Variability in length of stay following neuromuscular spinal fusion

Fletcher, Nicholas D.; Bellaire, Laura; Dilbone, Eric S.; Ward, Laura; Bruce, Robert W.

doi:10.1007/s43390-020-00081-w

Cited by 15 publications

(17 citation statements)

References 28 publications

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“…Paradoxically, in their analysis 90 days after hip and knee arthroplasty, Jørgensen et al found that fall-related hospital readmissions were due to physical activity and extrinsic factors other than surgery because of patient success and intent to return to a normal level of activity [ 24 ]. As emerged from all of the studies examined in this review, in turn, all of these interventions reduce the LOS as patients could be discharged sooner without increasing the risk of complications (References [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

Section: Resultsmentioning

confidence: 99%

“…Designation of positive, neutral and negative outcome for each examined study. (References [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ...…”

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confidence: 99%

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Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Salamanna

Contartese

Brogini

et al. 2022

JCM

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Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Salamanna

Contartese

Brogini

et al. 2022

JCM

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“…=complications, 30 days readmission and reoperation rates Flanders et al 2020 [ 29 ] Retrospective 1290 adult patients: -Fast-track group ( n = 1141, mean age 61.5 ± 13.4, 533 females); −Non-fast-track group ( n = 149, mean age 61.9 ± 12.1, 72 females) Yes Elective spine and peripheral nerve surgeries (cervical/thoracic/lumbar laminectomy and/or instrumented fusion, anterior cervical discectomy and fusion, combined anterior/posterior surgeries, and peripheral nerve procedures, brachial plexus surgery, ulnar and median nerve decompression, and common peroneal nerve surgery) 1–3 Chronic obstructive pulmonary disease, obstructive sleep apnea 44.9% 3.4 days 17.7% 6.4% 30 days readmission, 7.4% 90 days readmission 1, 3, 6 and 18 months ↓Opioids use (38.6% vs. 70.5% at 1 month, 36.5% vs. 70.9% at 3 months, 23.6% vs. 51.9% at 6 months), patient-controlled analgesia use (1.4% vs. 61.6%), LOS (3.4 vs. 3.9 days), ICU admissions (44.9% vs. 78.9%), likely to have an indwelling catheter while recovering in the inpatient ward (23.0% vs. 55.1%), nonopioid and ↑mobility at day 0 (63.5% vs. 20.7%), ambulation at day 0 (41.8% vs. 17.2%) in fast-track group vs. non-fast-track group. =satisfaction, complications, readmissions within 30 or 90 days Fletcher et al 2020 [ 30 ] Retrospective 197 patients (13.2 ± 3.2 age, 110 females, 87 males): -Fast-track + LOS < 3 days group ( n = 56); −Fast-track + LOS 3–7 days group ( n = 1111); −Fast-track + LOS > 7 days group ( n = 30) No PSF for NMS 1–3, 4–5 NR 1.0, 3.1, 5.6 days 3.6 h Pulmonary (1.8, 14, 40%), neurologic deficits (2, 4, 7%), infection (2, 1, 9%), decubitus ulcers (0, 1, 4%), cut out/loosening/implant malplacement (0, 2, 0%) Readmission (9, 17, 27%) 180 days ↓Fusion to pelvis (38% vs. 71 and 73%), levels fused (12.9 vs. 15.1 and 15.3), LOS (3.6 vs. 4.5 and 5.1 h), pulmonary complication (1.8% vs. 14 and 40%) in LOS < 3 days group vs. LOS 3–7 days and LOS > 7 days groups. =readmission, EBL, transfusion, complications, time ICU, required ICU Fletcher et al 2021 [ 31 ] Prospective 276 patients: -Fast-track group ( n = 203, mean age 14.3 ± 2.1, 78.8% females); −Non-fast-track group ( n = 73, mean age 16.09 ± 2.1, 80.2% females) Yes PSF for AIS NR NR NR 2.2 days 2 wound dehiscence, 1 constipation Readmission, revision surgery 3–4 weeks ↓Major curve (...…”

Section: Methodsmentioning

confidence: 99%

Fast-track protocols for patients undergoing spine surgery: a systematic review

Contartese

Salamanna

Brogini

et al. 2023

BMC Musculoskelet Disord

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Background context Fast-track is an evidence-based multidisciplinary strategy for pre-, intra-, and postoperative management of patients during major surgery. To date, fast-track has not been recognized or accepted in all surgical areas, particularly in orthopedic spine surgery where it still represents a relatively new paradigm. Purpose The aim of this review was provided an evidenced-based assessment of specific interventions, measurement, and associated outcomes linked to enhanced recovery pathways in spine surgery field. Methods We conducted a systematic review in three databases from February 2012 to August 2022 to assess the pre-, intra-, and postoperative key elements and the clinical evidence of fast-track protocols as well as specific interventions and associated outcomes, in patients undergoing to spine surgery. Results We included 57 full-text articles of which most were retrospective. Most common fast-track elements included patient’s education, multimodal analgesia, thrombo- and antibiotic prophylaxis, tranexamic acid use, urinary catheter and drainage removal within 24 hours after surgery, and early mobilization and nutrition. All studies demonstrated that these interventions were able to reduce patients’ length of stay (LOS) and opioid use. Comparative studies between fast-track and non-fast-track protocols also showed improved pain scores without increasing complication or readmission rates, thus improving patient’s satisfaction and functional recovery. Conclusions According to the review results, fast-track seems to be a successful tool to reduce LOS, accelerate return of function, minimize postoperative pain, and save costs in spine surgery. However, current studies are mainly on degenerative spine diseases and largely restricted to retrospective studies with non-randomized data, thus multicenter randomized trials comparing fast-track outcomes and implementation are mandatory to confirm its benefit in spine surgery.

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“…Surgical correction of spinal deformities may be associated with significant blood loss and consequent risks including blood transfusion requirements, organ hypoperfusion, spinal cord hypoperfusion, and increased length of stay [ 9 , 10 ]. Allogeneic or autologous blood transfusion rates for paediatric patients undergoing surgical correction of spinal deformity have been reported at between 18.2–25.1% [ 11 , 12 ].…”

Section: Intraoperative Complicationsmentioning

confidence: 99%

Paediatric Spinal Deformity Surgery: Complications and Their Management

Roberts

2022

Healthcare

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Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.

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Variability in length of stay following neuromuscular spinal fusion

Cited by 15 publications

References 28 publications

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Fast-track protocols for patients undergoing spine surgery: a systematic review

Paediatric Spinal Deformity Surgery: Complications and Their Management

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