Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion

Kammien, Alexander J.; Galivanche, Anoop R.; Gouzoulis, Michael J.; Moore, Harold E.; Mercier, Michael R.; Grauer, Jonathan N.

doi:10.1016/j.xnsj.2022.100122

Cited by 14 publications

(16 citation statements)

References 26 publications

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“…Rates of 90-day postoperative ED utilization are similar in other orthopaedic procedures, including 11.8% following total hip and knee arthroplasty, 30 8.3% following anterior cruciate ligament reconstruction, 13 and 11.9% following single-level anterior cervical discectomy and fusion. 12 In terms of timing of post-TAR ED visits, 32.0% occurred within the first 2 weeks, constituting the greatest density of visits within the 13-week study period. This indicates that the first 2 weeks following surgery are the most important to focus on from a care pathway perspective.…”

Section: Discussionmentioning

confidence: 98%

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Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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Background: Total ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration. Methods: This retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits. Results: Of 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) ( P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem. Conclusion: Of 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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“…This study is also subject to known limitations inherent to retrospective and administrative research, including the potential for selection bias and bias introduced from the misinterpretation of coding and frank errors. [28][29][30][31][32]…”

Section: Discussionmentioning

confidence: 99%

“…The database nature of the study prevents a full understanding of the details of the clinical encounter, including the evaluation of potential options for management between the patient and the surgeon. This study is also subject to known limitations inherent to retrospective and administrative research, including the potential for selection bias and bias introduced from the misinterpretation of coding and frank errors 28–32 …”

Section: Discussionmentioning

confidence: 99%

Single-level Anterior Cervical discEctomy and Fusion has Lower Five-year Revisions than Posterior Cervical Foraminotomy in a Large National Cohort

Jayaram

Joo

Gouzoulis

et al. 2023

Spine

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Study Design. A retrospective cohort study using the 2010-2020 MSpine PearlDiver administrative data set. Objective. To compare perioperative adverse events and fiveyear revisions for single-level anterior cervical discectomy and fusion (ACDF) versus posterior cervical foraminotomy (PCF). Summary of Background Data. Cervical disk disease can often be treated surgically using single-level ACDF or PCF. Prior studies have suggested that posterior approaches provide similar shortterm outcomes as ACDF; however, posterior procedures may have an increased risk of revision surgery. Materials and Methods. The database was queried for patients undergoing elective single-level ACDF or PCF (excluding cases performed for myelopathy, trauma, neoplasm, and/or infection). Outcomes, including specific complications, readmission, and reoperations, were assessed. Multivariable logistic regression was used to ascertain odds ratios (OR) of 90-day adverse events controlling for age, sex, and comorbidities. Kaplan-Meier survival analysis was performed to determine five-year rates of cervical reoperation in the ACDF and PCF cohorts. Results. A total of 31,953 patients treated by ACDF (29,958, 93.76%) or PCF (1995, 6.24%) were identified. Multivariable analysis, controlling for age, sex, and comorbidities, demonstrated that PCF was associated with significantly greater odds of aggregated serious adverse events (OR 2.17, P < 0.001), wound dehiscence (OR 5.89, P < 0.001), surgical site infection (OR 3.66, P < 0.001), and pulmonary embolism (OR 1.72, P = 0.04).However, PCF was associated with significantly lower odds of readmission (OR 0.32, P < 0.001), dysphagia (OR 0.44, P < 0.001), and pneumonia (OR 0.50, P = 0.004). At five years, PCF cases had a significantly higher cumulative revision rate compared with ACDF cases (19.0% vs. 14.8%, P < 0.001). Conclusions. The current study is the largest to date to compare short-term adverse events and five-year revision rates between single-level ACDF and PCF for nonmyelopathy elective cases. Perioperative adverse events differed by procedure, and it was notable that the incidence of cumulative revisions was higher for PCF. These findings can be used in decision-making when there is clinical equipoise between ACDF and PCF.

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“…Once unplanned readmission occurs, it will bring heavy mental burden and economic pressure to the patients and at the same time increase the difficulty of diagnosis and treatment for physicians. Ninety-day readmission is the rehospitalization of a patient who underwent cervical surgery within 90 days of discharge due to unpredictable factors such as the same disease or complications [ 10 , 11 ]. According to literature analysis, the readmission rate within 90 days after cervical surgery is 5–13% [ 9 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for ninety-day readmission following cervical surgery: a meta-analysis

Wang

Liao

et al. 2022

J Orthop Surg Res

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Background As an important evaluation index after cervical surgery, ninety-day readmission is gradually being valued. Our study collected the latest published relevant studies, analyzed the risk factors of ninety-day readmission after cervical surgery, and continuously improved the postoperative rehabilitation plan. This study focuses on two research hotspots: (1) What is the rate of ninety-day readmission after cervical surgery? (2) What are the risk factors affecting the ninety-day readmission? Methods Based on the Cochrane Library, PubMed, Web of Science, and Embase databases, this study searched for studies about ninety-day readmission after cervical surgery, from the establishment of the database to August 1, 2022. The evaluation indicators are as follows: age, American Society of Anesthesiology physical status (ASA) class, diabetes, hypertension, chronic heart diseases, chronic lung diseases, income, and payments for hospitalization. The meta-analysis was performed using Review Manager 5.4. Results Seven studies with 222,490 participants were eligible for our meta-analysis. The analysis displayed that there were statistically significant differences in the age (MD = − 4.60, 95%CI − 4.89–4.31, p < 0.001), diabetes (OR = 0.60, 95%CI 0.56–0.64, p < 0.00001), hypertension (OR = 0.40, 95%CI 0.30–0.54, p < 0.00001), chronic heart diseases (OR = 0.05, 95%CI 0.01–0.19, p < 0.00001), chronic lung diseases (OR = 0.46, 95%CI 0.43–0.49, p < 0.00001), income (OR = 2.85, 95%CI 1.82–4.46, p < 0.00001), and payments for hospitalization (OR = 2.29, 95%CI 1.14–4.59, p = 0.02) between readmission and no readmission groups. In terms of the ASA, there was no difference on the ninety-day readmission (p = 0.78). Conclusion Age, diabetes, hypertension, chronic heart diseases, chronic lung diseases, income, and payments for hospitalization are the risk factors of ninety‐day readmission following cervical surgery.

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Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion

Cited by 14 publications

References 26 publications

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Single-level Anterior Cervical discEctomy and Fusion has Lower Five-year Revisions than Posterior Cervical Foraminotomy in a Large National Cohort

Risk factors for ninety-day readmission following cervical surgery: a meta-analysis

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