.6%) and infectious complications such as surgical site infections (2.6%), pneumonia (1.6%), urinary tract infections (1.6%), and C. diff colitis (1.0%). Twenty-four percent of patients experienced bleeding requiring transfusion. The unplanned readmission rate was 12.5% (3.6% related to principle procedure), and the unplanned reoperation rate was 4.7% (4.2% related to principle procedure). The mortality rate was 1.0%. Neoadjuvant chemotherapy was associated with higher rates of wound dehiscence and infectious complications. There were no differences in adverse events with respect to tumor origin or location. Conclusion. Approximately 1 in 11 pediatric patients will experience a complication in the first thirty days following surgery. However, perioperative mortality remains low. This study represents the first comprehensive review of pediatric bone and soft tissue sarcoma surgery in the NSQIP-P database. As the case volume of NSQIP-P continues to grow, NSQIP-P has the potential to become a powerful tool for pediatric orthopedic oncology research.

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Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Cited by 36 publications

References 20 publications

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

Risk Factors for Medical and Surgical Complications After Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

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