Patient Comorbidities and Complications After Spinal Surgery

Whitmore, Robert G.; Stephen, James H.; Stein, Sherman C.; Campbell, Peter G.; Yadla, Sanjay; Harrop, James S.; Sharan, Ashwini; Maltenfort, Mitchell; Ratliff, John K.

doi:10.1097/brs.0b013e31823da22d

Cited by 114 publications

(59 citation statements)

References 24 publications

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“…This suggests that the location of the infection may have little impact on the cost. In a 2012 study evaluating the short-term direct hospital costs of spinal complications, Whitmore et al 32 found a cost increase of $4067 for 30 days after a deep wound infection. The difference between their findings and the $12,619 increase found in our study is likely due to the longer follow-up time of the present study.…”

Section: Discussionmentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

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OBJECT Infections following spine surgery negatively affect patient quality of life (QOL) and impose a significant financial burden on the health care system. Postoperative wound infections occur at higher rates following dorsal cervical procedures than ventral procedures. Quantifying the health outcomes and costs associated with infections following dorsal cervical procedures may help to guide treatment strategies to minimize the deleterious consequences of these infections. Therefore, the goals of this study were to determine the cost and QOL outcomes affecting patients who developed deep wound infections following subaxial dorsal cervical spine fusions. METHODS The authors identified 22 (4.0%) of 551 patients undergoing dorsal cervical fusions who developed deep wound infections requiring surgical debridement. These patients were individually matched with control patients who did not develop infections. Health outcomes were assessed using the EQ-5D, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and visual analog scale (VAS). QOL outcome measures were collected preoperatively and after 6 and 12 months. Health resource utilization was recorded from patient electronic medical records over an average follow-up of 18 months. Direct costs were estimated using Medicare national payment amounts, and indirect costs were based on patients' missed workdays and income. RESULTS No significant differences in preoperative QOL scores were found between the 2 cohorts. At 6 months postsurgery, the noninfection cohort had significant pre- to postoperative improvement in EQ-5D (p = 0.02), whereas the infection cohort did not (p = 0.2). The noninfection cohort also had a significantly higher 6-month postoperative EQ-5D scores than the infection cohort (p = 0.04). At 1 year postsurgery, there was no significant difference in EQ-5D scores between the groups. Health care–associated costs for the infection cohort were significantly higher ($16,970 vs $7658; p < 0.0001). Indirect costs for the infection cohort and the noninfection cohort were $6495 and $2756, respectively (p = 0.03). Adjusted for inflation, the total costs for the infection cohort were $21,778 compared with $9159 for the noninfection cohort, reflecting an average cost of $12,619 associated with developing a postoperative deep wound infection (p < 0.0001). CONCLUSIONS Dorsal cervical infections temporarily decrease patient QOL postoperatively, but with no long-term impact; they do, however, dramatically increase the cost of care. Knowledge of the financial burden of wound infections following dorsal cervical fusion may stimulate the development and use of improved prophylactic and therapeutic techniques to manage this serious complication.

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Section: Discussionmentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

View full text Add to dashboard Cite

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“…Although the clinical importance of minor adverse events is controversial [14], the economic burden should be considered. While minor adverse events are less costly individually, they appear with high frequency, thus contributing to more than half of the total costs of adverse events [18,44]. Furthermore, these events are the most potentially preventable [18], further enhancing the rationale for addressing them.…”

Section: Discussionmentioning

confidence: 99%

Can Surgeons Adequately Capture Adverse Events Using the Spinal Adverse Events Severity System (SAVES) and OrthoSAVES?

Chen

Garland

Roffey

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…In neurosurgery a simple wound infection may lead to multiple reoperations and long antibiotic treatments, and hence cause greater costs than infections in other surgical specialties. 15,25 The use of a surgical checklist is simple and inexpensive, and could indirectly save money, 18 redundant work, and suffer ing of patients. There is a need for surgical checklists in all types of surgery, 13 but especially in neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

Lepänluoma

Rahi

Takala

et al. 2015

JNS

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OBJECT Use of the WHO surgical checklist has been proven to reduce surgical morbidity and mortality, but its effect on surgical complications requiring reoperation has not been previously studied. The aim of this study was to determine whether the use of the WHO surgical checklist would have an impact on the number and causes of neurosurgical complications leading to a reoperation. METHODS The authors retrospectively gathered information on all neurosurgical reoperations using hospital discharge data as well as the operations and procedures registry, and tracked all primary neurosurgical operations (n = 175) preceding a complication-related reoperation from 2007 to 2011. There were a total of 5418 neurosurgical operations during the study period. For further analysis of electronic patient records, the primary operations were divided into 2 groups based on the time of the WHO surgical checklist implementation in the authors' unit: 103 operations before and 72 after the introduction of the checklist. Observed adverse events and reoperations were categorized as preventable or unpreventable, and the actual use of the checklist during each operation was recorded. RESULTS The overall rate of preventable complication-related neurosurgical reoperations decreased from 3.3% (95% CI 2.7%–4.0%) to 2.0% (95% CI 1.5%–2.6%) after the checklist implementation. The reoperations were mainly due to wound infections, 46% before and 39% after the checklist. All infection-related reoperations proportioned to all neurosurgical operations (2.5% before vs 1.6% after checklist implementation) showed a significant reduction (p = 0.02) after the implementation of the checklist. In particular, there was a significant decrease (p = 0.006) in the rate of preventable infections associated with reoperations, i.e., 2.2% before versus 1.2% after checklist implementation. The overall adherence to checklist use (the “time out” phase) in neurosurgical operations was 78%, and adherence was 70% in primary operations preceding a complication-related reoperation regarded as preventable. CONCLUSIONS The implementation of the WHO surgical checklist in neurosurgery was associated with a decrease in complication-related reoperations, especially those due to preventable infection complications, the majority of which were wound infections. The adherence to checklist use in individual operations after the checklist implementation did not appear to have an impact on the results.

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Patient Comorbidities and Complications After Spinal Surgery

Abstract: Both minor and major complications were found to increase the cost of care in a prospective assessment of spine surgery complications. Specific patient comorbidities and perioperative complications are associated with significant increases in the total cost of care to society.

Cited by 114 publications

References 24 publications

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Can Surgeons Adequately Capture Adverse Events Using the Spinal Adverse Events Severity System (SAVES) and OrthoSAVES?

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

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