Hospital-acquired conditions occur more frequently in elective spine surgery than for other common elective surgical procedures

Horn, Samantha R.; Segreto, Frank A.; Alas, Haddy; Bortz, Cole; Jackson-Fowl, Brendan; Brown, Avery; Pierce, Katherine E.; Vasquez-Montes, Dennis; Egers, Max; Line, Breton; Oh, Cheongeun; Moon, John Y.; Ramos, Rafael De la Garza; Vira, Shaleen; Diebo, Bassel G.; Frangella, Nicholas J.; Stekas, Nicholas; Shepard, Nicholas; Horowitz, Jason A.; Hassanzadeh, Hamid; Bendo, John A.; Lafage, Renaud; Lafage, Virginie; Passias, Peter G.

doi:10.1016/j.jocn.2020.04.067

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…Other high service utilizers are often not so lucky; increasing frequency and intensity of engagement with health care, especially if this involves elective surgical procedures, increases the likelihood of iatrogenic harm. 88 Although a dismantling study has yet to be conducted to identify which factors of FR are most effective for patients, anecdotal evidence suggests that "time and team" are likely candidates. Given the complex comorbidities of our patients, they seem to benefit from having providers who are versed in various complementary treatment paradigms, who actively collaborate, and who offer an array of interventions based on combined experience.…”

Section: Discussionmentioning

confidence: 99%

“…Fortunately, the patient’s increased health care utilization before she entered the FR program had only minimal repercussions, including being ineffective, time-intensive, and financially expensive. Other high service utilizers are often not so lucky; increasing frequency and intensity of engagement with health care, especially if this involves elective surgical procedures, increases the likelihood of iatrogenic harm 88…”

Section: Discussionmentioning

confidence: 99%

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Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Orme

Fowler

Bradshaw

et al. 2022

Journal of Psychiatric Practice

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The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Orme

Fowler

Bradshaw

et al. 2022

Journal of Psychiatric Practice

View full text Add to dashboard Cite

show abstract

“…Early postoperative complications were assessed using a publicly available list of adverse events introduced by the Agency for Healthcare Research and Quality and the Center for Medicare and Medicaid Services and referred to as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) [ 10 , 11 , 12 ]. PSIs included acute myocardial infarction, pressure ulcers, iatrogenic pneumothorax, transfusion reactions, peri- and postoperative hemorrhage, pulmonary embolism, acute postoperative respiratory failure, deep vein thrombosis, postoperative sepsis, and wound dehiscence, as well as accidental puncture or laceration.…”

Section: Materials and Methodsmentioning

confidence: 99%

Patient Safety Comparison of Frameless and Frame-Based Stereotactic Navigation for Brain Biopsy—A Single Center Cohort Study

et al. 2022

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Leksell stereotactic system-based aspiration biopsy is a common procedure in the neurosurgical treatment of deep-seated or multiple brain lesions. This study aimed to evaluate the benefit of frameless biopsy using VarioGuide compared to frame-based biopsy using the Leksell stereotactic system (LSS). We analyzed all brain biopsies using VarioGuide or LSS at our neurooncological Department of Neurosurgery in the University Hospital of Bonn between January 2018 and August 2020. We analyzed demographic data, duration of surgery, size of lesion, localization, and early complications. Uni-variable analyses were carried out on data from both groups. In total, 109 biopsies were compared (40 VarioGuide vs. 69 LSS). Patients with VarioGuide were significant older (74 (62–80) years vs. 67 (57–76) years; p = 0.03) and had a shorter duration of general anesthesia (163 (138–194) min vs. 193 (167–215) min, p < 0.001). We found no significant differences in surgery duration (VarioGuide median 28 min (IQR 20–38); LSS: median 30 min (IQR 25–39); p = 0.1352) or in early complication rates (5% vs. 7%; p = 0.644). A slightly higher false negative biopsy rate was registered in the LSS group (3 vs. 1; p = 0.1347). The size of the lesions also did not differ significantly between the two groups (18.31 ± 26.35 cm3 vs. 12.63 ± 14.62; p = 0.15). Our data showed that biopsies performed using VarioGuide took significantly less time than LSS biopsies and did not differ in complication rates. Both systems offered a high degree of patient safety.

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“…Surgery-related and in-hospital postoperative complications were defined as such adverse events occurring within 30 days of the initial surgery ( 7 , 14 ).…”

Section: Methodsmentioning

confidence: 99%

“…Geriatric patients play an increasingly important role in the world of spine surgery as life expectancy and the number of older patients undergoing spinal instrumentation continue to increase worldwide, in particular instrumentation of the cervical spine regardless of the underlying causes ( 2 – 6 ). Furthermore, patients with spine procedures suffer more from complications compared to patients undergoing other types of surgery (e.g., cardiothoracic surgery) ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Safety Evaluation of Cervical Dorsal Instrumentation in Geriatric Patients: Experience at a Level 1 Center for Spinal Surgery—A Single Center Cohort Study

et al. 2022

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ObjectiveDorsal instrumentation of the cervical spine is an established treatment in spine surgery. However, careful planning is required, particularly in elderly patients. This study evaluates early clinical outcomes in geriatric patients undergoing complex spine surgery.MethodsIn this retrospective, single center cohort study, we included all geriatric patients (aged ≥65 years) who underwent dorsal instrumentation between January 2013 and December 2020. We analyzed postoperative complications and the 30-day in-hospital mortality rate. Furthermore, the Charlson comorbidity index (CCI) and Clavien-Dindo grading system (CDG) were used to assess the patients' comorbidity burden.ResultsIn total, 153 patients were identified and included. The mean age of patients was 78 years (SD ± 7). Traumatic injury (53.6%) was the most common reason for surgery. 60.8% of the patients underwent dorsal instrumentation with 3 or more levels. The most common comorbidities were arterial hypertension (64%), diabetes mellitus (22.2%), coronary heart disease and atrial fibrillation (19.6%). The most common adverse event (AE) was pneumonia (4%) and the most common surgery-related complication was wound infection (5.2%). Among patients categorized as high risk for AE (CCI > 5), 14.6% suffered a postoperative AE. In our univariate analysis, we found no risk factors for high rates of complications or mortality.ConclusionOur data demonstrates that older patients were at no significant risk of postoperative complications. The CCI/CDG scores may identify patients at higher risk for adverse events after dorsal instrumentation, and these assessments should become an essential component of stratification in this older patient population.

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Hospital-acquired conditions occur more frequently in elective spine surgery than for other common elective surgical procedures

Cited by 9 publications

References 20 publications

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Patient Safety Comparison of Frameless and Frame-Based Stereotactic Navigation for Brain Biopsy—A Single Center Cohort Study

Safety Evaluation of Cervical Dorsal Instrumentation in Geriatric Patients: Experience at a Level 1 Center for Spinal Surgery—A Single Center Cohort Study

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