Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database

Ohya, Junichi; Chikuda, Hirotaka; Kato, So; Horiguchi, Hiromasa; Takeshita, Katsushi; Tanaka, Sakae; Yasunaga, Hideo

doi:10.1016/j.wneu.2014.12.019

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…The authors found that the rate of in-hospital mortality following atlantoaxial fusion was 0.5% in cases of subluxation. [40] In contrast to Ohya et al, we found that the rate of in-hospital mortality following atlantoaxial fusion was 2.7%. The difference is likely related to the study design, as Ohya et al only included patients with subluxation and excluded emergency admission patients.…”

Section: Discussioncontrasting

confidence: 82%

“…The present study included 8,189 patients that underwent atlantoaxial fusion, more than seven times the next largest study on outcomes following atlantoaxial fusion. [40] Identifying and quantifying these predictors can help improve patient selection and preoperative risk counseling for atlantoaxial fusion. For example, uncertainty exists regarding the optimal treatment approach for type II odontoid fractures, a pathology requiring atlantoaxial fusion.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of outcomes and hospital charges following atlantoaxial fusion

et al. 2016

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Background Context Atlantoaxial fusion is used to correct atlantoaxial instability that is often secondary to traumatic fractures, Down syndrome, or rheumatoid arthritis. The effect of age and comorbidities on outcomes following atlantoaxial fusion is unknown. Purpose To better understand trends and predictors of outcomes and charges following atlantoaxial fusion and to identify confounding variables that should be included in future prospective studies. Study Design Retrospective analysis of data from the Nationwide Inpatient Sample (NIS), a nationally representative, all-payer database of inpatient diagnoses and procedures in the United States. Patient Sample We included all patients that underwent atlantoaxial fusion (International Classification of Disease, Ninth Revision, Clinical Modification code 81.01) between 1998-2011 that were 18 years or older at the time of admission. Outcome Measures Outcome measures included in-hospital charges, length of hospital stay (LOS), in-hospital mortality, and discharge disposition. Methods Predictors of outcome following atlantoaxial fusion were assessed using a series of univariable analyses. Those predictors with a p-value of less than 0.2 were included in the final multivariable models. Independent predictors of outcome were those that were significant at an alpha level of 0.05 following inclusion in the final multivariable models. Logistic regression was used to determine predictors of in-hospital mortality and discharge disposition whereas linear regression was used to determine predictors of hospital charges and LOS. Discharge weights were used to produce generalizable results. Results From 1998-2011, there were 8,914 hospitalizations recorded wherein atlantoaxial fusion was performed during the inpatient hospital stay. Of these hospitalizations, 8,189 (91.9%) met inclusion criteria. 62% of the study sample was white, while the majority of patients were either insured by Medicare (47.2%) or had private health insurance (35.6%). The most common comorbidity as defined by the NIS and the Elixhauser comorbidity index was hypertension (43.2%). The in-hospital mortality rate for the study population was 2.7% and the median LOS was 6.0 days. The median total charge (inflation adjusted) per hospitalization was $73,561. 48.9% of patients were discharged to home. Significant predictors of in-hospital mortality included increased age, emergent or urgent admissions, weekend admissions, congestive heart failure, coagulopathy, depression, electrolyte disorder, metastatic cancer, neurological disorder, paralysis, and non-bleeding peptic ulcer. Many of these variables were also found to be predictors of LOS, hospital charges, and discharge disposition. Conclusion This study found that older patients and those with greater comorbidity burden had greater odds of postoperative mortality and being discharged to another care facility, longer hospital length of stay, and incurred greater hospital charges following atlantoaxial fusion.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Predictors of outcomes and hospital charges following atlantoaxial fusion

et al. 2016

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“…The pooled average early SSI rate among 14,517 patients was 2.1% (median, 2.6%; range, 0.5%–16.7%) [11,13,20,22,25,32,78,82–84,86,142,147,156,164,167,170,171] compared with 0.8% (median, 0.9%; range, 0.1%–4.7%) for pooled average late SSI rate among 12,238 patients [11,13,54,83,167,171]. In terms of specific types of spine operations, 52 studies evaluated SSI rates among patients who underwent spinal fusion [9,10,14,15,21,24,27,30,33,42,43,46,52,56,58,62,63,68–70,72,75,76,92,103,105,107–109,111,113–115,119,120,123,125,128,133,139,141–144,146,150,151,157,161,162,164,173]. The pooled average SSI rate was calculated to be 1.6% (median, 2.8%; range, 0.2%–18.3%) based on 64 cohorts comprising a total of 212,639 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, a relatively smaller retrospective Spanish study of 481 patients who underwent posterior spinal fusion and instrumentation reported a mortality rate of 2.3% among patients who developed deep SSIs [97]. Last, a retrospective analysis of data from a Japanese nationwide administrative inpatient database reported that among 465 patients who underwent spinal fusion surgery for atlantoaxial subluxation and had rheumatoid arthritis, the in-hospital mortality rate was 6.7% among patients who developed SSIs [46]. None of the patients without rheumatoid arthritis who went on to develop SSIs died, suggesting that patients with comorbidities may have a greater risk of SSI-related complications.…”

Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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“…[4][5][6][7]17,24 Briefly, the database includes administrative claims data and discharge abstract data from approximately 1000 hospitals across Japan. All 82 academic hospitals are obliged to contribute to the database, but the participation of community hospitals is voluntary.…”

Section: Methods Data Sourcementioning

confidence: 99%

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

Ohya¹,

Oshima²,

Chikuda³

et al. 2016

FOC

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OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups. RESULTS A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score–matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43–0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09–0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p < 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy. CONCLUSIONS The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.

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Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database

Cited by 17 publications

References 27 publications

Predictors of outcomes and hospital charges following atlantoaxial fusion

Predictors of outcomes and hospital charges following atlantoaxial fusion

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

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