Article

Comparative Safety of Simultaneous and Staged Anterior and Posterior Spinal Surgery

Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery/Weill Medical College of Cornell University, New York, NY, USA.
Spine (Impact Factor: 2.45). 02/2011; 37(3):247-55. DOI: 10.1097/BRS.0b013e31821350d0
Source: PubMed

ABSTRACT Analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.
To study perioperative outcomes of circumferential spine surgery performed on either the same or different days of the same hospitalization.
Circumferential spine fusion surgery has been linked to an increased adjusted risk in perioperative morbidity and mortality compared with procedures involving only 1 site. To minimize these risks, some surgeons elect to perform the 2 components of this procedure in separate sessions during the same hospitalization. The value of this approach is uncertain.
Data collected between 1998 and 2006 for the Nationwide Inpatient Sample were analyzed. Hospitalizations during which a circumferential noncervical spine fusion was performed were identified. Patients were divided into those who had their anterior and posterior portion performed on the same and those performed on different days of the same hospitalization. The prevalence of patient and health care system-related demographics was evaluated. Frequencies of procedure-related complications and mortality were determined. Multivariate regression models were created to identify whether timing of procedures was associated with an independent increase in risk for adverse events.
We identified a total of 11,265 entries for circumferential spine fusion. Of those, 71.2% (8022) were operated in 1 session. Complications were more frequent among staged- versus same-day surgery patients (28.4% vs. 21.7%, P < 0.0001). The incidence of venous thrombosis and adult respiratory distress syndrome also increased among staged candidates, while the trend toward higher mortality (0.5% vs. 0.4%) did not reach significance. In the regression model, staged circumferential spine fusions were associated with a 29% increase in the odds morbidity and mortality compared with same-day procedures.
Staging circumferential spine surgery procedures during the same hospitalization offers no mortality benefit and may even expose patients to increased morbidity.

0 Followers
 · 
114 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hassanzadeh H, Gjolaj JP, El Dafrawy MH, et al. The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery. Spine J 2013;13:1717-22 (in this issue).
    The spine journal: official journal of the North American Spine Society 12/2013; 13(12):1723-5. DOI:10.1016/j.spinee.2013.09.023 · 2.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Retrospective analysis of 53 patients who underwent single stage simultaneous surgery for tandem spinal stenosis (TSS) at single centre. To discuss the presentation of combined cervical and lumbar (tandem) stenosis and to evaluate the safety and efficacy of single-stage simultaneous surgery. Combined stenosis is an infrequent presentation with mixed presentation of upper motor neuron and lower motor neuron signs. Scarce literature on its presentation and management is available. There is a controversy in the surgical strategy of these patients. Staged surgeries are frequently recommended and only few single-stage surgeries reported. All the patients were clinico-radiologically diagnosed TSS. Surgeries were performed in single stage by two teams. Results were evaluated with Nurick grade, modified Japanese Orthopedic Association score (mJOA), oswestry disability index (ODI), patient satisfaction index, mJOA recovery rate, blood loss and complication. The mJOA cervical and ODI score improved from a mean 8.86 and 68.15 preoperatively to 13.00 and 30.11, respectively, at 12 months and to 14.52 and 24.03 at final follow-up. The average mJOA recovery rate was 48.23 ± 26.90 %. Patient satisfaction index was 2.13 ± 0.91 at final follow-up. Estimated blood loss of ≤400 ml and operating room time of <150 min showed improvement of scores and lessened the complications. In the age group below 60 years, the improvement was statistically significant in ODI (p = 0.02) and Nurick's grade (p = 0.03) with average improvement in mJOA score. Short-lasting surgery, single anaesthesia, reduced morbidity and hospital stay as well as costs, an early return to function, high patient satisfaction rate with encouraging results justify single-stage surgery in TSS. Age, blood loss and duration of surgery decide the complication rate and outcome of surgery. Staged surgery is recommended in patients above the age of 60 years.
    European Spine Journal 06/2013; 23(1). DOI:10.1007/s00586-013-2868-4 · 2.47 Impact Factor
  • Spine 04/2014; 39(16). DOI:10.1097/BRS.0000000000000352 · 2.45 Impact Factor

Preview

Download
0 Downloads
Available from