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  • SAGE Publications  (13)
  • Phan, Kevin  (13)
  • 2015-2019  (13)
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  • SAGE Publications  (13)
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  • 2015-2019  (13)
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  • 1
    Online Resource
    Online Resource
    Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion
    SAGE Publications ; 2017
    In:  Global Spine Journal Vol. 7, No. 6 ( 2017-09), p. 529-535
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 7, No. 6 ( 2017-09), p. 529-535
    Abstract: Retrospective study of prospectively collected data. Objective: To analyze the modified frailty index (mFI) as a predictor of adverse postoperative events following posterior lumbar fusion. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database including all adult patients undergoing posterior lumbar interbody fusion or transforaminal lumbar interbody fusion between 2005 and 2012. Outcomes measured included mortality, postoperative complications, length of stay, reoperations, and readmissions. The previously described mFI was calculated, and univariate and multivariate logistic regression analysis were used to analyze risk factors associated with morbidity, mortality, and adverse postoperative events. This study was qualified as exempt by the Mount Sinai Hospital Institutional Review Board. Results: A total of 6094 patients met inclusion criteria. The mean mFI was 0.087(0-0.545). Increasing mFI score was associated with increased complications, reoperations, prolonged length of stay (LOS), and morbidity ( P 〈 .05). As the mFI score increased from 0.27 (3/11 variables present) to ≥0.36 (4/11), the rate of any complication increased from 26.8% to 35% ( P 〈 .0001), sepsis 2.4% to 5.2% ( P 〈 .0001), wound complications 4.4% to 6.5% ( P 〈 .0001), unplanned readmissions 4.7% to 20% ( P = .02), and urinary tract infection 4.1% to 10.4% ( P 〈 .0001). An mFI of ≥0.36 was an independent predictor of any complication (odds ratio [OR]= 2.2, 95% confidence interval [CI] = 1.3-3.7), sepsis (OR = 6.3, 95%, CI = 1.8-21), wound complications (OR = 2.9, 95% CI = 1.1-8.2), prolonged LOS (OR = 2.3, 95% CI = 1.4-3.7), and readmission (OR = 4.3, 95% CI = 1.5-12.7). Conclusion: Patients with higher mFI scores (≥ 4/11 variables) are at a significantly higher risk of major complications, readmissions, and prolonged LOS following lumbar fusion.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217700099
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 2
    Online Resource
    Online Resource
    Early Complications and Outcomes in Adult Spinal Deformity Surgery: An NSQIP Study Based on 5803 Patients
    SAGE Publications ; 2017
    In:  Global Spine Journal Vol. 7, No. 5 ( 2017-08), p. 432-440
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 7, No. 5 ( 2017-08), p. 432-440
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217699384
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 3
    Online Resource
    Online Resource
    Predictors for Non-Home Patient Discharge Following Elective Adult Spinal Deformity Surgery
    SAGE Publications ; 2018
    In:  Global Spine Journal Vol. 8, No. 3 ( 2018-05), p. 266-272
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 8, No. 3 ( 2018-05), p. 266-272
    Abstract: Retrospective cohort study. Objectives: Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. The utilization of spinal surgery has increased and this trend is expected to continue. To effectively deal with an increasing patient volume, identifying variables associated with patient discharge destination can expedite placement and reduce length of stay. Methods: The 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision diagnosis codes relevant to ASD. Patients were divided based on discharge destination. Bivariate and multivariate logistic regression analyses were employed to identify predictors for patient discharge destination and hospital length of stay. Results: A total of 4552 patients met inclusion criteria, of which 1102 (24.2%) had non-home discharge. Multivariate regression revealed total relative value unit (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.00-1.01); female sex (OR = 1.54, 95% CI = 1.32-1.81); American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander versus black race (OR = 0.52, 95% CI = 0.35-0.78, P = .002); age ≥65 years (OR = 3.72, 95% CI = 3.19-4.35); obesity (OR = 1.18, 95% CI = 1.01-1.38, P = .034); partially/totally functionally dependent (OR = 2.11, 95% CI = 1.49-2.99); osteotomy (OR = 1.42, 95% CI = 1.12-1.80, P = .004) pelvis fixation (OR = 2.38, 95% CI = 1.82-3.11); operation time ≥4 hours (OR = 1.74, 95% CI = 1.47-2.05); recent weight loss (OR = 7.66, 95% CI = 1.52-38.65; P = .014); and American Society of Anesthesiologists class ≥3 (OR = 1.80, 95% CI = 1.53-2.11) as predictors of non-home discharge. P values were 〈 .001 unless otherwise noted. Additionally, multivariate regression found non-home discharge to be a significant variable in prolonged length of stay. Conclusions: The authors suggest these results can be used to inform patients preoperatively of expected discharge destination, anticipate patient discharge needs postoperatively, and reduce health care costs and morbidity associated with prolonged LOS.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217717971
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
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  • 4
    Online Resource
    Online Resource
    Primary Versus Revision Discectomy for Adults With Herniated Nucleus Pulposus: A Propensity Score–Matched Multicenter Study
    SAGE Publications ; 2018
    In:  Global Spine Journal Vol. 8, No. 8 ( 2018-12), p. 810-815
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 8, No. 8 ( 2018-12), p. 810-815
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568218773716
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
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  • 5
    Online Resource
    Online Resource
    Thirty-Day Perioperative Complications, Prolonged Length of Stay, and Readmission Following Elective Posterior Lumbar Fusion Associated With Poor Nutritional Status
    SAGE Publications ; 2019
    In:  Global Spine Journal Vol. 9, No. 4 ( 2019-06), p. 417-423
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 9, No. 4 ( 2019-06), p. 417-423
    Abstract: Retrospective study. Objective: To determine the rates of early postoperative mortality and morbidity in adults with hypoalbuminemia undergoing elective posterior lumbar fusion (PLF). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was examined from 2005 to 2012. Current Procedural Terminology (CPT) codes were used to query the database for adults (≥18 years) who underwent PLF and/or posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). Patients were divided into those with normal albumin concentration (≥3.5g/dL) and those with hypoalbuminemia ( 〈 3.5 g/dL). Both univariate and multivariate analyses were performed. Results: A total of 2410 patients were included, of whom 2251 (93.4%) were normoalbuminemic and 159 (6.6%) were hypoalbuminemic. Patients with preoperative serum albumin levels 〈 3.5 g/dL were older with a higher American Society of Anesthesiologists (ASA) score, and more comorbidities, including anemia, diabetes, dependent functional status, and preoperative history of chronic steroid therapy. Hypoalbuminemic patients had higher rates of any 30-day perioperative complication ( P 〈 .001), unplanned readmission ( P = .019), and prolonged length of stay (LOS) 〉 5 days ( P 〈 .001). However, hypoalbuminemia was not significantly associated with any specific perioperative complication. On multivariate analysis, preoperative hypoalbuminemia was found to be an independent predictor of prolonged LOS (OR 2.4, 95% CI 1.7-3.5; P 〈 .001) and unplanned readmission (OR 2.7, 95% CI 1.1-6.3; P = .023). Conclusion: Hypoalbuminemia was found to be an important predictor of patient outcomes in this population. This study suggests that clinicians should consider nutritional screening and optimization as part of the preoperative risk assessment algorithm. Level of Evidence: III
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568218797089
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 6
    Online Resource
    Online Resource
    Age Is a Risk Factor for Postoperative Complications Following Excisional Laminectomy for Intradural Extramedullary Spinal Tumors
    SAGE Publications ; 2019
    In:  Global Spine Journal Vol. 9, No. 2 ( 2019-04), p. 126-132
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 9, No. 2 ( 2019-04), p. 126-132
    Abstract: Retrospective analysis. Objective: The incidence of intradural extramedullary (IDEM) spinal tumors is increasing. Excisional laminectomy for removal and decompression is the standard of care, but complications associated with patient age are unreported in the literature. Our objective is to identify if age is a risk factor for postoperative complications after excisional laminectomy of IDEM spinal tumors. Methods: A retrospective analysis was performed on the 2011 to 2014 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database for patients undergoing excisional laminectomy of IDEM spinal tumors. Age groups were determined by interquartile analysis. Chi-squared tests, t tests, and multivariate logistic regression models were employed to identify independent risk factors. Institutional review board approval was not needed. Results: A total of 1368 patients met the inclusion criteria for the study. Group 1 (age ≤ 44) contained 372 patients, group 2 (age 45-54) contained 314 patients, group 3 (age 55-66) contained 364 patients, and group 4 (age 〉 66) contained 318 patients. The univariate analysis showed that mortality and unplanned readmission were highest among patients in group 4 (1.26%, P = .011, and 10.00%, P = .039, respectively). Postoperative wound complications were highest among patients in group 1 (2.15%, P = .009), and postoperative venous thromboembolism and cardiac complications were highest among patients in group 3 (4.4%, P = .007, and 1.10%, P = .032, respectively). Multivariate logistic regression revealed that elderly age was an independent risk factor for postoperative venous thromboembolism (group 3 vs group 1; odds ratio = 6.739, confidence interval = 1.522-29.831, P = .012). Conclusions: This analysis revealed that increased age is an independent risk factor for postoperative venous thromboembolism in patients undergoing excisional laminectomy for IDEM spinal tumors.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568218754512
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 7
    Online Resource
    Online Resource
    ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients
    SAGE Publications ; 2017
    In:  Global Spine Journal Vol. 7, No. 8 ( 2017-12), p. 719-726
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 7, No. 8 ( 2017-12), p. 719-726
    Abstract: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217700106
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 8
    Online Resource
    Online Resource
    Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery
    SAGE Publications ; 2017
    In:  Global Spine Journal Vol. 7, No. 7 ( 2017-10), p. 664-671
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 7, No. 7 ( 2017-10), p. 664-671
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217701110
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 9
    Online Resource
    Online Resource
    Elderly Age as a Risk Factor for 30-Day Postoperative Outcomes Following Elective Anterior Cervical Discectomy and Fusion
    SAGE Publications ; 2017
    In:  Global Spine Journal Vol. 7, No. 5 ( 2017-08), p. 425-431
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 7, No. 5 ( 2017-08), p. 425-431
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217699383
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 10
    Online Resource
    Online Resource
    Impact of Preoperative Anemia on Outcomes in Adults Undergoing Elective Posterior Cervical Fusion
    SAGE Publications ; 2017
    In:  Global Spine Journal Vol. 7, No. 8 ( 2017-12), p. 787-793
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 7, No. 8 ( 2017-12), p. 787-793
    Abstract: Retrospective analysis of prospectively collected data. Objectives: Few studies have investigated the role of preoperative anemia on postoperative outcomes of posterior cervical fusion. This study looked to investigate the potential relationship between preoperative anemia and postoperative outcomes following posterior cervical spine fusion. Methods: Data from patients undergoing elective posterior cervical fusions between 2005 and 2012 was collected from the American College of Surgeons National Surgical Quality Improvement Program database using inclusion/exclusion criteria. Multivariate analyses were used to identify the predictive power of anemia for postoperative outcomes. Results: A total of 473 adult patients undergoing elective posterior cervical fusions were identified with 106 (22.4%) diagnosed with anemia preoperatively. Anemic patients had higher rates of diabetes ( P = .0001), American Society of Anesthesiologists scores ≥3 ( P 〈 .0001), and higher dependent functional status prior to surgery ( P 〈 .0001). Intraoperatively, anemic patients also had higher rates of neuromuscular injuries ( P = .0303), stroke ( P = .013), bleeding disorders ( P = .0056), lower albumin ( P 〈 .0001), lower hematocrit ( P 〈 .0001), and higher international normalized ratio ( P = .002). Postoperatively, anemic patients had higher rates of complications ( P 〈 .0001), death ( P = .008), blood transfusion ( P = .001), reoperation ( P = .012), unplanned readmission ( P = .022), and extended length of stay ( 〉 5 days; P 〈 .0001). Conclusions: Preoperative anemia is linked to a number of postoperative complications, which can increase length of hospital stay and increase the likelihood of reoperation. Identifying preoperative anemia may play a role in optimizing and minimizing the complication rates and severity of comorbidities following posterior cervical fusion.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568217705654
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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