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Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion

Walia, Arnaav; Ani, Fares; Maglaras, Constance; Raman, Tina; Fischer, Charla
STUDY DESIGN/METHODS:Retrospective analysis. OBJECTIVES/OBJECTIVE:To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS:< .05. RESULTS:116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS:Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
PMID: 38315111
ISSN: 2192-5682
CID: 5632722

Reoperation Rates Due to Adjacent Segment Disease Following Primary 1 to 2-Level Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

Galetta, Matthew S; Lorentz, Nathan A; Lan, Rae; Chan, Calvin; Zabat, Michelle A; Raman, Tina; Protopsaltis, Themistocles S; Fischer, Charla R
STUDY DESIGN/METHODS:Retrospective analysis of prospectively collected data. OBJECTIVE:To investigate the effect of the approach of the transforaminal lumbar interbody fusion [TLIF; open vs . minimally invasive (MIS)] on reoperation rates due to ASD at 2 to 4-year follow-up. SUMMARY OF BACKGROUND DATA/BACKGROUND:Adjacent segment degeneration is a complication of lumbar fusion surgery, which may progress to adjacent segment disease (ASD) and cause debilitating postoperative pain potentially requiring additional operative management for relief. MIS TLIF surgery has been introduced to minimize this complication but the impact on ASD incidence is unclear. MATERIALS AND METHODS/METHODS:For a cohort of patients undergoing 1 or 2-level primary TLIF between 2013 and 2019, patient demographics and follow-up outcomes were collected and compared among patients who underwent open versus MIS TLIF using the Mann-Whitney U test, Fischer exact test, and binary logistic regression. RESULTS:Two hundred thirty-eight patients met the inclusion criteria. There was a significant difference in revision rates due to ASD between MIS and open TLIFs at 2 (5.8% vs . 15.4%, P =0.021) and 3 (8% vs . 23.2%, P =0.03) year follow-up, with open TLIFs demonstrating significantly higher revision rates. The surgical approach was the only independent predictor of reoperation rates at both 2 and 3-year follow-ups (2 yr, P =0.009; 3 yr, P =0.011). CONCLUSIONS:Open TLIF was found to have a significantly higher rate of reoperation due to ASD compared with the MIS approach. In addition, the surgical approach (MIS vs . open) seems to be an independent predictor of reoperation rates.
PMID: 36972142
ISSN: 1528-1159
CID: 5606732

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

Post-Operative Physical Therapy Following Cervical Spine Surgery: Analysis of Patient-Reported Outcomes

Lorentz, Nathan A; Galetta, Matthew S; Zabat, Michelle A; Raman, Tina; Protopsaltis, Themistocles S; Fischer, Charla
Introduction Post-operative physical therapy (PT) following anterior cervical discectomy and fusion (ACDF) surgery is often performed to improve a patient's functional ability and reduce neck pain. However, current literature evaluating the benefits of post-operative PT using patient-reported outcomes (PROs) is limited and remains inconclusive. Here we compare post-operative improvement between patients who did and did not undergo formal PT after ACDF using Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Methods A retrospective observational study examining patients who underwent one- or two-level primary ACDF or cervical disc replacement (CDR) at an academic orthopedic hospital and who had PROMIS scores recorded pre-operatively and through two-year follow-up. Patients were stratified according to whether or not they attended formal postoperative PT. PROMIS scores and patient demographics were compared using the Mann-Whitney U test, Fisher's exact test, chi-square test of independence, and Student's t-test within and between cohorts. Results Two hundred and twenty patients were identified. Demographic differences between PT and no PT groups include age (PT 54.1 vs. no PT 49.5, p=0.005) and BMI (PT 28.1 vs. no PT 29.8, p=0.028). The only significant difference in post-operative PROMIS scores was in physical health scores at three months post-operatively (no PT 43.9 vs. PT 39.1, p=0.008). Physical health scores improved from baseline to one-year follow-up in both cohorts (PT +3.5, p=0.025; no PT +6.6, p=0.008). There were no significant differences when comparing improvements in physical health scores between groups at six months and one year. Conclusion In conclusion, there was no significance to support the benefits of post-operative PT as measured by PROMIS scores. No significant differences in PROMIS were observed between groups from pre-operative baseline scores to six-month and one-year follow-ups.
PMID: 37465791
ISSN: 2168-8184
CID: 5535722

The Effect of Inpatient Step Count on Complications in the Elderly Patient after Adult Spinal Deformity Surgery

Ani, Fares; Bono, Juliana; Walia, Arnaav; van Perrier, Gregory; O"™Connell, Brooke; Maglaras, Constance; Protopsaltis, Themistocles S.; Raman, Tina
Background: The number of elderly patients undergoing adult spinal deformity (ASD) surgery has increased with the advent of new techniques and more nuanced understanding of global malalignment as patients age. The relationship between inpatient physical activity after ASD surgery and postoperative complications in elderly patients has not been reported; thus, we sought to investigate this relationship. Methods: We performed a medical record review of 185 ASD patients older than 65 years (age: 71.5 ± 4.7; body mass index: 30.0 ± 6.1, American Society of Anesthesiologists: 2.7 ± 0.5, and levels fused: 10.5 ± 3.4). We derived the number of feet walked over the first 3 days after surgery from physical therapy documentation and evaluated for association with 90-day perioperative complications. Patients who sustained an incidental durotomy were excluded from the study. Results: The 185 patients were divided into groups based on whether they were among the 50th percentile for number of feet walked (62 ft). Walking less than 62 ft after ASD surgery was associated with higher incidence of postoperative complications (54.3%, P = 0.05), cardiac complications (34.8%, P = 0.03), pulmonary complications (21.7%, P = 0.01), and ileus (15.2%, P = 0.03). Patients who developed any postoperative complication (106 ± 172 vs 211 ± 279 ft, P = 0.001), ileus (26 ± 49 vs 174 ± 248 ft, P = 0.001), deep venous thrombosis (23 ± 30 vs 171 ± 247 ft, P = 0.001), and cardiac complications (58 ± 94 vs 192 ± 261 ft) walked less than patients who did not. Conclusion: Elderly patients who walked less than 62 ft in the first 3 days after ASD surgery have a higher rate of postoperative complications, specifically pulmonary and ileus compared with those patients who walked more. Steps walked after ASD surgery may be a helpful and practical addition to the surgeon"™s armamentarium for monitoring the recovery of their patients. Clinical Relevence: Monitoring the steps walked by patients after ASD surgery can be a practical and useful tool for surgeons to track and improve their patients"™ recovery.
ISSN: 2211-4599
CID: 5500582

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

Predictors of Complication Severity Following Adult Spinal Deformity Surgery: Smoking Rate, Diabetes, and Osteotomy Increase Risk of Severe Adverse Events

Bortz, Cole A.; Pierce, Katherine E.; Krol, Oscar; Kummer, Nicholas; Passfall, Lara; Egers, Max; Oh, Cheongeun; Horn, Samantha R.; Segreto, Frank A.; Vasquez-Montes, Dennis; Frangella, Nicholas J.; Buza, John A.; Raman, Tina; Kuprys, Tomas; Lafage, Renaud; Jankowski, Pawel P.; Hassanzadeh, Hamid; Vira, Shaleen N.; Diebo, Bassel G.; Gerling, Michael C.; Passias, Peter G.
Background: Given the physical and economic burden of complications in spine surgery, reducing the prevalence of perioperative adverse events is a primary concern of both patients and health care professionals. This study aims to identify specific perioperative factors predictive of developing varying grades of postoperative complications in adult spinal deformity (ASD) patients, as assessed by the Clavien-Dindo complication classification (Cc) system. Methods: Surgical ASD patients ≥18 years were identified in the American College of Surgeons"™ National Surgical Quality Improvement Program from 2005 to 2015. Postoperative complications were stratified by Cc grade severity: minor (I, II, and III) and severe (IV and V). Stepwise regression models generated dataset-specific predictive models for Cc groups. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the model. Significance was set at P < 0.05. Results: Included were 3936 patients (59 ± 16 years, 63% women, 29 ± 7 kg/m2) undergoing surgery for ASD (4.4 ± 4.7 levels, 71% posterior approach, 11% anterior, and 18% combined). Overall, 1% of cases were revisions, 39% of procedures involved decompression, 27% osteotomy, and 15% iliac fixation. Additionally, 66% of patients experienced at least 1 complication, 0% of which were Cc grade I, 51% II, 5% III, 43% IV, and 1% V. The final model predicting severe Cc (IV"“V) complications yielded an AUC of 75.6% and included male sex, diabetes, increased operative time, central nervous system tumor, osteotomy, cigarette pack-years, anterior decompression, and anterior lumbar interbody fusion. Final models predicting specific Cc grades were created. Conclusions: Specific predictors of adverse events following ASD-corrective surgery varied for complications of different severities. Multivariate modeling showed smoking rate, osteotomy, diabetes, anterior lumbar interbody fusion, and higher operative time, among other factors, as predictive of severe complications, as classified by the Clavien-Dindo Cc system. These factors can help in the identification of high-risk patients and, consequently, improve preoperative patient counseling. Clinical Relevance: The findings of this study provide a foundation for identifying ASD patients at high risk of postoperative complications .
ISSN: 2211-4599
CID: 5460082

P37. Postoperative hematocrit predicts postoperative complications in diabetic patients undergoing spinal deformity surgery [Meeting Abstract]

O'Malley, N; Maglaras, C; Burapachaisri, A; Protopsaltis, T S; Raman, T
BACKGROUND CONTEXT: Previous orthopedic literature has shown that patients with diabetes mellitus (DM) are more likely to develop complications in the postoperative period. To date, however, no study has assessed the specific pre- and postoperative risk factors that may contribute to this association for diabetic patients undergoing adult spinal deformity surgery. PURPOSE: Establish relevant risk factors for postoperative complications in a cohort of diabetic patients undergoing spinal deformity surgery. STUDY DESIGN/SETTING: Single-center retrospective cohort study. PATIENT SAMPLE: A total of 138 patients with DM who underwent spinal deformity surgery at a single academic hospital from 2012-2019. OUTCOME MEASURES: Primary outcomes were the development of any post-operative complications. These complications included the development of neurologic complications, urinary complications, cardiac complications, pulmonary complications, venous thromboembolism (VTE) and surgical site infections (SSI).
METHOD(S): This study is a retrospective cohort review of diabetic patients undergoing spinal deformity surgery, with 5 levels fused at a single academic medical center. Patients' age, BMI, levels fused, pre- and postoperative hemoglobin (Hgb), hematocrit (HCT) and preoperative HbA1C were collected. T-test and chi-square analyses were used to compare relevant outcomes. Significance was set to p<0.05.
RESULT(S): A total of 138 patients with DM met the inclusion criteria and were included in the analysis. Of these, 50.7% of the total cohort developed a postoperative complication within 90 days of the index surgery. Patients who developed postoperative complications were noted to have significantly lower postoperative Hgb (9.82+/-1.46 g/dL vs 10.72+/-1.76 g/dL, p=0.002) postoperative HCT (28.8+/-3.92% vs 32.60+/-4.61%, p<0.001) and significantly greater number of levels fused (9.49+/-3.74 vs 7.47+/-3.16, p=0.001). Diabetic patients who developed cardiac complications had significantly lower postoperative Hgb (9.47+/-1.50 g/dL vs 10.40+/-1.66 g/dL, p=0.021) and HCT (27.87+/-3.16% vs 31.15+/-4.72%, p=0.003) compared with those who did not. Diabetic patients who developed urinary complications were noted to be older on average (72.56+/-8.20 vs 64.43+/-11.70 years, p=0.043), while patients who developed VTE and pulmonary complications were noted to have significantly higher numbers of levels fused (VTE: 14.00+/-3.61 vs 8.37+/-3.51, p=0.007; PC: 10.82+/-4.14 vs 8.29+/-3.49, p=0.025)Finally, diabetic patients who developed a surgical site infection had significantly lower postoperative HCT (26.74+/-3.27% vs 30.86+/-4.64%, p=0.022) than those who did not. Multivariate logistic regression analysis showed that postoperative HCT (OR: 0.765 [0.613-1.098], p=0.001) and number of levels fused (OR: 1.243 [1.084-1.425], p=0.002) were predictive of development of any postoperative complication, when controlled for BMI, age, and and postoperative Hgb. Postoperative HCT was an independent predictor of the development of cardiac complications (OR: 0.827 [0.692-0.989], p=0.037) and SSI (OR: 0.709 [0.528-0.952], p=0.022).
CONCLUSION(S): Postoperative HCT is predictive of the development of postoperative complications in general, and more specifically the development of cardiac complications and surgical site infections. Along with blood-glucose and HbA1C, it should be closely monitored perioperatively in diabetic patients undergoing spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
ISSN: 1878-1632
CID: 5510242

108. Mass effect: BMI predicts postoperative infection in diabetic spine fusion patients [Meeting Abstract]

O'Malley, N; Maglaras, C; Raman, T
BACKGROUND CONTEXT: Diabetic patients with elevated hemoglobin A1C (HbA1C) are at higher risk of developing complications after surgery than their nondiabetic peers. This is especially true of wound complications, including wound infections. Previous research has shown this relationship to be multifactorial, so more investigation is needed into these complications. PURPOSE: Establish pertinent factors which contribute to increased wound complication incidence among diabetic patients undergoing thoracolumbar fusion. STUDY DESIGN/SETTING: Single center retrospective cohort study. PATIENT SAMPLE: This study included 228 patients with a diagnosis of diabetes mellitus who underwent thoracic, lumbar, or thoracolumbar posterior spinal fusion (PSF) from 2013-2018 with preoperative HbA1C values. Patients without preoperative HbA1C results or undergoing cervical fusions were excluded. OUTCOME MEASURES: Development of wound complications and infection in the perioperative period were recorded for analysis. Wound complications were defined as dehiscence, superficial SSI and deep SSI.
METHOD(S): Significant perioperative complications were determined using t-test and chi-square analyses. Complications were tested against confounding factors using binary logistic regressions. Efficacy of various preoperative demographic measures as markers for complication was determined using Receiver Operating Characteristic (ROC) analyses. Cutoff points were calculated by Youden's index. Significance set at p <0.05.
RESULT(S): A total of 228 patients met inclusion. Significant differences in BMI were noted between patients who developed infection (n=7) and those who did not (37.5 kg/m2 vs 32.0 kg/m2; p=0.039). In addition, binary logistic regression showed that, controlled for HbA1C, BMI was a significant predictor of infection (OR: 1.110; p=0.043). ROC curve demonstrated an AUC of 0.754 (p=0.022) and Youden's J calculated the cutoff point to be 34.08 kg/m2 (Spec: 64.3%, Sens: 85.7%). No differences between those with postop wound complications were noted in HbA1C (7.29 vs 6.88; p=0.345), age (70.14 vs 64.92; p=0.197), gender (vs 71.4% female vs 55.5% female; p=0.469), smoking status (28.6% smoking history vs 33.9% smoking history), levels fused (2.71 vs 2.62; p=0.931), LOS (3.29 vs 4.82; p=0.243). Sub-analysis of superficial infections revealed no significant differences in HbA1C (7.15 vs 6.88; p=0.565), age (70.8 vs 64.9; p=0.175), BMI (36.5 vs 32.1; p=0.114), levels fused (2.5 vs 2.6; p=0.911), gender (66.7% female vs 55.4% female; p=0.697), smoking status (33.3% smoking history vs 33.7% smoking history; p=1.000), or LOS (2.8 vs 4.8; p=0.159). Subanalysis of deep SSI revealed only one infection.
CONCLUSION(S): BMI above 34.08 kg/m2 is a significant predictor of postoperative infection in diabetic patients undergoing posterior fusion. To ensure optimal outcomes, diabetic patients should be encouraged to get below this threshold before surgery. More research must be done to further establish the relationship of BMI with regard to superficial and deep infections. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
ISSN: 1878-1632
CID: 5510382