Research Coordinator, Rush University Medical Center, Chicago, IL Associate Professor, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL Medical Student, Georgetown University School of Medicine, Washington, DC Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Study Design. Retrospective national database analysis.Objective. A national population-based database was analyzed to characterize cervical spine procedures performed at teaching and non-teaching hospitals with regards to patient demographics, clinical outcomes/complications, resource utilization and costs.Summary of Background Data. There are mixed reports in the literature regarding the quality and costs of healthcare provided by teaching hospitals in the United States. However, outcomes of cervical spine surgery based upon teaching-status remains largely unknown.Methods. Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing elective anterior or posterior cervical fusion (ACF, PCF), or posterior cervical decompression (PCD; i.e. laminoforaminotomy, laminectomy, laminoplasty) for a diagnosis of cervical myelopathy and/or radiculopathy were identified and separated into two cohorts (teaching and non-teaching hospitals). Patient demographics, co-morbidities, complications, length of hospitalization, costs, and mortality were compared for both groups. Regression analysis was performed to assess independent predictors of mortality.Results. A total of 212,385 cervical procedures were identified from 2002-2009 in the United States, with 54.6% performed at teaching hospitals. More multilevel fusions and posterior approaches were performed in teaching hospitals (p<0.0005). Patients treated in teaching hospitals trended towards male gender, increased costs, and hospitalizations. Overall, procedure-related complications and in-hospital mortality were increased in teaching hospitals. Regression analysis revealed that significant predictors of mortality were age ≥ 65 (O.R. = 3.0) and multiple co-morbidities. Teaching status was not a significant predictor of mortality (p = 0.07).Conclusion. Patients treated in teaching hospitals for cervical spine surgery demonstrated longer hospitalizations, increased costs, and mortality over patients treated in non-teaching hospitals. Incidences of post-operative complications were identified as higher in teaching hospitals. Possible explanations for these findings are an increased complexity of procedures performed at teaching hospitals. Older age and presence of co-morbidities were more significant predictors of in-hospital mortality than teaching-status. Future studies should identify long-term complications and costs beyond an in-patient setting to assess if differences extend beyond the peri-operative period.
"First, our data are based on patients undergoing ACFs in a single academic institution. Although our total hospital costs, operative time, complication rates, and LOS are comparable to those in previous multicenter studies, it has previously been shown that health-care costs and postoperative morbidity after cervical spine surgery are increased in teaching hospitals as compared with nonteaching hospitals . Hence, our results may not be applicable to all types of spine surgical centers. "
[Show abstract][Hide abstract] ABSTRACT: Background Context: The frequency of anterior cervical fusion (ACF) surgery as well as total
hospital costs in spine surgery has substantially increased in the last several years. Purpose: To
determine which patient comorbidities are associated with increased total hospital costs following
elective one or two-level ACFs.Study Design/Setting: retrospective cohort analysis Patient Sample:
Individuals who have undergone elective one or two-level ACFs at our single institution. 1082 total
patients. Outcome measure: Total hospital costs during single admission. Methods: Multivariate linear
regression models were used to analyze independent effects of preoperative patient characteristics on
total hospital costs. Univariate analysis was utilized to examine association of these characteristics on
operative time, length of stay (LOS), and complications. Results: Age, obesity, and diabetes were
independently associated with increased average hospital costs of $1404 [Confidence Interval (CI)
$857 - $1951, p<0.001], $681 (CI $285 - $1076, p=0.001), and $1877 (CI $726 - $3072, p=0.001),
respectively. Age was associated with increased LOS (p<0.001) and complications (p<0.001), but not
operative time (p=0.431). Diabetes was associated with increased LOS (<0.001) and complications
(p=0.042), but not operative time (p=0.234). Obesity was not associated with increased LOS (p=0.164),
complications (p=0.890), or operative time (p=0.067). Conclusions: This study highlights the patient
comorbidities associated with increased hospital costs following one or two-level ACFs and the
potential drivers of these costs.
The Spine Journal 01/2015; DOI:10.1016/j.spinee.2015.01.022 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study Design: A randomized, double-blind, active-controlled trial.
Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain.
Summary of Background Data: Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck pain.
Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone.
The primary outcome measure was ≥ 50% improvement in pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight.
Results: Significant pain relief and functional improvement (≥ 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up.
Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and functioning in patients with chronic discogenic or axial pain that is function-limiting and not related to facet joint pain.
International journal of medical sciences 02/2014; 11(4):309-20. DOI:10.7150/ijms.8069 · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study Design. Retrospective cohort studyObjective. To determine the impact of spine surgeon specialty on 30-day post-operative complication rates of single-level anterior cervical discectomy and fusions (ACDFs).Summary of Background Data. ACDFs are performed by both neurological and orthopaedic surgeons. Although previous studies have examined pre-operative risk factors for post-operative complications in ACDFs, no studies have shown the impact of surgical specialty on these variables.Methods. All patients who underwent any single-level ACDF between 2006 and 2012 were selected from the American College of Surgeon's National Surgical Quality Improvement Program database. Propensity-score matching was utilized to reduce confounding pre-operative differences. Baseline demographics, comorbidities, and complications were compared between the two surgical specialties using univariate analyses. Multivariate logistic regression models were created to isolate independent effects of surgeon specialty on complications.Results. A total of 1,944 patients undergoing single-level ACDFs were included in our analysis. 19.9% and 80.1% of ACDFs were performed by orthopaedic surgeons (ORTHO) and neurosurgeons (NEURO), respectively. NEURO patients had a higher number of comorbidities. After propensity matching, however, all preoperative variables did not vary significantly between the specialty cohorts. Multivariate analysis of the propensity-matched groups revealed that for single-level ACDFs, treating physician cohort (ORTHO vs NEURO) was not associated with higher odds for overall complications (OR 1.708, 95% CI 0.849-3.436, p = 0.133), surgical site complications (OR 0.869, 95% CI 0.233-3.247, p = 0.835), or medical complications (OR 1.863, 95% CI 0.805-4.311, p = 0.146).Conclusion. Spine surgeon specialty is not a risk factor for any reported post-operative complication in patients undergoing single-level ACDFs.
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