Faculty Bibliography

BACKGROUND CONTEXT/BACKGROUND:Postoperative ileus is a known complication of surgery. The incidence and risk factors for ileus after lumbar fusion surgery is not well characterized. PURPOSE/OBJECTIVE:To determine rates of postoperative ileus, a population-based database was analyzed to identify incidence, mortality, and risk factors associated with anterior (ALF), posterior (PLF), and combined anterior/posterior (APLF) lumbar fusions. STUDY DESIGN/METHODS:This was a retrospective database analysis. PATIENT SAMPLE/METHODS:The sample consisted of 220,522 patients from the Nationwide Inpatient Sample (NIS) database. OUTCOME MEASURES/METHODS:Outcome measures were incidence of postoperative ileus, length of stay (LOS), in-hospital costs, and mortality. METHODS:Data from the NIS were obtained from 2002 to 2009. Patients undergoing ALF, PLF, and APLF for degenerative pathologies were identified and the incidence of postoperative ileus was assessed. Patient demographics, Charlson comorbidity index (CCI), LOS, costs, and mortality were assessed. SPSS v.20 was used to detect statistical differences between groups and perform logistic regression analyses to identify independent predictors of postoperative ileus. A p value less than .001 denoted significance. RESULTS:A total of 220,522 lumbar fusions were identified in the United States from 2002 to 2009. There were 19,762 ALFs, 182,801 PLFs, and 17,959 APLFs. The incidence of postoperative ileus was increased in ALFs over PLFs (74.9 vs. 26.0 per 1,000; p<.001). Within PLF and APLF groups, CCI scores were increased in the presence of postoperative ileus (p<.001). Across cohorts, patients with postoperative ileus demonstrated greater LOS and costs (p<.001). PLF-treated patients with postoperative ileus demonstrated increased mortality (p<.001). Independent predictors of postoperative ileus included male gender, 3+ fusion levels, alcohol abuse, anemia, fluid/electrolyte disorders, and weight loss (p<.001). CONCLUSIONS:The results of our study demonstrate increased incidence of postoperative ileus associated with anterior approaches for lumbar fusion. Across cohorts, postoperative ileus was associated with increased LOS and costs. To determine the mortality and resource use associated with postoperative ileus, we recommend preoperatively identifying and treating modifiable risk factors, especially when an anterior approach is used.

STUDY DESIGN/METHODS:Retrospective cohort. OBJECTIVE:A national population-based database was queried to investigate the incidence of sentinel events in cervical spine surgery as well as the associated perioperative outcomes. SUMMARY OF BACKGROUND DATA/BACKGROUND:Sentinel events in cervical spine surgery are potentially catastrophic complications. The incidence and perioperative outcomes associated with sentinel events in cervical spine surgery have not been well characterized. METHODS:The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients who underwent elective cervical spinal surgery were identified. Sentinel events including esophageal perforation, vascular injury, nerve injury, retention of foreign objects, and wrong-site surgery were identified. Patient demographics, comorbidities (Charlson Comorbidity Index), surgical procedures, length of stay, total hospital costs, and postoperative outcomes were assessed. The risk for in-hospital mortality associated with each complication was calculated using a 95% confidence interval (CI). Statistical analysis was performed with SPSS version 20, and a P ≤ 0.001 denoted significance. RESULTS:A total of 251,318 cervical spine procedures were identified between 2002 and 2011, of which 123 patients (0.5 per 1000 cases) incurred sentinel events. Circumferential cervical fusion (anterior-posterior cervical fusion) demonstrated an increased risk of vascular injury (odds ratio [OR], 4.5; CI, 1.8-11.2), whereas cervical total disc replacement was associated with an increased risk of esophageal perforation (OR, 10.9; CI, 1.4-85.2) and nerve injury (OR, 36.4; CI, 1.5-892.3). Posterior cervical fusions were associated with an increased risk of wrong-site surgery (OR, 3.9; CI, 1.5-10.5). The sentinel event cohort incurred longer hospitalization, greater costs, mortality, and greater incidence of postoperative complications. CONCLUSION/CONCLUSIONS:This database analysis demonstrates that sentinel events are associated with a significant increase in hospital resource utilization and worsened perioperative outcomes. The type of cervical spine procedure and the number of fusion levels significantly impact the risk of sentinel events. Further research is warranted to understand the etiology of sentinel events in cervical spine surgery and to implement protocols to mitigate the associated risk factors. LEVEL OF EVIDENCE/METHODS:4.