Faculty Bibliography

BACKGROUND CONTEXT: Adult spinal deformity is a complex pathology that often requires challenging surgical intervention for treatment. In patients with osteoporosis, there may be increased risk of complications and reoperations. Our study aimed to evaluate the effect of treating osteoporosis patients with bisphosphonate preoperatively on future reoperations. PURPOSE: Investigate the effect of preoperative bisphosphonate on osteoporosis patients undergoing corrective surgery for adult spinal deformity. STUDY DESIGN/SETTING: Retrospective review of the PearlDiver database between the years 2008-2015. PATIENT SAMPLE: This study included 2,842 adult spinal deformity patients. OUTCOME MEASURES: Ninety-day complications, reoperations.
METHOD(S): Adult spinal deformity patients undergoing a fusion were isolated using ICD-9 CM and CPT codes in the PearlDiver database between the years 2008-2015. Patients were stratified based on diagnosis of osteoporosis and whether there was a filled prescription for bisphosphonate 6 months prior to surgery. ASD patients with osteoporosis and bisphosphonate use who underwent corrective intervention were compared with age- and sex-matched cohorts of osteoporotic and nonosteoporotic controls with no bisphosphonate prescriptions. Means comparison tests compared differences in demographics, comorbidities, 90-day complications, and 2Y reoperation rates. Logistic regression analysis assessed the odds of complication and reoperations controlling for age, sex, and comorbidities (odds ratio [95% confidence interval]). Statistical significance was set p<0.05.
RESULT(S): A total of 2,842 operative adult spinal deformity patients were isolated. Four hundred and six patients had osteoporosis and bisphosphonate use, 807 osteoporosis with no bisphosphonate use, and 1,629 non-osteoporosis patients. At baseline, osteoporosis patients had higher rates of obesity, diabetes, hyperlipidemia, and peripheral vascular disease compared to osteoporotic bisphosphonate cohort. There were no differences in 90-day complication rates or 2Y reoperations rates between osteoporosis bisphosphonate users and osteoporosis controls (p>0.05). Compared to nonosteoporotic patients, osteoporosis patients with bisphosphonate use trended toward lower rates of revisions at 1Y (5% vs 7%) and 2Y (7% vs 8%, both p>0.05).
CONCLUSION(S): In a matched cohort, osteoporosis patients treated preoperatively with bisphosphonates trended towards lower rates of revisions two years postoperatively compared to nonosteoporotic controls. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The risk assessment of elective spine fusion patients with a previous history of cardiac intervention, particularly a coronary artery bypass graft (CABG), has been understudied. This study aimed to assess postoperative outcomes of elective spine fusion patients with a prior history of single- to multilevel coronary artery bypass grafting. PURPOSE: Investigate effect of revascularization on 30-day and 90-day outcomes in elective spine fusion patients. STUDY DESIGN/SETTING: Retrospective review of the PearlDiver database between the years 2006-2013. PATIENT SAMPLE: A total of 733,007 elective spine fusion patients. OUTCOME MEASURES: Comorbidity burden, 30-day and 90-day complications (myocardial infarction, pneumonia, sepsis, death, would complications, transfusions), readmission.
METHOD(S): Elective spine fusion patients were isolated with ICD-9 and CPT procedures codes in the PearlDiver database. Patients were stratified by number of coronary arteries grafted during a coronary artery bypass grafting procedure prior to spine fusion: (1) 1-2 grafts (G12); (2) 3-4 grafts (G34); (3) no grafts. Means comparison tests compared differences in demographics, diagnoses, comorbidities, and 30-day complication outcomes. Logistic regression assessed the odds of complication associated with number of arteries grafted, controlling for levels fused, age, sex, and comorbidities (odds ratio [95% confidence interval]).
RESULT(S): A total of 733,007 elective spine fusion patients were isolated;723,606 pts had no grafts, 5,356 were G12, and 4,045 were G34. G12 patients at baseline had higher rates of morbid obesity, PVD, chronic kidney disease, CHF, and COPD (p<0.001). Relative to no graft patients, G12 patients had higher rates of pneumonia, CVA, myocardial infaraction (MI), sepsis, and death 30-days postoperatively (all p<0.05). Compared to no graft patients, G34 had increased rates of pneumonia, CVA, MI, and sepsis 30 days postoperatively. Comparing G12 to G34 pts, there were no significant differences in 30-day major or minor complications (p>0.05). Overall, G34 patients had higher rates of 30-day and 90-day readmissions (p<0.05).
CONCLUSION(S): Compared to patients who had no history of cardiac intervention, patients who had single or multivessel coronary artery bypass graft had an increase in 30-day complications. However, comparing between groups that had 1-2 or 3-4 level grafts, there were no significant differences in major and minor complications 30 days postoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Surgical intervention aimed at addressing adult spinal deformity (ASD) is an invasive and complex procedure that surgeons often elect to perform anterior/posterior (A/P) on different days. Literature on the effect of the interval between procedures on outcomes is limited. PURPOSE: Identifying optimal interval of time between A/P staged surgeries during same hospitalization. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective multicenter database of ASD patients. PATIENT SAMPLE: A total of 176 propensity score matched A/P ASD patients. OUTCOME MEASURES: Health-related quality of life (HRQL) measures including Oswestry Disability Index (ODI), Scoliosis Research Society Questionnaire (SRS22); SF-36, EBL, LOS.
METHOD(S): Op patients who met ASD database criteria (>18yrs, scoliosis >=20degree, SVA >=5cm, PT >=25degree and/or TK >60degree), had a A/P fusion to the pelvis and had complete radiographic and HRQL data at baseline (BL) and 2Y were included. Propensity score match for levels fused, number of interbodies, interbody approach, number of osteotomies, baseline frailty, ODI, CCI, revisions, SVA, PI-LL, and UIV isolated a matched cohort of A/P same day and staged surgical patients. All patients underwent both A/P procedures during same admission. Posterior-only procedures were excluded. Patients that underwent a staged (not same day) corrective procedure were further stratified into percentiles of days between staging: (1) 25th percentile (2 days); (2) 50th percentile (3 days); (3) 75th percentile (5 days). Means comparison tests assessed differences in baseline demographic, clinical data, and intervals of staging.
RESULT(S): A total of 176 propensity score matched patients (63.0yrs, 80% F, 29.2 kg/m2) were isolated. Radiographically at baseline, patients presented with: PT (26.8+/-10.0), PI-LL (24.5+/-18.7), SVA (96.1+/-78.7). The median interval between A/P staged procedures was 3.0 days+/-2.6. Staged patients had significantly greater overall operative time (628 min vs 501 min) and lower ICU stays postoperatively (p<0.05). Radiographically, at 2Y staged patients compared to same day showed a significantly greater improvement in PI, TS-CL, C2SS, SVA according to SRS-Schwab(p<0.05). Furthermore, staged patients had greater rates of gain in MCID for SRS appearance at 1Y and PCS at 2Y Assessing different intervals of staging, patients reaching 75th percentile interval showed greater improvement in SRS Pain and Total postoperatively as well as SRS Activity, Pain, Satisfaction, and Total at 1Y (both p<0.05). Compared to the 25th percentile interval of staging, patients reaching the 50th interval of staging were associated with significantly increased odds of improvement in GAP proportionality (OR:9.3[1.6-53.2], p=0.01). Adjusting for institution and surgeon, patients at the 50th percentile interval continued to show higher rate of improvement in GAP proportionality at 2Y(p<0.05).
CONCLUSION(S): In the closest matched cohort known to date of A/P staged and same day surgery patients, staged procedures were shown to result in significant improvement radiographically, reduced ICU stays, and superior patient reported outcomes. An interval of three days between A/P staged procedures was associated with increased improvement in GAP proportionality even after adjusting for institution and surgeon. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Recent studies have suggested that for patients with chronic neck pain, both psychological and physical symptoms need to be addressed. Studies have shown that psychological distress is associated with poor outcomes in these patients. The fear avoidance model has been used to explain how maladaptive thoughts and behaviors contribute to chronicity and disability. Cognitive behavioral therapy (CBT) addresses these risk factors through education about pain, modification of maladaptive beliefs, and increasing patient's self-efficacy. PURPOSE: Determine the effectiveness of brief psychological intervention on psychological outcomes in cervical spine surgery. STUDY DESIGN/SETTING: Prospective, blind, and placebo-controlled trial. PATIENT SAMPLE: A total of 42 symptomatic Cervical Degenerative Disorders patients. OUTCOME MEASURES: Distress and Risk Assessment Method (DRAM), Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Outcome Expectation Question (OEQ). Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA).
METHOD(S): Forty-two patients age >18 with symptomatic cervical degenerative disease have been enrolled in the study. If patients met psychological distress criteria, they were in the treatment group: DRAM >17 and <33, FABQ >49/66, PCS >30/52 or OEQ <=2 (randomized to CBT or Placebo). CBT and Placebo treatment groups had 6 sessions prior to surgery. The control group had no intervention prior to surgery. Baseline and 1-year (1Y) changes were assessed for all outcome measures.
RESULT(S): Forty-two patients were enrolled (53.6 years, BMI 29.4 kg/m2); 23 patients met psychological distress criteria and were randomized into a treatment group (14 CBT vs 9 placebo). Ten patients were in the control group, with nine exceeding DRAM scores to be CBT candidates. At enrollment, the CBT group had greater EQ5D scores (CBT: 10.8, Placebo: 9.5, Control: 7.5, DRAM:8.7) while the Placebo group had greater PCS scores (Placebo: 33.1, CBT: 32.4, Control:18.6, DRAM: 30.8; all p<0.05). From BL to 1Y postop, the CBT patients improved in all psychological-related questionnaires (NDI: 29.2 to 2, PCS: 32.4 to 20.7, FABQ:41.3 to 32.3, mJOA: 2.3 to 3.4, DRAM:12.9 to 16.6). Placebo patients also improved post-operatively, but to a lesser degree in NDI (26.6 to 2), PCS (33.1 to 28.3), and worsened in FABQ (40.4 to 54.1), mJOA(12.5 to 11.8), and DRAM (36.6 to 31.6). In contrast, patients in the control group showed improvement to a much lesser degree than CBT and Placebo patients (NDI: 18.1 to 2, PCS:18.6 to 3.2, FABQ:26.2 to 17.6, mJOA: 15.3 to 16.4). DRAM patients showed minimal changes in psychological- and spine-related questionnaires. Comparing treatment groups at 1Y, CBT pts had significantly lower FABQ scores than Placebo pts (32.3 vs 54.1; p<0.05). CBT pts also had better DRAM scores than the control group at 1Y (30.3 vs 11.4; p=0.03).
CONCLUSION(S): Cognitive behavior treatment can be beneficial in patients undergoing cervical surgery as it was identified in our study to minimize fear avoidance beliefs more than the Placebo group. This type of professional treatment has also shown a steady improvement in all psychological questionnaires and spine related neck disability from baseline to 1-year postoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Spinal fusion is increasingly considered for management of patients with osteoporosis (OP) and degenerative disc disease (DDD). Little data is available regarding long-term outcomes in OP patients undergoing short-segment, lumbar fusion for DDD. PURPOSE: Analyze the impact of OP on long-term outcomes in patients who have had 2-3-level lumbar fusions for degenerative disc disease. STUDY DESIGN/SETTING: Retrospective review of the New York State Statewide Planning and Research Cooperative System (NYS SPARCS) database. PATIENT SAMPLE: Patients with DDD undergoing 2-3-level lumbar fusion. OUTCOME MEASURES: Frequency of 2-year medical and surgical complications and reoperations.
METHOD(S): Utilizing SPARCS, all patients from 2009-2011 with ICD-9 codes for DDD who underwent 2-3-level lumbar fusion were identified. Patients with bone mineralization disorders, systemic and endocrine disorders affecting bone quality were excluded. Surgical indications of trauma, systemic disease(s), and infection were excluded. Patients with and without OP were compared for demographics, hospital-related parameters, and 2-year complications and reoperations. Logistic regression models were utilized to identify predictors of complications.
RESULT(S): A total of 29,028 patients (OP=1,353 (4.7%), No-OP=27,675) were included. OP patients were older (66.9 vs 52.6 years) as well as more often female (85.1% vs 48.4%) and white (82.8% vs 73.5%), all p<0.001. Deyo index did not differ between groups. LOS and total charges were higher for OP patients (4.9 vs 4.1 days; $74,484 vs $73,724), all p<0.001. Medical complications were higher for OP patients: acute renal failure (8.9% vs 4.7%), and deep vein thromboses (3.4% vs 1.6%), all p<0.01. OP patients also had higher rates of implant-related (3.4% vs 1.9%) and wound complications (9.8% vs 5.9%) (p<0.01). Preoperative OP was associated with 2-year medical and surgical complications (OR=1.62, 1.66; p<0.001). Patients with OP had greater odds of reoperations (OR=1.34).
CONCLUSION(S): Patients with OP undergoing 2-3-level lumbar fusion for DDD were at higher risk of 2-year medical and surgical complications, and 3.4% of OP patients experienced implant-related complication. These findings highlight the importance of rigorous preoperative metabolic workup prior to spinal surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Proximal junctional failure (PJF) is a common and particularly adverse complication of adult spinal deformity (ASD) surgery. There is evidence that the rigidity of posterior spinal constructs may impact risk of PJF. PURPOSE: We hypothesized that lower mean screws per level and decreased rod stiffness would be associated with lower incidence of PJF. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients with ASD and 2-year minimum follow-up were included. Only patients undergoing fusion of >=5 levels, and with LIV at the sacro-pelvis were included. Patients undergoing revision surgery were excluded. In total, 420 patients were analyzed. OUTCOME MEASURES: The primary outcome variable was PJF, defined using previously published radiographic criteria (PJ angle >28degreeand PJ angle >22degree, and >=8mm/>=3mm listhesis at upper thoracic / thoracolumbar levels, respectively).
METHOD(S): The primary independent variables were the mean number of screws per level fused analyzed with a cutoff of 1.8 (determined by ROC analysis) and rod material/diameter. Multivariable logistic regression was utilized to investigate confounding factors, including age, history of osteoporosis, BMI, gender, CCI, preoperative Schwab modifiers, preoperative TPA, postoperative change in lumbar lordosis, upper instrumented vertebra, osteotomy, approach, UIV type (ie, pedicle screw vs other), and number of levels fused.
RESULT(S): Of the total patients, 78.8% were female. PJF occurred in 14.1% of patients. The mean screws per level was 1.7 (SD 0.2), and 57.6% of patients had <1.8 screws per level. PJF occurred in 19.4% vs 9.8% of patients with >=1.8 vs <1.8 screws per level, respectively (p<0.01). In multivariable analysis, patients with <1.8 screws per level exhibited lower odds of PJF (OR 0.39, p<0.01). Rod material and diameter (both p>0.2) were not significantly associated with PJF. Screw density specifically adjacent to the UIV was not related to PJF (p>0.2).
CONCLUSION(S): Among ASD patients undergoing long-segment primary fusion to the pelvis, the risk of PJF was lower among patients with <1.8 screws per level. Rod diameter and material, however, were not significantly associated with PJF. This finding may be related to construct rigidity. It is possible that residual confounding by other patient and surgeon-specific characteristics may exist. Further biomechanical and clinical studies exploring the relationship between screw density and PJK/PJF are warranted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Little is known of the impact of myelopathy severity in patients undergoing cervical deformity (CD) on postoperative patient-reported outcomes when stratified by baseline deformity severity. PURPOSE: To investigate the impact of myelopathy severity on outcomes and satisfaction post-operatively over baseline deformity severity. STUDY DESIGN/SETTING: Retrospective cohort study of a single-surgeon CD database PATIENT SAMPLE: A total of 128 CD Patients. OUTCOME MEASURES: HRQL Instruments: Neck Disability Index [NDI], Euro-Qol 5-Dimension questionnaire [EQ5D], meeting the Minimal Clinically Important Difference [MCID]; complications; reoperations METHODS: Included: surgical adult CD patients (C2-C7 Cobb>10degree, CL>10degree, cSVA >4cm, or CBVA>25degree) with baseline and 1-year HRQLs and radiographic follow-up. The modified Japanese Orthopaedic Association scale [mJOA] was utilized to assess baseline myelopathy severity (mJOA=18 was excluded). Moderate myelopathy: 12-17 mJOA scores at baseline; Severe myelopathy: <12 mJOA. Moderate deformity: <=25degree TS-CL at baseline; Severe deformity: >25degree. TS-CL. Groups assessed: (1) severe myelopathy/deformity, (2) severe myelopathy and moderate deformity, (3) moderate myelopathy/deformity, (4) moderate myelopathy and severe deformity. Groups 2 and 4 were compared as mismatched groups. Univariate analyses were performed with a statistical cut-off p<0.050 to determine whether myelopathy severity or deformity severity had a greater impact on patient-reported outcomes.
RESULT(S): A total of 128 CD patients were included (56.5+/-9.2 years, 46% female, 30.4+/-6.4kg/m2). The average Charlson Comorbidity Index (CCI) score was 0.56, 18% current smokers. Cohort surgical factors included, by approach, 27.9% anterior, 47.5% posterior and 24.6% combined (mean levels fused: 5). Mean total operative time was 588.5 minutes, with an EBL of 766.9ccs. Baseline mJOA score was 12.8+/-2.7, with a mean TS-CL of 25.9+/-16.1degree. 30.5% of patients had severe baseline myelopathy, 69.5% Moderate mJOA. By baseline deformity severity, 35.2% were Moderate TS-CL, while 64.8% Severe. By myelopathy/deformity groups: (1) 11.1%, (2) 21%, (3) 34.6%, (4) 33.3%. At baseline, NDI score was the greatest in Group 2 at 69.4 (1: 69.1, 3: 57.1, 4: 52.6, p = 0.011), whereas Group 4 had the lowest EQ5D scores (p<0.001). According to baseline neurologic exam factors were significantly greater in the groups with severe myelopathy (1 and 2, p<0.050). At one year, 55.6% of patients with severe myelopathy and severe deformity (Group 1) met MCID for NDI, while 6.9% of Group 2, 25% Group 3, and 55.6% Group 4, p= 0.002. Mismatch myelopathy/deformity analysis determined that a greater myelopathy over deformity (Group 2) had significantly worse patient reported outcomes compared to Group 4 in terms of 1-year NDI (2: 57 vs 4: 28.1; p=0.004), EQ5D(p=0.028), and NRS Neck (2:5.9, 4:3.6; p=0.046), as well as meeting MCID for NDI (2: 5.9%, 4: 55.6%; p=0.001).
CONCLUSION(S): Patients who present with moderate deformity and severe myelopathy have worse patient-reported outcomes compared to patients classified with severe deformity and moderate myelopathy. In moderate deformity, the myelopathy decompression and symptomatic alleviation plays more of a role, but, most importantly, in severe deformity, decompression is inadequate and realignment is necessary due to cord tension. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: AI algorithms have shown substantial promise in medical image analysis. Previous studies of ASD clusters have analyzed alignment metrics - this study sought to complement these efforts by analyzing images of anatomical landmarks. PURPOSE: We hypothesized that a neural-network-based artificial intelligence (AI) algorithm would cluster preoperative lateral radiographs of into groups with distinct morphology. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: A total of 915 patients with adult spinal deformity and preoperative lateral radiographs. OUTCOME MEASURES: Schwab modifiers for SVA and PI-LL, three-column osteotomy, upper instrumented vertebrae, baseline Oswestry Disability Index, and 2-year likelihood of reaching MCID in ODI (set at -12.8). Proximal junctional kyphosis and proximal junctional failure were defined using previously published radiographic criteria.
METHOD(S): Vertebral locations for C3-L5, sacral endplate, and femoral heads were measured on lateral radiographs. Pixel locations were used to create a black-and-white overlay to the image, which was subsequently standardized for size and position using the femoral heads and sacral endplate. These images were used to train a self-organizing map (SOM). SOMs are a form of artificial neural network frequently employed in unsupervised classification tasks.
RESULT(S): In total, 915 preoperative lateral radiographs were analyzed. A 2 x 3, toroidal SOM was trained. The mean spine shape was plotted for each cluster. Alignment, surgical characteristics, and outcomes were compared between clusters. Clusters C and D exhibited a particularly high proportion of patients with optimal (ie, modifier 0) values of PI-LL (65.0% and 68.5%) and SVA (72.8% and 53.1%). Conversely, clusters B, E, and F tended to have poor (ie, modifier ++) PI-LL (74.8%, 66.9%, and 74.6%) and SVA (75.5%, 48.6%, and 58.7%). 3-CO was most common among cluster A (26.8%), cluster B (32.6%), and cluster F (32.7%). UIV at T7-T12 was most common among cluster B (51.1%) and cluster F (60.3%). ODI <30 was most prevalent among cluster D (31.4%). There was little difference, however, between groups in likelihood of reaching MCID in ODI at 2-year follow-up. PJK and PJF were particularly prevalent among clusters A (51.2% and 15.5%) and E (50.4% and 18.7%).
CONCLUSION(S): This study developed a self-organizing map that clustered preoperative lateral radiographs of ASD patients into groups with highly distinct overall spinal morphology. These clusters predicted alignment, surgical characteristics, and HRQOL. Further studies of this classification approach will expand to compare pre- and postoperative radiographs. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Surgical intervention of the cervical spine is a challenging procedure that can present postoperative complications such as dysphagia, swelling, and reoperations. However, the risk of reoperation can possibly be mitigated with the use of biologics to enhance fusion. There is paucity in the literature on long-term incidence of reoperations after application of BMP during ACDF. PURPOSE: To evaluate if bone morphogenetic protein usage during anterior cervical discectomy and fusion will decrease reoperation rates. STUDY DESIGN/SETTING: Retrospective review of the PearlDiver database between 2006-2014. PATIENT SAMPLE: Matched cohort of 35,544 ACDF patients. OUTCOME MEASURES: Reoperations.
METHOD(S): Patients undergoing an anterior cervical discectomy and fusion between the years 2006-2014 were isolated in the PearlDiver database. Patients receiving BMP operatively and a control with no BMP were matched for baseline demographics including age, sex, and comorbidities. A Kaplan Meier Survival analysis assessed five-Year Reoperation-Free Survival between BMP patients and controls. Statistical significance was set to p<0.05.
RESULT(S): A matched cohort of 35,544 ACDF patients was isolated. A total of 17,772 patients received BMP while undergoing cervical fusion and 17,772 did not receive any BMP during surgery. Patients did not differ in age, sex or comorbidities (p>0.05). Kaplan Meier survival analysis showed patients receiving BMP during cervical fusion were significantly more likely to remain reoperation free five years after index surgery (p<0.05). Overall, 91.3% of BMP patients remained reoperation free at five years.
CONCLUSION(S): For patients receiving bone morphogenetic protein during anterior cervical discectomy and fusion, Kaplan-Meier survival analysis following five years post index surgery had showed a 91.3% reoperation-free survivorship. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: For patients with coronary artery disease, the two most common options for intervention are a cardiac stent or a coronary artery bypass graft. Although less invasive, stents may pose a long-term risk for patients undergoing further invasive procedures such as elective spine surgery. This study aimed to provide surgeons with insight on possible major complications for elective spine surgery patients with a history of coronary artery disease. PURPOSE: Investigate outcomes of elective spine fusion patients with prior history of cardiac intervention STUDY DESIGN/SETTING: Retrospective review of the PearlDiver database between the years 2006-2013 PATIENT SAMPLE: A total of 731,173 elective spine fusion patients OUTCOME MEASURES: Comorbidity burden, 30-day and 90-day complications, readmission METHODS: Elective spine fusion patients were isolated with ICD-9 and CPT procedures codes in the PearlDiver database. Patients were stratified by having previous history of a coronary stent (Stent), coronary artery bypass graft (CABG), and no previous heart procedure (No-HP). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, and comorbidities. Logistic regression assessed the odds of 30-day and 90-day postoperative (postop) complications associated with each heart procedure (Odds Ratio [95% confidence interval]). Statistical significance was set p<0.05.
RESULT(S): A total of 731,173 elective spine fusion patients were included. Overall, 8,401 pts underwent a CABG, 24,037 patients Stent, and 698,735 had No-HP prior to spine fusion surgery. Compared to Stent and No-HP patients, CABG patients had higher rates of morbid obesity, chronic kidney disease and diabetes (p<0.001 for all). Stent patients had higher rates of peripheral vascular disease, hypertension, and hyperlipidemia (all p<0.001). Within 30 days postoperatively of index surgery, CABG patients had significantly higher complication rates including pneumonia, cerebrovascular accident (CVA), myocardial infarction (MI), sepsis, and death compared to No-HP (all p<0.001). Stent patients vs No-HF also had higher 30-day postoperative complication rates including pneumonia, CVA, MI, sepsis, and death. Adjusting for age, comorbidities and sex, Stent was significantly predictive of a MI 30-days post-op (OR: 1.90 [1.53-2.34], P<0.001). Additionally, Stent patients compared to CABG patients had 1.99x greater odds of a MI within 30-days (OR: 1.99 [1.26-3.31], p=0.005) and 2.02x greater odds of readmission within 90-days postop (OR: 2.2 [1.53-2.71, p<0.001).
CONCLUSION(S): With regards to spine surgery, coronary artery bypass graft remains the gold standard for risk reduction. Stenting does not appear to minimize risk as significantly as CABG. When assessing patients with a history of coronary artery disease for elective spine fusion surgery, surgeons should be cautious of the significant risk of major complications associated with stents compared to coronary artery bypass grafting. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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