Predicting Short-Term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis

Basques, Bryce A.; Lukasiewicz, Adam M.; Webb, Matthew L.; Samuel, Andre M.; Bohl, Daniel D.; Smith, Brian G.; Grauer, Jonathan N.

doi:10.1016/j.spinee.2015.07.322

Cited by 5 publications

(9 citation statements)

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“…Our findings add to a previous study which found that ambulatory procedures can be safely performed in children with CHD with a relatively low rate of unanticipated hospital admissions immediately following surgery . Our results are also similar to prior studies reporting no excess risk of postoperative complications due to CHD, which have explored procedures other than T/A using the NSQIP‐P registry . In line with these studies, our analytic sample included a population of relatively older children, with a median age of 6 years.…”

Section: Discussionsupporting

confidence: 86%

“…Notably, most recent studies examining the impact of CHD on adverse outcomes in non‐cardiac surgery have used the National Surgical Quality Improvement Program‐Pediatric (NSQIP‐P) database . While this database contains standardized information on patient comorbidities and surgical complications, only a select group of procedures are sampled for inclusion.…”

Section: Introductionmentioning

confidence: 99%

“…12 Yet, studies of procedures performed primarily in older children (eg, posterior spinal fusion) have typically found no association between CHD and postoperative outcomes. [13][14][15][16][17] Because common pediatric surgical procedures vary by age, the overall association of CHD with adverse outcomes in pediatric surgery can be difficult to characterize.…”

Section: Introductionmentioning

confidence: 99%

“…Notably, most recent studies examining the impact of CHD on adverse outcomes in non-cardiac surgery have used the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. 2,3,5,[7][8][9][10][11][13][14][15][16][17] While this database contains standardized information on patient comorbidities and surgical complications, only a select group of procedures are sampled for inclusion. Tonsillectomy with or without adenoidectomy (T/A), for example, is a very common procedure with a high rate of revisits (7-15%), 18,19 but this procedure is not included in the NSQIP-P database.…”

Section: Introductionmentioning

confidence: 99%

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Population‐based study of congenital heart disease and revisits after pediatric tonsillectomy

Miller

Tumin

McKee

et al. 2019

Laryngoscope Investig Oto

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Objective Accurate assessment of risk factors such as congenital heart disease (CHD) can aid in risk stratification of children presenting for surgery. Risk stratification is especially important in tonsillectomy ± adenoidectomy (T/A), a common pediatric procedure that is usually performed electively, but that has a high rate of adverse events. In this study, we examined the association of CHD with revisits after T/A. Methods We identified children who underwent T/A at hospitals and hospital‐owned facilities during 2010 to 2014 using the State Inpatient Databases and State Ambulatory Surgery and Services Databases of Florida, Georgia, Iowa, New York, and Utah. We evaluated the association between CHD severity and the occurrence of an unplanned hospital readmission or ED visit within 30 days following discharge using multivariable logistic regression. Results The analysis included 244,598 patients, of whom 858 had minor or major CHD. In multivariable analysis, CHD was not associated with an increased risk of 30‐day revisits (minor OR = 1.1; 95% CI: 0.8, 1.5; P = .65; major OR = 1.2; 95% CI: 0.9, 1.6; P = .34). Other comorbidities, including chromosomal anomalies (OR = 1.4; 95% CI: 1.2, 1.6; P < .001), congenital airway anomalies (OR = 1.3; 95% CI: 1.03, 1.7; P = .03), and neuromuscular impairment (OR = 1.4; 95% CI: 1.2, 1.7; P < .001) predicted an increased likelihood of revisits. Conclusion Neither minor nor major CHD was independently associated with an increased risk of 30‐day revisits among children undergoing T/A. Other characteristics, particularly non‐cardiac comorbidities, socioeconomic status, and geographic region may be of greater utility for predicting revisit risk following pediatric T/A. Level of Evidence 2b

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Population‐based study of congenital heart disease and revisits after pediatric tonsillectomy

Miller

Tumin

McKee

et al. 2019

Laryngoscope Investig Oto

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“…The accuracy of data collection by the NSQIP (including cumulative incidence and reasons for readmission) has been externally validated, 84 and this data source has been previously used to evaluate patients undergoing neurosurgical intervention, 4,8,12,14,15,28,29,45,54,83 including spine surgery. 2,6,9,10,25,40,53,59,61,82,91 Our institutional review board has exempted the de-identified NSQIP data set from individual review.…”

Section: Data Sourcementioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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Necessidades não atendidas de cuidados cirúrgicos para crianças: Estudo de caso no Sistema Único de Saúde financiado pelo governo no Brasil

Neto

Filezio

Ferri-de-Barros

et al. 2021

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Medir e documentar o impacto clínico do tempo de espera para tratamento cirúrgico de pacientes com deformidades na coluna vertebral em um centro quaternário no Brasil. Métodos No total, 59 pacientes com deformidade espinhal à espera de cirurgia na lista do nosso hospital foram avaliados para observar o impacto dos tempos de espera na progressão da deformidade. A avaliação do paciente foi realizada utilizando o questionário SRS-22r para qualidade de vida relacionada à saúde (QLRS), e imagens radiográficas para avaliar a deformidade da coluna vertebral quando os pacientes foram incluídos na lista de espera e na consulta mais recente. Os parâmetros radiográficos selecionados para comparação foram: ângulo de Cobb de curvas primárias e secundárias, alinhamento coronal, translação de vértebra apical, obliquidade pélvica, eixo vertebral sagital, cifose (T5-T12), e lordose (L1-S1). Resultados Baixos escores de QLRS segundo o questionário SRS-22r foram observados em pacientes que aguardavam cirurgia. Os parâmetros radiográficos mostraram progressão da deformidade na avaliação inicial em comparação com a avaliação de seguimento mais recente. Conclusão Os pacientes que aguardavam tratamento cirúrgico de deformidade espinhal em nosso centro apresentaram os escores de QLRS relativamente baixos e progressão radiográfica da deformidade.

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Predicting Short-Term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis

Cited by 5 publications

References 0 publications

Population‐based study of congenital heart disease and revisits after pediatric tonsillectomy

Population‐based study of congenital heart disease and revisits after pediatric tonsillectomy

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Necessidades não atendidas de cuidados cirúrgicos para crianças: Estudo de caso no Sistema Único de Saúde financiado pelo governo no Brasil

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