Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion Is Not Attributable to Baseline Illness Severity or Postoperative Complications

Adogwa, Owoicho; Lilly, Daniel T.; Vuong, Victoria D.; Desai, Shyam A.; Ouyang, Bo; Khalid, Syed I.; Khanna, Raman; Bagley, Carlos A.; Cheng, Joseph

doi:10.1016/j.wneu.2018.04.094

Cited by 17 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This variation in practice may be a cause of extended hospitalizations in patients undergoing lumbar and cervical spine surgeries. 1,2 Given their nature as evidence-based platforms intended to streamline care and reduce waste, enhanced-recovery strategies enforce the use of standardized principles to minimize variations in practice among surgical teams. Enforcing consistency of postoperative care may underlie some of the benefit imparted by the adoption of ERAS programs.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after spine surgery: a systematic review

Elsarrag¹,

Soldozy²,

Patel³

et al. 2019

Neurosurgical Focus

175

113

View full text Add to dashboard Cite

OBJECTIVEEnhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience. Although extensively examined in other surgical areas, ERAS principles have been applied to spine surgery only in recent years. The authors examine studies investigating the application of ERAS programs to patients undergoing spine surgery.METHODSThe authors conducted a systematic review of the PubMed and MEDLINE databases up to November 20, 2018.RESULTSTwenty full-text articles were included in the qualitative analysis. The majority of studies were retrospective reviews of nonrandomized data sets or qualitative investigations lacking formal control groups; there was 1 protocol for a future randomized controlled trial. Most studies demonstrated reduced lengths of stay and no increase in rates of readmissions or complications after introduction of an ERAS pathway.CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after spine surgery: a systematic review

Elsarrag¹,

Soldozy²,

Patel³

et al. 2019

Neurosurgical Focus

175

113

View full text Add to dashboard Cite

show abstract

“…Adogwa et al performed a retrospective database study using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from January 2008 through December 2014 and analyzed 23,102 patients undergoing lumbar decompression and fusion procedures; the authors found that patients with extended LHS had a higher incidence of post-operative MI: 0.16% for those with normal LHS and 1.29% for those with extended LHS [ 11 ]. Similarly, another investigation by Adogwa et al of adult patients aged 65 and older in the ACS NSQIP database who underwent certain SF procedures ( n = 4730) from 2008 through 2014 also found that patients with extended LHS had a higher incidence of post-operative MI: 0.06% for those with normal LHS and 1.18% for those with extended LHS [ 12 ]. In both studies, the authors stressed that much of the variation in LHS after spinal surgery was most likely due to differences in practice style or surgeon preference (as opposed to in-hospital complications or baseline comorbidities).…”

Section: Discussionmentioning

confidence: 95%

The incidence of acute myocardial infarction after elective spinal fusions or joint replacement surgery in the United States: a large-scale retrospective observational cohort study in 322,585 patients

Arena

Liu

et al. 2021

Patient Saf Surg

View full text Add to dashboard Cite

Background Acute myocardial infarction (AMI) is an uncommon but fatal complication among patients undergoing elective spinal fusion surgery (SF), total hip arthroplasty (THA), and total knee arthroplasty (TKA). Our objective was to estimate the incidence of AMI among adults undergoing elective SF, THA, and TKA in different post-operative risk windows and characterize high-risk sub-populations in the United States. Methods A retrospective cohort study was conducted using data from a longitudinal electronic healthcare record (EHR) database from January 1, 2007 to June 30, 2018. ICD codes were used to identify SF, THA, TKA, AMI, and selected clinical characteristics. Incidence proportions (IPs) and 95% confidence intervals were estimated in the following risk windows: index hospitalization, ≤ 30, ≤ 90, ≤ 180, and ≤ 365 days post-operation. Results A total of 67,533 SF patients, 87,572 THA patients, and 167,480 TKA patients were eligible for the study. The IP of AMI after SF, THA, and TKA ranged from 0.36, 0.28, and 0.25% during index hospitalization to 1.05, 0.93, and 0.85% ≤ 365 days post-operation, respectively. The IP of AMI was higher among patients who were older, male, with longer hospital stays, had a history of AMI, and had a history of diabetes. Conclusion The IP of post-operative AMI was generally highest among the SF cohort compared to the THA and TKA cohorts. Additionally, potential high-risk populations were identified. Future studies in this area are warranted to confirm these findings via improved confounder control and to identify effect measure modifiers.

show abstract

“…Using multivariable logistic regression, they did not find LOS variations to be related to baseline patient illness or complications. 11 In another study, Passias et al 10 investigated 3057 patients with surgical cervical spondylotic myelopathy and found increased age, diabetes, posterior surgical approach, and operative time among positive predictors of extended LOS. DePasse et al 13 , in 950 patients who underwent cervical spine osteotomy, found decreased functional status, disseminated cancer, increased operative duration, and orthopedic surgeons to be risk factors for increased LOS.…”

Section: Discussionmentioning

confidence: 99%

Pragmatic Prediction of Excessive Length of Stay After Cervical Spine Surgery With Machine Learning and Validation on a National Scale

et al. 2022

View full text Add to dashboard Cite

BACKGROUND: Extended postoperative hospital stays are associated with numerous clinical risks and increased economic cost. Accurate preoperative prediction of extended length of stay (LOS) can facilitate targeted interventions to mitigate clinical harm and resource utilization. OBJECTIVE: To develop a machine learning algorithm aimed at predicting extended LOS after cervical spine surgery on a national level and elucidate drivers of prediction. METHODS: Electronic medical records from a large, urban academic medical center were retrospectively examined to identify patients who underwent cervical spine fusion surgeries between 2008 and 2019 for machine learning algorithm development and insample validation. The National Inpatient Sample database was queried to identify cervical spine fusion surgeries between 2009 and 2017 for out-of-sample validation of algorithm performance. Gradient-boosted trees predicted LOS and efficacy was assessed using the area under the receiver operating characteristic curve (AUROC). Shapley values were calculated to characterize preoperative risk factors for extended LOS and explain algorithm predictions. RESULTS: Gradient-boosted trees accurately predicted extended LOS across cohorts, achieving an AUROC of 0.87 (SD = 0.01) on the single-center validation set and an AUROC of 0.84 (SD = 0.00) on the nationwide National Inpatient Sample data set. Anterior approach only, elective admission status, age, and total number of Elixhauser comorbidities were important predictors that affected the likelihood of prolonged LOS. CONCLUSION: Machine learning algorithms accurately predict extended LOS across single-center and national patient cohorts and characterize key preoperative drivers of increased LOS after cervical spine surgery.

show abstract

Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion Is Not Attributable to Baseline Illness Severity or Postoperative Complications

Cited by 17 publications

References 25 publications

Enhanced recovery after spine surgery: a systematic review

Enhanced recovery after spine surgery: a systematic review

The incidence of acute myocardial infarction after elective spinal fusions or joint replacement surgery in the United States: a large-scale retrospective observational cohort study in 322,585 patients

Pragmatic Prediction of Excessive Length of Stay After Cervical Spine Surgery With Machine Learning and Validation on a National Scale

Contact Info

Product

Resources

About