Predicting In-Hospital Complications After Anterior Cervical Discectomy and Fusion: A Comparison of the Elixhauser and Charlson Comorbidity Indices

Ranson, William A.; Neifert, Sean N; Cheung, Zoe B.; Mikhail, Christopher; Caridi, John M.; Cho, Samuel K.

doi:10.1016/j.wneu.2019.10.102

Cited by 24 publications

(18 citation statements)

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“…23 Although this study is the first to report on these adverse outcomes by admission status, the positive association between comorbidities captured by the ECI and rates of non-home discharge, delayed extubation, early reoperation, and postoperative complications has been established in the literature. [24][25][26] Kukreja et al 14 found that patients undergoing emergent lumbar fusions had higher mortality, higher rates of deep-vein thrombosis, surgical site infection and blood transfusion, longer hospital stay, and higher rates of non-routine discharge. These differences were compounded when surgeries for emergent cases were not performed on the day of initial presentation.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion

Chapman

Doctor

Gal

et al. 2021

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Study Design. Retrospective cohort study. Objective. To evaluate the impact of admission status on patient outcomes and healthcare costs in anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Undergoing ACDF nonelectively has been associated with higher patient comorbidity burdens. However, the impact of non-elective status on the total cost of hospital stay has yet to be quantified. Methods. Patients undergoing ACDF at a single institution were placed into elective or non-elective cohorts. Propensity scorematching analysis in a 5:1 ratio controlling for insurance type and comorbidities was used to minimize selection bias. Demographics were compared by univariate analysis. Cost of care, length of stay (LOS), and clinical outcomes were compared between groups using multivariable linear and logistic regression with elective patients as reference cohort. All analyses controlled for sex, preoperative diagnosis, elixhauser comorbidity index (ECI), age, length of surgery, number of segments fused, and insurance type. Results. Of 708 patients in the final ACDF cohort, 590 underwent an elective procedure and 118 underwent a nonelective procedure. The non-elective group was significantly younger (53.7 vs. 49.5 yr; P ¼ 0.0007). Cohorts had similar proportions of private versus public health insurance, although elective had higher rates of commercial insurance (39.22% vs. 15.25%; P < 0.0001) and non-elective had higher rates of managed care (32.77% vs. 56.78%; P < 0.0001). Operation duration was significantly longer in non-elective patients (158 vs. 177 minutes; P ¼ 0.01). Adjusted analysis also demonstrated that admission status independently affected cost

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Section: Discussionmentioning

confidence: 99%

The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion

Chapman

Doctor

Gal

et al. 2021

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“…Validation the nomogram was carried out in both TCGA and the CGGA datasets. Area under curves (AUCs) were calculated to evaluate the discrimination of the nomogram with AUC>0.7 being acceptable and AUC>0.8 being excellent (21,22). Calibration was performed to compare the predicted probability and the actual observation, indicating the predicative accuracy of the nomogram.…”

Section: Development and Validation Of A Nomogrammentioning

confidence: 99%

Integrated Analysis Reveals Prognostic Value and Immune Correlates of CD86 Expression in Lower Grade Glioma

Qiu

Tian

et al. 2021

Front. Oncol.

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BackgroundCD86 has great potential to be a new target of immunotherapy by regulating cancer immune response. However, it remains unclear whether CD86 is a friend or foe in lower-grade glioma (LGG).MethodsThe prognostic value of CD86 expression in pan-cancer was analyzed using Cox regression and Kaplan-Meier analysis with data from the cancer genome atlas (TCGA). Cancer types where CD86 showed prognostic value in overall survival and disease-specific survival were identified for further analyses. The Chinese Glioma Genome Atlas (CGGA) dataset were utilized for external validation. Quantitative real-time PCR (qRT-PCR), Western blot (WB), and Immunohistochemistry (IHC) were conducted for further validation using surgical samples from Jiangsu Province hospital. The correlations between CD86 expression and tumor immunity were analyzed using the Estimation of Stromal and Immune cells in Malignant Tumours using Expression data (ESTIMATE) algorithm, Tumor IMmune Estimation Resource (TIMER) database, and expressions of immune checkpoint molecules. Gene Set Enrichment Analysis (GSEA) was performed using clusterprofiler r package to reveal potential pathways.ResultsPan-cancer survival analysis established CD86 expression as an unfavorable prognostic factor in tumor progression and survival for LGG. CD86 expression between Grade-II and Grade-III LGG was validated using qRT-PCR and WB. Additionally, CD86 expression in LGG with unmethylated O(6)-methylguanine-DNA-methyltransferase (MGMT) promoter was significantly higher than those with methylated MGMT (P<0.05), while in LGG with codeletion of 1p/19q it was significantly downregulated as opposed to those with non-codeletion (P<2.2*10-16). IHC staining validated that CD86 expression was correlated with MGMT status and X1p/19q subtypes, which was independent of tumor grade. Multivariate regression validated that CD86 expression acts as an unfavorable prognostic factor independent of clinicopathological factors in overall survival of LGG patients. Analysis of tumor immunity and GSEA revealed pivotal role of CD86 in immune response for LGG.ConclusionsIntegrated analysis shows that CD86 is an unfavorable prognostic biomarker in LGG patients. Targeting CD86 may become a novel approach for immunotherapy of LGG.

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“…[2][3][4][5][6][7] More specific to the cervical spine, a similar disparity in operative outcomes was also demonstrated in those undergoing anterior cervical discectomy and fusion (ACDF), where investigators reported higher rates of complications for individuals carrying larger comorbidity burdens. 8 While the negative effects of comorbidities on operative outcomes is well defined, its impact can extend to other areas of a patient's quality of life. Such outcomes associated with ACDF are commonly assessed with patient-reported outcome measures (PROMs) for neck and arm pain and disability.…”

Section: Introductionmentioning

confidence: 99%

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

et al. 2021

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This study aims to detail the association between comorbidity burden and achieving minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF). Methods: A prospective surgical registry was retrospectively reviewed. Patients with missing preoperative Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) were excluded. Patients were stratified by Charlson Comorbidity Index (CCI): no comorbidities = 0 point; low CCI = 1-2 points; high CCI = ≥ 3 points. Demographic and perioperative characteristics were collected and evaluated for differences. Visual analogue scale (VAS), 12-item Short Form health survey (SF-12), and PROMIS PF were collected pre-and postoperatively and assessed for differences. Differences in achievement of MCID were compared using established values: VAS neck = 2.6, VAS arm = 4.1, NDI = 8.5, SF-12 physical composite score (SF-12 PCS) = 8.1, PROMIS PF = 4.5. Results: One hundred twenty-five ACDF patients were included: 37 had no comorbidities, 64 with low CCI, and 24 with high CCI. Higher CCI groups were older, nonsmokers, diabetic, arthritic, hypertensive, and had cancer. Multilevel fusions, operative time, length of stay, and later discharge day were associated with high CCI. VAS neck differed preoperatively by group. SF-12 PCS and PROMIS PF were inversely associated with CCI groups. CCI did not impact achievement of MCID for all outcomes. A lower rate of reaching MCID was demonstrated at 3 months for SF-12 PCS. Conclusion: Regardless of comorbidity burden, patients undergoing ACDF for cervical pathology demonstrated a similar rate of achieving MCID for VAS neck, VAS arm, NDI, and PROMIS PF. Regardless of CCI score, ACDF can have a significant benefit for patients.

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Predicting In-Hospital Complications After Anterior Cervical Discectomy and Fusion: A Comparison of the Elixhauser and Charlson Comorbidity Indices

Cited by 24 publications

References 50 publications

The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion

The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion

Integrated Analysis Reveals Prognostic Value and Immune Correlates of CD86 Expression in Lower Grade Glioma

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

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