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Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis

Passias, Peter G; Passfall, Lara; Moattari, Kevin; Krol, Oscar; Kummer, Nicholas A; Tretiakov, Peter; Williamson, Tyler; Joujon-Roche, Rachel; Imbo, Bailey; Burhan Janjua, Muhammad; Jankowski, Pawel; Paulino, Carl; Schwab, Frank J; Owusu-Sarpong, Stephane; Singh, Vivek; Ahmad, Salman; Onafowokan, Tobi; Lebovic, Jordan; Tariq, Muhammad; Saleh, Hesham; Vira, Shaleen; Smith, Justin S; Diebo, Bassel; Schoenfeld, Andrew J
STUDY DESIGN/METHODS:Retrospective review. OBJECTIVE:To assess the factors contributing to durability of surgical results following adult spinal deformity surgery. SUMMARY OF BACKGROUND/BACKGROUND:Factors contributing to the long-term sustainability of ASD correction are currently undefined. METHODS:Operative ASD patients with preop(BL) and 3-year(3Y) postop radiographic/HRQL data were included. At 1Y and 3Y postop, a favorable outcome was defined as meeting at least 3 of 4 criteria: 1) no PJF or mechanical failure with reoperation, 2) best clinical outcome for SRS[≥4.5] or ODI[<15], 3) improving in at least one SRS-Schwab modifier, and 4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1Y and 3Y. Predictors of robust outcomes were identified using multivariable regression analysis, with conditional inference tree (CIT) for continuous variables. RESULTS:We included 157 ASD patients in this analysis. At 1Y postop, 62 patients (39.5%) met the best clinical outcome [BCO] definition for ODI and 33 (21.0%) met the BCO for SRS. At 3Y, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. 95 patients (60.5%) were identified as having a favorable outcome at 1Y postop. At 3Y, 85 patients (54.1%) had a favorable outcome. Seventy-eight (49.7%) patients met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6 week PI-LL difference >13.9°, and having a proportional Global Alignment and Proportion (GAP) score at 6 weeks. CONCLUSIONS:Nearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.
PMID: 37199423
ISSN: 1528-1159
CID: 5508072

The Impact of Isolated Preoperative Cannabis Use on Outcomes Following Cervical Spinal Fusion: A Propensity Score-Matched Analysis

Shah, Neil V; Moattari, Cameron R; Lavian, Joshua D; Gedailovich, Samuel; Krasnyanskiy, Benjamin; Beyer, George A; Condron, Nolan; Passias, Peter G; Lafage, Renaud; Jo Kim, Han; Schwab, Frank J; Lafage, Virginie; Paulino, Carl B; Diebo, Bassel G
BACKGROUND/UNASSIGNED:Cannabis is the most commonly used recreational drug in the USA. Studies evaluating cannabis use and its impact on outcomes following cervical spinal fusion (CF) are limited. This study sought to assess the impact of isolated (exclusive) cannabis use on postoperative outcomes following CF by analyzing outcomes like complications, readmissions, and revisions. METHODS/UNASSIGNED:The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent CF between January 2009 and September 2013. Inclusion criteria were age ≥18 years and either a minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Patients with systemic disease, osteomyelitis, cancer, trauma, and concomitant substance or polysubstance abuse/dependence were excluded. Patients with a preoperative International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis of isolated cannabis abuse (Cannabis) or dependence were identified. The primary outcome measures were 90-day complications, 90-day readmissions, and two-year revisions following CF. Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, surgical approach, and tobacco use to non-cannabis users and compared for outcomes. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes. RESULTS/UNASSIGNED:432 patients (n=216 each) with comparable age, sex, Deyo scores, tobacco use, and distribution of anterior or posterior surgical approaches were identified (all p>0.05). Cannabis patients were predominantly Black (27.8% vs. 12.0%), primarily utilized Medicaid (29.6% vs. 12.5%), and had longer LOS (3.0 vs. 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical and surgical, as well as overall complications (5.6% vs. 3.7%) and two-year revisions (4.2% vs. 2.8%, p=0.430), but isolated cannabis patients had higher 90-day readmission rates (11.6% vs. 6.0%, p=0.042). Isolated cannabis use independently predicted 90-day readmission (Odds Ratio=2.0), but did not predict any 90-day complications or two year revisions (all p>0.05). CONCLUSION/UNASSIGNED:.
PMCID:10777691
PMID: 38213849
ISSN: 1555-1377
CID: 5626592

Long-term Morbidity in Patients After Surgical Correction of Adult Spinal Deformity: Results From a Cohort With Minimum 5-year Follow-up

Imbo, Bailey; Williamson, Tyler; Joujon-Roche, Rachel; Krol, Oscar; Tretiakov, Peter; Ahmad, Salman; Bennett-Caso, Claudia; Schoenfeld, Andrew J; Dinizo, Michael; De La Garza-Ramos, Rafael; Janjua, M Burhan; Vira, Shaleen; Ihejirika-Lomedico, Rivka; Raman, Tina; O'Connell, Brooke; Maglaras, Constance; Paulino, Carl; Diebo, Bassel; Lafage, Renaud; Lafage, Virginie; Passias, Peter G
STUDY DESIGN/METHODS:Retrospective. OBJECTIVE:The objective of this study is to describe the rate of postoperative morbidity before and after two-year (2Y) follow-up for patients undergoing surgical correction of adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA/BACKGROUND:Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results. However, the permanence of radiographic correction, mechanical complications, and revision surgery in ASD surgery remains a clinical challenge. Little information exists on the incidence of long-term morbidity beyond the acute postoperative window. METHODS:ASD patients with complete baseline and five-year (5Y) health-related quality of life and radiographic data were included. The rates of adverse events, including proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and reoperations up to 5Y were documented. Primary and revision surgeries were compared. We used logistic regression analysis to adjust for demographic and surgical confounders. RESULTS:Of 118 patients eligible for 5Y follow-up, 99(83.9%) had complete follow-up data. The majority were female (83%), mean age 54.1 years and 10.4 levels fused and 14 undergoing three-column osteotomy. Thirty-three patients had a prior fusion and 66 were primary cases. By 5Y postop, the cohort had an adverse event rate of 70.7% with 25 (25.3%) sustaining a major complication and 26 (26.3%) receiving reoperation. Thirty-eight (38.4%) developed PJK by 5Y and 3 (4.0%) developed PJF. The cohort had a significantly higher rate of complications (63.6% vs. 19.2%), PJK (34.3% vs. 4.0%), and reoperations (21.2% vs. 5.1%) before 2Y, all P <0.01. The most common complications beyond 2Y were mechanical complications. CONCLUSIONS:Although the incidence of adverse events was high before 2Y, there was a substantial reduction in longer follow-up indicating complications after 2Y are less common. Complications beyond 2Y consisted mostly of mechanical issues.
PMID: 37040468
ISSN: 1528-1159
CID: 5535002

Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity?

Passias, Peter G; Williamson, Tyler K; Krol, Oscar; Tretiakov, Peter; Joujon-Roche, Rachel; Imbo, Bailey; Ahmad, Salman; Bennett-Caso, Claudia; Owusu-Sarpong, Stephane; Lebovic, Jordan; Robertson, Djani; Vira, Shaleen; Dhillon, Ekamjeet; Schoenfeld, Andrew J; Janjua, M Burhan; Raman, Tina; Protopsaltis, Themistocles; Maglaras, Constance; O'Connell, Brooke; Daniels, Alan H; Paulino, Carl; Diebo, Bassel G; Smith, Justin S; Schwab, Frank J; Lafage, Renaud; Lafage, Virginie
STUDY DESIGN/METHODS:Retrospective Cohort Study. OBJECTIVE:Assess whether modifying spinal alignment goals to accommodate frailty considerations will decrease mechanical complications and maximize clinical outcomes. SUMMARY OF BACKGROUND DATA/BACKGROUND:The Global Alignment and Proportion(GAP) score was developed to assist in reducing mechanical complications, but has had less success predicting such events in external validation. Higher frailty and many of its components have been linked to development of implant failure. Therefore, modifying the GAP score with frailty may strengthen its ability to predict mechanical complications. METHODS:We included 412 surgical ASD patients with two-year(2Y) follow-up. Frailty was quantified using the ASD modified Frailty Index(mASD-FI). Outcomes: proximal junctional kyphosis(PJK) and failure(PJF), major mechanical complications, and 'Best Clinical Outcome'(BCO), defined as ODI<15 and SRS-22 Total>4.5. Logistic regression analysis established a six-week score based on GAP score,frailty and ODI US-Norms. Logistic regression followed by conditional inference tree(CIT) analysis generated categorical thresholds. Multivariable logistic regression analysis controlling for confounders was used to assess the performance of the frailty modified GAP score. RESULTS:Baseline frailty categories: 57% Not Frail,30% frail,14% severely frail. Overall, 39% of patients developed PJK, 8% PJF, 21% mechanical complications, 22% underwent reoperation, and 15% met BCO. The modified ASD-FI demonstrated correlation with developing PJF, mechanical complications, undergoing reoperation, and meeting BCO at 2Y(all P<0.05). Regression analysis generated the following equation: Frailty-Adjusted Realignment Score(FAR Score) =0.49*mASD-FI + 0.38*GAP Score. Thresholds for the FAR score(0-13): Proportioned:<3.5,Moderately Disproportioned:3.5-7.5,Severely Disproportioned:>7.5. Multivariable logistic regression assessing FAR Score demonstrated associations with mechanical complications, reoperation, and meeting Best Clinical Outcome by two years(all P<0.05), whereas the original GAP score was only significant for reoperation. CONCLUSION/CONCLUSIONS:This study demonstrated adjusting alignment goals in adult spinal deformity surgery for a patient's baseline frailty status and disability may be useful in minimizing the risk of complications and adverse events, outperforming the original GAP score in terms of prognostic capacity. LEVEL OF EVIDENCE/METHODS:III.
PMID: 36191091
ISSN: 1528-1159
CID: 5361622

The Effects of Global Alignment and Proportionality Scores on Postoperative Outcomes After Adult Spinal Deformity Correction

Passias, Peter G; Krol, Oscar; Owusu-Sarpong, Stephane; Tretiakov, Peter; Passfall, Lara; Kummer, Nicholas; Ani, Fares; Imbo, Bailey; Joujon-Roche, Rachel; Williamson, Tyler K; Sagoo, Navraj S; Vira, Shaleen; Schoenfeld, Andrew; De la Garza Ramos, Rafael; Janjua, Muhammad Burhan; Sciubba, Daniel; Diebo, Bassel G; Paulino, Carl; Smith, Justin; Lafage, Renaud; Lafage, Virginie
BACKGROUND:Recent studies have suggested achieving global alignment and proportionality (GAP) alignment may influence mechanical complications after adult spinal deformity (ASD) surgery. OBJECTIVE:To investigate the association between the GAP score and mechanical complications after ASD surgery. METHODS:Patients with ASD with at least 5-level fusion to pelvis and minimum 2-year data were included. Multivariate analysis was used to find an association between proportioned (P), GAP-moderately disproportioned, and severely disproportioned (GAP-SD) states and mechanical complications (inclusive of proximal junctional kyphosis [PJK], proximal junctional failure [PJF], and implant-related complications [IC]). Severe sagittal deformity was defined by a "++" in the Scoliosis Research Society (SRS)-Schwab criteria for sagittal vertebral axis or pelvic incidence and lumbar lordosis. RESULTS:Two hundred ninety patients with ASD were included. Controlling for age, Charlson comorbidity index, invasiveness and baseline deformity, and multivariate analysis showed no association of GAP-moderately disproportioned patients with proximal junctional kyphosis, PJF, or IC, while GAP-SD patients showed association with IC (odds ratio [OR]: 1.7, [1.1-3.3]; P = .043). Aligning in GAP-relative pelvic version led to lower likelihood of all 3 mechanical complications (all P < .04). In patients with severe sagittal deformity, GAP-SD was predictive of IC (OR: 2.1, [1.1-4.7]; P = .047), and in patients 70 years and older, GAP-SD was also predictive of PJF development (OR: 2.5, [1.1-14.9]; P = .045), while improving in GAP led to lower likelihood of PJF (OR: 0.2, [0.02-0.8]; P = .023). CONCLUSION/CONCLUSIONS:Severely disproportioned in GAP is associated with development of any IC and junctional failure specifically in older patients and those with severe baseline deformity. Therefore, incorporation of patient-specific factors into realignment goals may better strengthen the utility of this novel tool.
PMID: 36688681
ISSN: 2332-4260
CID: 5419472

Metabolic Bone Disorders Are Predictors for 2-year Adverse Outcomes in Patients Undergoing 2-3 Level Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy or Myelopathy

Diebo, Bassel G; Kovoor, Matthew; Alsoof, Daniel; Beyer, George A; Rompala, Alexander; Balmaceno-Criss, Mariah; Mai, David H; Segreto, Frank A; Shah, Neil V; Lafage, Renaud; Passias, Peter G; Aaron, Roy K; Daniels, Alan H; Paulino, Carl B; Schwab, Frank J; Lafage, Virginie
STUDY DESIGN/METHODS:Retrospective cohort study utilizing the New York statewide planning and research cooperative system. STUDY OBJECTIVE/OBJECTIVE:To investigate postoperative complications of patients with metabolic bone disorders (MBDs) who undergo 2-3 levels of anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA/BACKGROUND:MBDs and cervical degenerative pathologies, including cervical radiculopathy (CR) and cervical myelopathy (CM), are prevalent in the aging population. Complications with ACDF procedures can lead to increased hospitalization times, more expensive overhead, and worse patient outcomes. METHOD/METHODS:Patients with CM/CR who underwent an ACDF of 2-3 vertebrae from 2009 to 2011 with a minimum 2-year follow-up were identified. Patients diagnosed with 1 or more MBD at baseline were compared with a control cohort without any MBD diagnosis. Cohorts were compared for demographics, hospital-related parameters, and 2-year medical, surgical, and overall complications. Binary multivariate logistic regression was used to identify independent predictors. RESULTS:A total of 22,276 patients were identified (MBD: 214; no-MBD: 22,062). Among MBD patients, the majority had vitamin D deficiency (n = 194, 90.7%). MBD patients were older (53.0 vs 49.7 y, P < 0.001), and with higher Deyo index (1.0 vs 0.5, P < 0.001). MBD patients had higher rates of medical complications, including anemia (6.1% vs 2.3%), pneumonia (4.7% vs 2.1%), hematoma (3.3% vs 0.7%), infection (2.8% vs 0.9%), and sepsis (3.7% vs 0.9%), as well as overall medical complications (23.8% vs 9.6%) (all, P ≤0.033). MBD patients also experienced higher surgical complications, including implant-related (5.7% vs 1.9%), wound infection (4.2% vs 1.2%), and wound disruption (0.9% vs 0.2%), and overall surgical complications (9.8% vs 3.2%) (all, P ≤0.039). Regression analysis revealed that a baseline diagnosis of MBD was independently associated with an increased risk of 2-year surgical complications (odds ratio = 2.10, P < 0.001) and medical complications (odds ratio = 1.84, P = 0.001). CONCLUSIONS:MBD as a comorbidity was associated with an increased risk of 2-year postoperative complications after 2-3 level ACDF for CR or CM.
PMID: 36864582
ISSN: 2380-0194
CID: 5462342

Can We Predict Imbalance in Patients? Analysis of the CDC National Health and Nutrition Examination Survey

Diebo, Bassel G.; Stroud, Sarah G.; Shah, Neil V.; Messina, James; Hong, James M.; Alsoof, Daniel; Ansari, Kashif; Lafage, Renaud; Passias, Peter G.; Lafage, Virginie; Schwab, Frank J.; Paulino, Carl B.; Aaron, Roy; Daniels, Alan H.
Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All participants who said "yes" (Imbalanced) or "no" (Balanced) to the following question were identified from 1999"“2004: "During the past 12 months, have you had dizziness, difficulty with balance or difficulty with falling?" Univariate analyses compared Imbalanced versus Balanced subjects and binary logistic regression modeling predicted for Imbalance. Of 9964 patients, imbalanced (26.5%) were older (65.4 vs. 60.6 years), with more females (60% vs. 48%). Imbalanced subjects reported higher rates of comorbidities, including osteoporosis (14.4% vs. 6.6%), arthritis (51.6% vs. 31.9%), and low back pain (54.4% vs 32.7%). Imbalanced patients had more difficulty with activities, including climbing 10 steps (43.8% vs. 21%) and stooping/crouching/kneeling (74.3% vs. 44.7%), and they needed greater time to walk 20 feet (9.5 vs. 7.1 s). Imbalanced subjects had significantly lower caloric and dietary intake. Regression revealed that difficulties using fingers to grasp small objects (OR: 1.73), female gender (OR: 1.43), difficulties with prolonged standing (OR: 1.29), difficulties stooping/crouching/kneeling (OR: 1.28), and increased time to walk 20 feet (OR: 1.06) were independent predictors of Imbalance (all p < 0.05). Imbalanced patients were found to have identifiable comorbidities and were detectable using simple functional assessments. Structured tests that assess dynamic functional status may be useful for preoperative optimization and risk-stratification for patients undergoing spinal or lower limb surgical realignment.
SCOPUS:85149835625
ISSN: 2077-0383
CID: 5446762

Crossing the Bridge from Degeneration to Deformity: When Does Sagittal Correction Impact Outcomes in Adult Spinal Deformity Surgery?

Williamson, Tyler K; Krol, Oscar; Tretiakov, Peter; Joujon-Roche, Rachel; Imbo, Bailey; Ahmad, Salman; Owusu-Sarpong, Stephane; Lebovic, Jordan; Ihejirika-Lomedico, Rivka; Dinizo, Michael; Vira, Shaleen; Dhillon, Ekamjeet; O'Connell, Brooke; Maglaras, Constance; Schoenfeld, Andrew J; Janjua, M Burhan; Alan, Nima; Diebo, Bassel; Paulino, Carl; Smith, Justin S; Raman, Tina; Lafage, Renaud; Protopsaltis, Themistocles; Lafage, Virginie; Passias, Peter G
BACKGROUND:Patients with less severe adult spinal deformity undergo surgical correction and often achieve good clinical outcomes. However, it is not well understood how much clinical improvement is due to sagittal correction rather than treatment of the spondylotic process. PURPOSE/OBJECTIVE:Determine baseline thresholds in radiographic parameters that, when exceeded, may result in substantive clinical improvement from surgical correction. STUDY DESIGN/METHODS:Retrospective. METHODS:ASD patients with BL and 2-year(2Y) data were included. Parameters assessed: SVA, PI-LL, PT, T1PA, L1PA, L4-S1 Lordosis, C2-C7 SVA(cSVA), C2-T3, C2 Slope(C2S). Outcomes: Good Outcome(GO) at 2Y: [Meeting either: 1) SCB for ODI(change greater than 18.8), or 2) ODI<15 and SRS-Total>4.5. Binary logistic regression assessed each parameter to determine if correction was more likely needed to achieve GO. Conditional inference tree(CIT) run machine learning analysis generated baseline thresholds for each parameter, above which, correction was necessary to achieve GO. RESULTS:We included 431 ASD patients. There were 223(50%) that achieved a GO by two years. Binary logistic regression analysis demonstrated, with increasing baseline severity in deformity, sagittal correction was more often seen in those achieving GO for each parameter(all P<0.001). Of patients with baseline T1PA above the threshold, 95% required correction to meet Good Outcome(95% vs. 54%,P<0.001). A baseline PI-LL above 10° (74% of patients meeting GO) needed correction to achieve GO (OR: 2.6,[95% CI 1.4-4.8]). A baseline C2 slope above 15° also necessitated correction to obtain clinical success (OR: 7.7,[95% CI 3.7-15.7]). CONCLUSION/CONCLUSIONS:Our study highlighted point may be present at which sagittal correction has an outsized influence on clinical improvement, reflecting the line where deformity becomes a significant contributor to disability. These new thresholds give us insight into which patients may be more suitable for sagittal correction, as opposed to intervention for the spondylotic process only, leading to a more efficient utility of surgical intervention for adult spinal deformity. LEVEL OF EVIDENCE/METHODS:III.
PMID: 36007130
ISSN: 1528-1159
CID: 5338432

The Impact of Prematurity at Birth on Short-Term Postoperative Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Shah, Neil V.; Coste, Marine; Wolfert, Adam J.; Gedailovich, Samuel; Ford, Brian; Kim, David J.; Kim, Nathan S.; Ikwuazom, Chibuokem P.; Patel, Neil; Dave, Amanda M.; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie; Paulino, Carl B.; Diebo, Bassel G.
Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012"“2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28"“31 weeks), and moderate-to-late (32"“36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations.
SCOPUS:85147826107
ISSN: 2077-0383
CID: 5425212

The Impact of Asymptomatic Human Immunodeficiency Virus-Positive Disease Status on Inpatient Complications Following Spine Surgery: A Propensity Score-Matched Analysis

Shah, Neil V.; Lettieri, Matthew J.; Gedailovich, Samuel; Kim, David; Oad, Madhu; Veenema, Ryne J.; Wolfert, Adam J.; Beyer, George A.; Wang, Hanbin; Nunna, Ravi S.; Hollern, Douglas A.; Lafage, Renaud; Challier, Vincent; Merola, Andrew A.; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie; Paulino, Carl B.; Diebo, Bassel G.
In the United States, nearly 1.2 million people > 12 years old have human immunodeficiency virus (HIV), which is associated with postoperative complications following orthopedic procedures. Little is known about how asymptomatic HIV (AHIV) patients fare postoperatively. This study compares complications after common spine surgeries between patients with and without AHIV. The Nationwide Inpatient Sample (NIS) was retrospectively reviewed from 2005"“2013, identifying patients aged > 18 years who underwent 2"“3-level anterior cervical discectomy and fusion (ACDF), ≥4-level thoracolumbar fusion (TLF), or 2"“3-level lumbar fusion (LF). Patients with AHIV and without HIV were 1:1 propensity score-matched. Univariate analysis and multivariable binary logistic regression were performed to assess associations between HIV status and outcomes by cohort. 2"“3-level ACDF (n = 594 total patients) and ≥4-level TLF (n = 86 total patients) cohorts demonstrated comparable length of stay (LOS), rates of wound-related, implant-related, medical, surgical, and overall complications between AHIV and controls. 2"“3-level LF (n = 570 total patients) cohorts had comparable LOS, implant-related, medical, surgical, and overall complications. AHIV patients experienced higher postoperative respiratory complications (4.3% vs. 0.4%,). AHIV was not associated with higher risks of medical, surgical, or overall inpatient postoperative complications following most spine surgical procedures. The results suggest the postoperative course may be improved in patients with baseline control of HIV infection.
SCOPUS:85148957155
ISSN: 2077-0383
CID: 5446092