Faculty Bibliography

BACKGROUND:Incentive spirometers (IS) are commonly prescribed after various surgical procedures with the intended effect of reducing postoperative pulmonary complications. Factors associated with correct use of IS by postoperative patients has not previously been studied. METHODS:A cross-sectional analysis of postoperative patients was completed to assess whether patients knew how to correctly inhale on their IS. For each patient, the following variables were collected: whether the device was within arm's reach of the patient, if the patient reported having used their IS, if they considered the IS to be helpful, and if they felt more confident using IS after a brief educational intervention was performed by study investigators. RESULTS:A total of 26.2% (11/42) of patients failed to use their IS correctly, and 38.1% (16/42) denied ever using the device in their postoperative care. Device location, perceived benefit, and previous use were identified as statistically significant determinants of successful use. Following a brief educational intervention by a physician, 73.8% (31/42) of patients were more confident in their ability to use IS during the remainder of their care. DISCUSSION/CONCLUSIONS:A substantial portion of postoperative patients failed to correctly utilize their IS. Device proximity to the patient, patient perspectives on potential benefits of IS, and previous use of the device may affect correct use. Patient education and optimization of device placement should be considered to increase compliance during IS implementation.

Lumbar disc herniation is a prevalent condition in the general population that can cause disabling symptoms. The treatment of lumbar disc herniation, like many conditions of the spine, has come under increased scrutiny in this era of value-based health care delivery. In response, there has been an increase in cost-effectiveness research in this area. Studies have demonstrated that surgery is cost-effective for the treatment of symptomatic lumbar disc herniation using a traditional open approach. Such research is limited for specific conservative treatment options as well as alternative surgical approaches to treating this condition, such as the minimally invasive approach.

In this current area of value-based health care, it is important to consider both the effectiveness and the cost of an intervention. Anterior cervical discectomy and fusion (ACDF) has long been considered as an effective treatment option for patients with symptomatic cervical spondylosis and/or disc herniation that is refractory to conservative treatment. Other treatment options, such as posterior decompression and cervical disc replacement (CDR), are also effective for certain types of pathology. More recent studies have looked at the cost-effectiveness of these interventions.

STUDY DESIGN/METHODS:Retrospective case series. OBJECTIVE:The objectives of this study were to (1) determine the rate of postoperative urinary retention (POUR) in a series of patients undergoing lumbar spine surgery, (2) compare length of hospital stay between patients who developed POUR and patients who did not, and (3) identify the patient and surgical factors associated with the development of POUR. SUMMARY OF BACKGROUND DATA/BACKGROUND:Although POUR is a common complication in many surgical subspecialties, sparse literature is present regarding development of POUR after posterior lumbar surgical procedures. METHODS:A retrospective review was conducted of all posterior lumbar surgery cases performed at single institute from July 2008 to July 2012. Data collected included demographic variables (age, sex, body mass index), length of stay, comorbid medical conditions, and surgical data. The Wilcoxon rank sum test with continuity correction was used to compare length of hospital stay between patients who developed POUR and patients who did not. A multivariate logistic regression model was created using all patient and surgical factors and systematically pruned of variables not improving overall predictive power. RESULTS:A total of 647 patients (291 decompression, 356 decompression and fusion) were included in the study. Of 647 patients, 36 had urinary retention after lumbar spine surgery (5.6%). Patients who developed POUR had a longer length of stay than patients who did not develop POUR (3.94 d vs. 2.34 d; P=0.005). Male sex, benign prostatic hyperplasia, age, diabetes, and depression were significantly associated with development of POUR (odds ratio=3.05, 9.82, 1.04, 3.32, and 2.51, respectively). Smoking was inversely associated with the development of POUR (odds ratio=0.45). CONCLUSION/CONCLUSIONS:The risk of developing POUR after posterior lumbar spine surgery is approximately 5%. Male sex, benign prostatic hyperplasia, age, diabetes, and depression were significantly associated with the POUR group. Patients who developed POUR had a greater length of hospital stay. LEVEL OF EVIDENCE/METHODS:4.