Publications (15) View all
-
Article: The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND CONTEXT: To our knowledge, the effect of the staging regimen on the surgical outcome in patients undergoing combined anterior/posterior surgery for the treatment of spinal deformity has not been previously studied. PURPOSE: To compare outcomes of anterior/posterior surgery for adult spinal deformity staged less than 21 days apart versus those 21 or more days apart. STUDY DESIGN: A retrospective comparison study. PATIENT SAMPLE: Patients aged 40 years or older who underwent combined anterior/posterior fusions for spinal deformities. OUTCOME MEASURES: Self-reported measures, physiological measures, and functional measures. METHODS: We retrospectively reviewed prospectively collected data for 63 consecutive patients (50 females and 13 males) older than 40 years who underwent combined anterior/posterior fusions for spinal deformities and who had a minimum of 2-year follow-up. We divided them into those who had surgery staged less than 21 days apart (Group 1, N=29) and those who had surgery staged 21 or more days apart (Group 2, N=34). The groups were not statistically different in age; preoperative American Society of Anesthesiologists, Scoliosis Research Society-22 (SRS-22) patient questionnaire, and Oswestry Disability Index (ODI) scores; number of previous surgeries; number of levels fused; or total operative time. Hotelling t square test and the chi-squared test were used to compare clinical and radiographic parameters, complications, and functional outcomes between groups (significance, p<.05). RESULTS: Compared with Group 1 patients, Group 2 (staged) patients had a lower total estimated blood loss (average, 4.5 L [range, 1.90-8.75 L] vs. 4 L [range, 1.8-10.1 L], respectively), fewer combined hospital days (average, 14 days [range, 7-70 days] vs. 12 days [range, 6-44 days], respectively), and fewer major complications (total, 10 [35%] vs. 6 [18%], respectively). Preoperative SRS-22 and ODI scores were significantly better in Group 2 than in Group 1 at 6 weeks (p<.001) and at final follow-up (p<.001), respectively. CONCLUSION: For patients who require both anterior and posterior surgery for spinal deformity correction, staging the two procedures 21 or more days apart decreases total perioperative transfusion requirements although significantly improving functional outcomes.The spine journal: official journal of the North American Spine Society 04/2013; · 2.90 Impact Factor -
Article: Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.
[show abstract] [hide abstract]
ABSTRACT: Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case cohort analysis of all adult patients who underwent surgery for kyphosis or scoliosis, between June 1996 and December 2005, by our adult spine division in an academic institution to asses the incidence and identify risk factors for SSI. We reviewed the electronic patient records of 830 adult patients. SSI was classified as deep or superficial to the fascia. 46 (5.5%) patients were found to have a SSI with 29 patients (3.5%) having deep infections. Obesity was found to be an independent risk factor for all SSI and superficial SSI (P = 0.014 and P = 0.013). As well, a history of prior SSI was also found to be a risk factor for SSI (P = 0.041). Patient obesity and history of prior SSI lead to increased risk of infection. Since obesity was related to an increased risk of both superficial and deep SSI, counseling and treatment for obesity should be considered before elective deformity surgery.European Spine Journal 06/2010; 19(6):982-8. · 1.97 Impact Factor -
Article: Surgical site infection after osteotomy of the adult spine: does type of osteotomy matter?
[show abstract] [hide abstract]
ABSTRACT: Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other spinal surgeries. Both of these factors have previously been identified as significant risk factors for SSI. We performed a cohort study of this high-risk population to identify risk factors and rates of SSI after spinal osteotomy surgery and identify difference in risk between different types of osteotomies. The objective of the study was to assess the incidence and identify significant risk factors for surgical site infection (SSI) after spinal osteotomy. Retrospective review of all adult patients who underwent spinal osteotomy surgery for deformity by an orthopedic surgeon in our university. All electronic records of adult orthopedic patients whom underwent a spinal osteotomy procedure at our department between January 1998 and December 2005 (n=363) were abstracted. During surgery, a pedicle subtraction osteotomy (transpedicular wedge resection), anterior spine osteotomy (resection of anterior and middle columns), posterior Smith-Petersen osteotomy (resection of a portion of the superior and inferior lamina, ligamentum flavum, and the inferior and superior articular processed), or a combined anterior and posterior osteotomy (vertebral column resection [VCR]) (circumferential resection of the vertebrae via either a combined anterior/posterior or posterior-only approach) was performed. Primary outcome measurement was SSI. Subanalysis to deep and superficial SSI was performed. Twenty patients (5.5%) were found to have an SSI, with nine (2.5%) having deep SSI. Analysis showed that patients undergoing VCR (p=.042) had a significant increased risk for deep SSI (11.1%). Obese patients had a significant increased risk (p=.045) for superficial SSI. Vertebral column resection has a significant increased risk for SSI (11.1%) compared with other types of osteotomies (4.1%). When possible, osteotomy techniques that involve less extensive exposures and soft-tissue dissection should be chosen to minimize deep SSI risk. Obese patients should be counseled on weight loss to try minimizing superficial SSI risk.The spine journal: official journal of the North American Spine Society 05/2010; 10(5):410-6. · 2.90 Impact Factor -
Article: The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery.
[show abstract] [hide abstract]
ABSTRACT: Descriptive, retrospective cohort analysis. To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery. SSI after spine surgery is frequently seen. Small case control studies have been published reporting the results of treatment options of SSI. We performed this study to identify the most common clinical and laboratory presentation of a SSI, the most frequently seen infective organism, and evaluate the effectiveness of current treatment. All patients who underwent spinal surgery at our institution for diagnosis other than infection between June 1996 and December 2005 (N=3174) were reviewed. All cases of SSI were identified. Patient and operative characteristics were reviewed. Infection type (deep or superficial), treatment course, laboratory and culture results were abstracted. A total of 132 cases of SSI (84 deep and 48 superficial) were identified. About 72.7% of the SSI were detected as outpatients an average 28.7 days (deep, 29.9; superficial, 25.2) after the index procedure. Wound drainage was the most common complaint (68.2%). C-reactive protein level was elevated in 98.0%, erythrocyte sedimentation rate was elevated in 94.4%, but only 48.6% had elevated white blood cell count. Staphylococcus aureus was isolated in 72.6% of deep and 85.7% of superficial positive cultures. Seventy-six percent of deep SSI could be treated with a single debridement to clear the SSI. Instrumentation was retained or primarily exchanged if loose in all cases. Around 72.9% of superficial SSI were treated without formal debridement in the operating room. Antibiotic treatment was longer in deep SSI (40.8 vs. 19.6 days). Deep SSI following spinal surgery was effectively treated with single stage debridement and intravenous antibiotics. Superficial SSI could be treated effectively with local wound care and oral antibiotic therapy.Spine 02/2010; 35(13):1323-8. · 2.08 Impact Factor -
Article: Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery.
[show abstract] [hide abstract]
ABSTRACT: : Randomized, placebo-controlled trial. : To evaluate the efficacy of epsilon aminocaproic acid (EACA) to reduce the number of red-cell (RBC) transfusions in adult patients undergoing major spinal surgery. : Reconstructive spinal surgery is associated with significant blood loss. The number of studies evaluating the efficacy of EACA in adult patients undergoing spinal surgery remains scarce and limited. : EACA (100 mg/kg) or placebo was administered to 182 adult patients after the induction of anesthesia followed by an infusion that was continued for 8 hours after surgery. Primary end points included total allogeneic RBC transfusions through postoperative day 8 and postoperative allogeneic plus autologus RBC transfusions through postoperative day 8. : Mean total allogeneic RBC transfusions were not statistically different between the groups (5.9 units EACA vs. 6.9 units placebo; P = 0.17). Mean postoperative RBC transfusions in the EACA group was less (2.0 units vs. 2.8 units placebo; P = 0.03). There was no significantdifference in mean estimated intraoperative estimated-blood loss (2938 cc EACA vs. 3273 cc placebo; P = 0.32). Mean intensive care unit length of stay was decreased (EACA: 1.8 days vs. 2.8 days placebo; P = 0.04). The incidence of thromboembolic complications was similar (2.2% EACA vs. 6.6% placebo; P = 0.15). : The difference in total allogeneic RBC transfusions between the groups was not statistically significant. EACA was associated with a 30% (0.8 units) reduction in postoperative RBC transfusions and a 1-day reduction in ICU LOS, without an increased incidence of thromboembolic events. EACA may be considered for patients undergoing major spinal surgery. Larger studies are needed to evaluate the relationship between EACA and total RBC requirements.Spine 10/2009; 34(19):2096-103. · 2.08 Impact Factor
