Hypothyroidism increases 90-day postoperative complications in patients undergoing primary single level anterior cervical disectomy and fusion: a matched control analysis

Vakharia, Rushabh M.; Vakharia, Ajit M.; Ameri, Bijan; Niedzielak, Timothy; Donnally, Chester J.; Malloy, John P.

doi:10.21037/jss.2018.05.26

Cited by 14 publications

(12 citation statements)

References 29 publications

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“…PearlDiver is a commercially available database that is Health Information Portability and Affordability Act compliant and has been used extensively for orthopaedic-related research. [8][9][10] Since the database contains de-identified patient information, the study was exempt from our institution's internal review board approval. Patients were queried using the International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes.…”

Section: Methods Databasementioning

confidence: 99%

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

et al. 2019

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Robotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, gender, comorbidities, Charlson-Comorbidity Index, and geographic region) were compared between cohorts. Annual primary and revision utilization rates as well as risk factors for revision procedures were also compared. Kaplan–Meier survivorship was also calculated. The Pearson χ2 test was used to test for significance in patient demographics, whereas the Welch t-test was used to compare the incidence of revisions as well as the revision burden (proportion of revisions to total sum of primary and revision procedures). Multivariate binomial logistic regression analysis was performed to compare risk factors for revision procedures. There were statistically significant differences in RAUKA versus MUKA patients with respect to age (p < 0.001), gender (p < 0.001), and region (p < 0.001). RAUKA procedures performed increased over 12-fold compared with manual, which increased only 4.5-fold. RAUKA procedures had significantly lower revision incidence (0.99 vs. 4.24%, p = 0.003) and revision burden (0.91 vs. 4.23%, p = 0.005) compared with manuals. For patients undergoing RAUKA, normal (19–24 kg/m2) and obese (30–39 kg/m2) body mass index (p < 0.05), congestive heart failure (p = 0.004), hypothyroidism (p < 0.001), opioid dependency (p = 0.002), and rheumatoid arthritis (p < 0.001) were risk factors for a revision procedure. Kaplan–Meier survival curve 3 years following the index procedure to all-cause revisions demonstrated that RAUKA patients maintained nearly 100% survivorship compared with manual patients who had 97.5% survivorship. The data demonstrate increased utilization of RAUKA in the United States. The current data indicated that RAUKA has significantly lower revision rates and improved survivorship compared with patients undergoing non-RAUKA within Medicare patients.

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Section: Methods Databasementioning

confidence: 99%

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

et al. 2019

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“…In 2018, Vakharia et al published the first study evaluating complications directly associated with hypothyroidism in the first 90 days post-single level anterior cervical discectomy and fusion (ACDF). They found that hypothyroid patients had higher rates of non-healing wounds (OR 2.27, 95% CI: 1.11-4.62, p < 0.0232), PE (OR 2.16, 95% CI: 1.51-3.09, p < 0.001), MI (OR 2.10, 95% CI: 1.43-3.08, p < 0.001), and 90-day readmission (OR 1.45, 95% CI: 1.41-1.49, p < 0.001) [ 17 ]. Although our study also showed increased rates of wound complications in cervical fusions, we elected to include all types of cervical fusions, both posterior and anterior, in an effort to eliminate the selection bias that limited their analysis.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Outcomes of Hypothyroidism in Patients Undergoing Spinal Fusion

Luther¹,

Perez-Roman²,

McCarthy³

et al. 2021

Cureus

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Background Hypothyroidism has been independently associated with the development of several comorbidities and is known to increase complication rates in non-spinal surgeries. However, there are limited data regarding the effects of hypothyroidism in major spine surgery. Therefore, we present the largest retrospective analysis evaluating outcomes in hypothyroid patients undergoing spinal fusion. Methods A retrospective review of the National Inpatient Sample (NIS) from 2004-2014 was performed. Patients with an International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) procedure code indicating spinal fusion (81.04-81.08, 81.34-81.38, 81.0x, 81.3x) were included. Patients with an ICD-9-CM diagnosis code indicating hypothyroidism (244.x) were compared to those without. Cervical and lumbar fusions were evaluated independently. Significant covariates in univariable logistic regression were utilized to construct multivariable models to analyze the effect of hypothyroidism on perioperative morbidity and mortality. Results A total of 4,149,125 patients were identified, of which 9.4% were hypothyroid. Although, hypothyroid patients had a higher risk of hematologic complications (lumbar - odds ratio [OR] 1.176, p < 0.0001; cervical - OR 1.162, p < 0.0001), they exhibited decreased in-hospital mortality (lumbar - OR .643, p < 0.0001; cervical - OR .606, p < 0.0001). Hypothyroid lumbar fusion patients also demonstrated decreased rates of perioperative myocardial infarction (MI) (OR .851, p < 0.0001). All these results were independent of patient gender. Conclusions Hypothyroid patients undergoing spinal fusion demonstrated lower rates of inpatient mortality and, in lumbar fusions, also had lower rates of acute MI when compared to their euthyroid counterparts. This suggests that hypothyroidism may offer protection against all-cause mortality and may be cardioprotective in the postoperative period for lumbar spinal fusions independent of patient gender.

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“…As has been demonstrated in other orthopedic Medicare database research, CCI is a marker to ensure that both cohorts were matched properly and no statistical difference existed between the 2 groups. 12,13 Since comorbidities represent categorical variables, a Pearson chi-square analysis was performed to determine the significance between the study and control groups, whereas Welch's t test was utilized to test for significance in CCI between the cohorts.…”

Section: Discussionmentioning

confidence: 99%

High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion

Donnally

Vakharia

Sheu

et al. 2019

Global Spine Journal

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Study Design: Retrospective study. Objective: To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. Results: Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates ( P = .010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs ( P = .078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process ( P = 1.00). Conclusion: Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.

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Hypothyroidism increases 90-day postoperative complications in patients undergoing primary single level anterior cervical disectomy and fusion: a matched control analysis

Cited by 14 publications

References 29 publications

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

Incidence and Clinical Outcomes of Hypothyroidism in Patients Undergoing Spinal Fusion

High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion

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