Multivariable analysis of factors affecting length of stay and hospital charges after single-level corpectomy

Anterior cervical corpectomy and fusion (ACCF) is commonly employed for treating myelopathy, deformity, and a variety of other cervical pathologies. Limited data are available on factors associated with longer hospitalization and higher hospital charges following ACCF. The purpose of this study was to evaluate the pre-, intra-, and postoperative variables that are associated with length of hospital stay and hospital charges for patients undergoing single-level anterior cervical corpectomy and fusion in a retrospective case series. We retrospectively identified from a clinical database 69 patients who underwent single-level ACCF at a single institution from 2010 through 2014. Demographic variables, clinical information, and intraoperative data were analyzed with respect to length of hospitalization and hospital charges. T-test and Chi-squared testing as well as univariate and multivariable analysis were performed with p < 0.05 considered significant. On multivariable analysis, polytrauma, postoperative complications, lower postoperative hematocrit, and two-staged procedures were significantly associated with longer lengths of stay. Length of stay, postoperative complications, and two-staged procedures were significantly associated with higher hospital charges. Patients undergoing a two-staged procedure and those having postoperative complications experience a longer postoperative length of stay and incur higher hospital charges. Avoidance of postoperative anemia may help to reduce length of stay following ACCF.     

胸椎结核椎管内外病灶清除同期后路内固定矫形

目的:探讨胸椎结核Ⅰ期病灶清除及后路短节段椎弓根螺钉系统重建脊柱稳定性的外科治疗方法。方法:对1999年2月以来收治的15例合并椎管内外脓肿的胸椎结核患者,采用后路Ⅰ期双侧肋骨横突切除病灶清除、短节段椎弓根螺钉矫正脊柱后凸畸形、取髂骨植骨的综合性手术方法进行治疗,并对其疗效进行分析。结果:术后随访6个月-2年5个月,平均1年8个月,本组15例术后胸部症状均完全消失,术后脊柱后凸角度为6°-15°,平均矫正度数为17°。术后脊髓神经功能均有不同程度的改善,植骨全部骨性融合,植骨融合时间平均3.2个月。结论:经后路可Ⅰ期有效地进行胸椎结核的彻底病灶清除及脊柱稳定性的重建。     

Outcomes following cervical disc arthroplasty: A retrospective review

Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty. We performed a retrospective review of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty from August 2008 to August 2012. The clinical outcomes and complications associated with the procedure were evaluated. A total of 219 consecutive patients were included in the review, with an average follow-up of 11.2 (±11.0) months. Relief of pre-operative symptoms was noted in 88.7% of patients, and 92.2% of patients were able to return to full pre-operative activity. There was a low rate of complications related to the anterior cervical approach (3.2% with recurrent laryngeal nerve injury, 8.9% with dysphagia), with no device/implant related complications. Symptomatic cervical radiculopathy is a common problem in both the civilian and active duty military populations and can cause significant disability leading to loss of work and decreased operational readiness. There exist several surgical treatment options for appropriately indicated patients. Based on our findings, cervical disc arthroplasty is a safe and effective treatment for symptomatic cervical radiculopathy and myelopathy, with a low incidence of complications and high rate of symptom relief.     

Outpatient anterior cervical discectomy and fusion: A meta-analysis

Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. Data from studies meeting inclusion criteria (minimum of 25 patients, control group of inpatient ACDF patients, non-duplicative data source) was then categorized and assimilated for analysis. Seven studies met inclusion criteria, encompassing a 21-year timespan. Each provided Oxford Center for Evidence-Based Medicine Level 3 evidence. The studies yielded a total of 2448 outpatient ACDF patients; only 125 (5.1%) originated from studies published prior to 2011. Single-level surgery occurred in 63.8% of patients, with 0.5% extending beyond two-level fusions. The overall complication rate was 1.8% (mean follow-up of 141.2 days); only 2% of patients required readmission. In conclusion, outpatient ACDF has become increasingly popular, with more than 95% of patients represented by studies published since 2011. Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2–5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.     

Analysis of the incidence and clinical effect of the heterotopic ossification in a single-level cervical artificial disc replacement

Background contextHeterotopic ossification (HO) is a well-known phenomenon occurring after joint arthroplasty. However, its incidence and clinical effects have not yet been clearly identified with cervical disc replacement.PurposeThe first aim of this study was to evaluate the incidence of HO in single-level cervical disc replacement. The second aim was to identify the relationship of HO with clinical outcomes and radiological findings.Study designA retrospective study of 48 patients who underwent single-level artificial disc replacement in one of our clinics.Patient sampleBetween November 2004 and December 2008, 48 consecutive patients underwent single-level cervical artificial disc replacement in Seoul Wooridul Hospital, Seoul, Korea.Outcomes measuresClinical outcomes were graded using visual analog scale (VAS) scores (score range, 0–10, with 0 reflecting no pain). Functional outcomes were measured using Oswestry Disability Index (ODI) scores. Radiological outcomes were evaluated with follow-up dynamic X-ray.MethodsOccurrence of HO was investigated with the McAfee classification on the follow-up cervical dynamic X-ray. We also measured cervical range of motion (ROM) to identify HO's biomechanical effects. For the clinical effects, the VAS and the ODI were evaluated in correlation with the occurrence of HO.ResultsIn 48 treated patients, a total of 13 HOs were detectable. Grade 1 and 2 HO occurred in 11 patients and Grade 3 HO in two patients. Mean occurrence of HO was observed on the 11th month after the surgery. HO that led to the restriction of the ROM was not present in any patients. The clinical outcome was not significantly correlated with the occurrence of HO.ConclusionsThe overall incidence of HO after cervical artificial disc replacement was relatively high. However, Grade 3 and 4 HO that limit the ROM rarely occurred. Moreover, the occurrence of HO did not affect the clinical symptoms and biomechanical dynamics. A longer follow-up with a larger group of patients should be undertaken, which may demonstrate a higher rate of HO and long-term effects on the ROM.     

Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery – a prospective observational study

BACKGROUND CONTENTThe goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively.PURPOSEThe primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries.STUDY DESIGNProspective, observational study.PATIENT SAMPLESixty patients requiring a single-level lumbar fusion surgery.OUTCOME MEASURESPostoperative pain intensity and the amount of postoperative analgesics consumption.METHODSIn our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, and intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3.RESULTSThe average age of the patients was 51.11±13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<.0016), higher PSQ (p<.001), higher ODI scores(p<.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for postoperative VAS at 6 hours period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (p<.05). There was a significant correlation between algometer average scores (p<.001) with the breakthrough analgesics.CONCLUSIONPreoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.