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  • Schoell, Kyle  (3)
  • Wang, Jeffrey C.  (3)
  • 1
    Online Resource
    Online Resource
    Risk Factors for Postoperative Venous Thromboembolic Events in Patients Undergoing Lumbar Spine Surgery
    SAGE Publications ; 2019
    In:  Global Spine Journal Vol. 9, No. 4 ( 2019-06), p. 409-416
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 9, No. 4 ( 2019-06), p. 409-416
    Abstract: Retrospective, database study. Objectives: The aim of this study was to investigate incidence and risk factors associated with venous thromboembolic events (VTEs) after lumbar spine surgery. Methods: Patients who underwent lumbar surgery between 2007 and 2014 were identified using the Humana within PearlDiver database. ICD-9 (International Classification of Diseases Ninth Revision) diagnosis codes were used to search for the incidence of VTEs among surgery types, patient demographics and comorbidities. Complications including DVT and PE were queried each day from the day of surgery to postoperative day 7 and for periods 0 to 1 week, 0 to 1 month, 0 to 2 months, and 0 to 3 months postoperatively. Results: A total of 64 892 patients within the Humana insurance database received lumbar surgery between 2007 and 2014. Overall VTE rate was 0.9% at 1 week, 1.8% at 1 month, and 2.6% at 3 months postoperatively. Among patients that developed a VTE within 1 week postoperatively, 45.3% had a VTE on the day of surgery. Patients with 1 or more identified risk factors had a VTE incidence of 2.73%, compared with 0.95% for patients without risk factors ( P 〈 .001). Risk factors associated with the highest VTE incidence and odds ratios (ORs) were primary coagulation disorder (10.01%, OR 4.33), extremity paralysis (7.49%, OR 2.96), central venous line (6.70%, OR 2.87), and varicose veins (6.51%, OR 2.58). Conclusions: This study identified several patient comorbidities that were independent predictors of postoperative VTE occurrence after lumbar surgery. Clinical VTE risk assessment may improve with increased focus toward patient comorbidities rather than surgery type or patient demographics.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1177/2192568218797094
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2648287-3
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  • 2
    Online Resource
    Online Resource
    Perioperative Invasive Vascular Catheterization Associated With Increased Risk of Postoperative Infection in Lumbar Spine Surgery : An Analysis of 114,259 Patient Records
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Clinical Spine Surgery: A Spine Publication Vol. 32, No. 3 ( 2019-04), p. E145-E152
    Details
    In: Clinical Spine Surgery: A Spine Publication, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 3 ( 2019-04), p. E145-E152
    Abstract: This is a retrospective cohort study. Objective: This study’s objective was to determine whether perioperative invasive vascular catheter placement, independent of comorbid conditions, modified the risk of postoperative infection in lumbar spine surgery. Summary of Background Data: Infection is a risk inherent to lumbar spine surgery, with overall postoperative infection rates of 0.86%–8.5%. Patients experiencing postoperative infection have higher rates of mortality, revision surgeries, pseudarthrosis, and worsening pain and disability. Methods: Data were collected for patients undergoing lumbar spine surgery between January 2007 and October 2015 with records in the nationwide Humana private insurance database. Patients receiving fusion, laminectomy, and discectomy were followed for 3 months from the date of surgery for surgical site infection (SSI), 6 months for subsequent incision and drainage (I & D), and 1 year for vertebral osteomyelitis (VO). Risk factors investigated included central venous catheter and arterial-line placement. Results: Analysis of 114,259 patient records showed an overall SSI rate of 3.2% within 1 month and 4.5% within 3 months, overall vertebral osteomyelitis rate of 0.82%–0.83% within 1 year, and overall I & D rate of 2.8% within 6 months. Patients receiving a first-time invasive vascular catheter on the day of surgery were more likely to experience SSI within 1 month [risk ratios (RR), 2.5, 95% confidence interval (CI): 2.3–2.7], SSI within 3 months (RR, 2.4; 95% CI: 2.3–2.7), osteomyelitis within 1 year (RR, 4.2–4.3; 95% CI: 3.7–4.5), and undergo an I & D within 6 months (RR, 1.9; 95% CI: 1.8–2.0). These trends were consistent by procedure type and independent of the patient’s weighted comorbidity index score (Charlson Comorbidity Index). Conclusions: Perioperative invasive vascular catheterization was significantly associated with an increased the risk of postoperative infections in lumbar spine surgery, independent of a patient’s concomitant comorbidities. Therefore, in patients with an indication for invasive catheterization, surgeons should consider risks and benefits of surgery carefully. Level of Evidence: Level III.
    Type of Medium: Online Resource
    ISSN: 2380-0186
    URL: Article
    DOI: 10.1097/BSD.0000000000000751
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2849652-8
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  • 3
    Online Resource
    Online Resource
    Depression Increases the Rates of Neurological Complications and Failed Back Surgery Syndrome in Patients Undergoing Lumbar Spine Surgery
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Clinical Spine Surgery: A Spine Publication Vol. 32, No. 2 ( 2019-03), p. E78-E85
    Details
    In: Clinical Spine Surgery: A Spine Publication, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 2 ( 2019-03), p. E78-E85
    Abstract: This was a retrospective database study. Objective: The aim of this study was to use a large sample to accurately determine risk factors and rates of neurological complications in patients undergoing commonly performed lumbar spine surgeries. Summary of Background Data: Damage to neurological structures and failed back surgery syndrome (FBSS) are among the most feared complications of lumbar spine surgery. Despite the large impact on quality of life these complications have, reported rates of neurological complications vary immensely, ranging from 0.46% to 24%. Materials and Methods: Data were obtained for patients undergoing initial posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, anterior lumbar interbody fusion, posterolateral fusion, discectomy, and laminectomy procedures from January 2007 to June 2015 covered by the nationwide insurance carrier Humana. Patient records were analyzed to determine rates of dural tear, damage to nervous tissue, cauda equina syndrome, neurogenic bowel/bladder, and FBSS following each procedure. Rates were determined for patients undergoing single/multilevel procedures, by age, and for patients with a previous diagnosis of depression to determine the influence these factors had on the risk of neurologic complications. Results: Analysis of 70,581 patient records revealed a dural tear rate of 2.87%, damage to the nervous tissue of 1.47%, cauda equina syndrome of 0.75%, neurogenic bowel or bladder of 0.45%, and FBSS of 15.05% following lumbar spine surgery. The incidence of complications was highest for patients undergoing multilevel procedures and posterior fusion. Depression was a significant risk factor for FBSS (risk ratio, 1.74; P 〈 0.0001), damage to nervous tissue (1.41; P 〈 0.0001), and dural tear (1.15; P 〈 0.0001), but had no impact on risk of cauda equina syndrome or neurogenic bowel or bladder. Increased age was associated with higher rates of dural tear and damage to nervous tissue. Conclusions: Patients with a history of depression are at significantly increased risk for neurologic complications following lumbar spine surgery and should be managed accordingly.
    Type of Medium: Online Resource
    ISSN: 2380-0186
    URL: Article
    DOI: 10.1097/BSD.0000000000000730
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2849652-8
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