Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study

Oichi, Takeshi; Chikuda, Hirotaka; Ohya, Junichi; Ohtomo, Ryo; Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Tanaka, Sakae; Yasunaga, Hideo

doi:10.1016/j.spinee.2016.10.024

Cited by 45 publications

(41 citation statements)

References 35 publications

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“…We classified A-DROP score as follows; mild: 0, moderate: 1-2, severe: 3, most severe: 4-5 or systolic blood pressure < 90 mmHg. Multiple imputation method was utilized to impute missing values in BMI and A-DROP items [23,24]. Multivariate imputation by chained equations technique was applied to obtain 20 imputed datasets by using the following covariates: dementia, age, sex, CCI, cancer, hemodialysis and intensive care unit admission.…”

Section: Discussionmentioning

confidence: 99%

Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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Background: Pneumonia is the most common cause of death in patients with dementia, but the outcomes of patients with dementia hospitalized with pneumonia are poorly understood. We sought to illuminate the association between dementia and in-hospital mortality and discharge status in patients hospitalized with pneumonia. Methods: We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify retrospectively patients aged ≥60 years admitted to hospital with pneumonia during the study period of May 1, 2010 to March 31, 2014. We recorded their sex, age, body mass index, severity of pneumonia and comorbidities (including dementia). The outcomes were in-hospital mortality and discharge home. Multivariable Cox regression analysis was performed to analyze factors influencing discharge home. Results: We identified 470,829 patients hospitalized with pneumonia; 45,031 were recorded as having dementia (9.6%). In-hospital mortality was 13.1% and 13.4% in patients with and without dementia, respectively (P = 0.63). The proportions of patients discharged home were 52.9% and 71.3% in patients with and without dementia, respectively (P < 0.001). The adjusted hazard ratio for discharge home for patients with dementia was 0.68 (95% confidence interval, 0.67-0.69; P < 0.001). Conclusions: In-hospital mortality from pneumonia did not differ significantly between patients with and without dementia; however, those with dementia were less likely to be discharged home.

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Section: Discussionmentioning

confidence: 99%

Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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“…For thrombotic events, the incidence was relatively high in PD patients, but we could not nd statistically signi cant difference in this study. However, a previous study suggested the signi cantly increased risk for PE in PD patients using large national database [27]. PE is recognized as a possible adverse reaction to dopamine precursors, such as levodopa [28].…”

Section: Resultsmentioning

confidence: 99%

Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study

Kawabata

Yoshii

Sakai

et al. 2020

Preprint

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Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those studies are limited, and few have made direct comparisons with patients who do not have PD.Methods: A retrospective cohort study. We retrospectively reviewed all surgically treated ASD patients with at least a 2-year follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients.Results: For early complications, the PD(+) group demonstrated a higher rate of delirium than the PD(−) group. With regard to late complications, the rate of radiological pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group.Conclusion: Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of radiological pseudarthrosis were greater in these patients.

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“…In a large-scale cohort study of thoracolumbar spine fusion surgery using a national insurance database in the US, PD was signi cantly associated with an increased risk for medical complications (odds ratio 1.22) and revision surgery (odds ratio 1.70) [16]. Another large-scale matchedpair cohort study using an inpatient database in Japan also suggested that PD was a signi cant predictor of postoperative complications (odds ratio 1.74) following spine surgery, with delirium being most frequent [17]. In our study, postoperative complications were associated with lower preoperative lumbar YAM, decreased lumbar lordosis, and longer fusion surgery.…”

Section: Discussionmentioning

confidence: 95%

Differences in clinical and imaging features of low lumbar osteoporotic vertebral collapse in patients with or without Parkinson’s disease: Rapid destructive progression and appearance of a cauda equina sign in Parkinson’s disease patients

Nakajima¹,

Kubota²,

Watanabe³

et al. 2020

Preprint

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BackgroundOsteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common with aging of society. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD) and a higher mechanical failure rate, compared with those with thoracolumbar junction collapse. The aim of this study was to identify differences in clinical and imaging features, and in outcomes of low lumbar OVC with or without PD and to discuss the appropriate treatment for lower lumbar OVC in patients with PD.MethodsThe subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. Clinical symptoms, morphological features of affected vertebrae, neurological status, surgical procedures, and complications were compared in patients with and without PD.ResultsThe main clinical symptoms were radicular leg pain in non-PD cases (68.8%) and a cauda equina sign in PD cases (72.7%). Rapid progression and destructive changes of OVC were seen in patients with PD at 24.5 ± 10.5 days after injury. The morphological features of OVC were flat-type in non-PD cases with old compression fracture at the thoracolumbar lesion, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar YAM, and severe sarcopenia, all of which can affect postoperative instrumentation-related complications. High postoperative complication rates may be due to vertebral fragility and longer fusion surgery. ConclusionsRapid progression and destructive changes of low lumbar OVC may occur in PD patients, and significantly more PD cases have a cauda equina sign and require urgent surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure, especially at an upper adjacent level. Given the progression of PD after surgery, invasive long-fusion surgery should be avoided for single low lumbar OVC. A surgical strategy considering the severities of PD and osteoporosis, and aggressive control of PD before and after surgery are important to prevent complications.

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Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study

Cited by 45 publications

References 35 publications

Association between dementia and discharge status in patients hospitalized with pneumonia

Association between dementia and discharge status in patients hospitalized with pneumonia

Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study

Differences in clinical and imaging features of low lumbar osteoporotic vertebral collapse in patients with or without Parkinson’s disease: Rapid destructive progression and appearance of a cauda equina sign in Parkinson’s disease patients

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