Article

Metabolic Syndrome and Lumbar Spine Fusion Surgery Epidemiology and Perioperative Outcomes

Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA.
Spine (Impact Factor: 2.45). 10/2011; 37(11):989-95. DOI: 10.1097/BRS.0b013e31823a3a13
Source: PubMed

ABSTRACT Analysis of the National Inpatient Sample database from 2000 to 2008.
To identify whether metabolic syndrome is an independent risk factor for increased major perioperative complications, cost, length of stay, and nonroutine discharge.
Metabolic syndrome is a combination of medical disorders that has been shown to increase the health risk of the general population. No study has analyzed its impact in the perioperative spine surgery setting.
We obtained the National Inpatient Sample from the Hospital Cost and Utilization Project for each year between 2000 and 2008. All patients undergoing primary posterior lumbar spine fusion were identified and separated into groups with and without metabolic syndrome. Patient demographics and health care system-related parameters were compared. The outcomes of major complications, nonroutine discharge, length of hospital stay, and hospitalization charges were assessed for both groups. Regression analysis was performed to identify whether the presence of metabolic syndrome was an independent risk factor for each outcome.
An estimated 1,152,747 primary posterior lumbar spine fusions were performed between 2000 and 2008 in the United States. The prevalence of metabolic syndrome as well as the comorbidities of the patients increased significantly over time. Patients with metabolic syndrome had significantly longer length of stay, higher hospital charges, higher rates of nonroutine discharges, and increased rates of major life-threatening complications than patients without metabolic syndrome.
Patients with metabolic syndrome undergoing primary posterior lumbar spinal fusion represent an increasing financial burden on the health care system. Clinicians should recognize that metabolic syndrome represents a risk factor for increased perioperative morbidity.

Download full-text

Full-text

Available from: Stavros G Memtsoudis, Aug 28, 2015
0 Followers
 · 
149 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Low back pain (LBP) is the world's most debilitating condition. Disk degeneration has been regarded as a strong determinant associated with LBP. Overweight and obesity are public health concerns that affect every population worldwide and whose prevalence continues to rise. Studies have indicated strong associations between overweight/obesity and disk degeneration as well as with LBP. This broad narrative review article addresses the various mechanisms that may be involved leading to disk degeneration and/or LBP in the setting of overweight/obesity. In particular, our goal is to raise awareness of the role of fat cells and their involvement via altered metabolism or the release of adipokines as well as other pathways that may lead to the development of disk degeneration and LBP. Understanding the role of fat in this process may aid in the development of novel biological therapies and technologies to halt the progression or regenerate the disk. Moreover, with genetic advancements and the appreciation of genetic epidemiology, a more personalized approach to spine care may have to consider the role of fat in any preventative, therapeutic, and/or prognosis modalities toward the disk and LBP.
    06/2013; 3(3):133-144. DOI:10.1055/s-0033-1350054
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Data on the utilization of critical care services (CCSs) among patients who underwent spine fusion are rare. Given the increasing popularity of this procedure, information regarding demographics and risk factors for the use of these advanced services is needed in order to appropriately allocate resources, educate clinical staff, and identify targets for future research. METHODS: We analyzed hospital discharge data of patients who underwent lumbar spine fusion in approximately 400 US hospitals between 2006 and 2010. Patient, procedure, and health care system-related demographics for those requiring CCS were compared to those who did not. Outcomes such as mortality, complications, disposition status, and hospital charges were compared among groups and risk factors for the utilization of CCS identified. RESULTS: A total of 95 434 entries of patients who underwent posterior lumbar spine fusion surgery between 2006 and 2010 were identified. Approximately 10% of the patients required CCS. On average, patients requiring CCS were older and had a higher comorbidity burden, developed more complications, had longer hospital stays and higher costs, and were less likely to be discharged home compared to non-CCS patients. Risk factors with increased odds for requiring CCS included advanced age, increasing comorbidity burden, increasing surgical invasiveness, and presence of postoperative complications, especially pulmonary. CONCLUSIONS: Approximately, 10% of the patients undergoing lumbar spine surgery require CCS. Utilizing the present data, critical care physicians and administrators can identify patients at risk, educate clinical staff, identify targets for intervention, and allocate resources to meet the needs of this particular patient population.
    Journal of Intensive Care Medicine 06/2013; 29(5). DOI:10.1177/0885066613491924 · 7.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Elective posterior lumbar fusion is a common surgical procedure, but reported length of hospital stay is variable (usually 3-7 days). The effect of individual or select few factors on LOS has previously been evaluated. However, multivariate analysis using LOS as a dependent variable in order to separate potentially confounding variables has not been performed. To facilitate setting of realistic expectations and considering the significant costs of hospitalization, it would be ideal to have a clear understanding of the variables affecting length of stay (LOS) for this surgery. Study Design/Setting: Retrospective case series at a tertiary care center. 103 patients undergoing elective, open 1-3 level posterior lumbar instrumented fusion (with or without decompression) by the orthopedic spine service at our institution between January 2010 and June 2012. LOS was determined from the date of surgery to the date of discharge. Preoperative factors (patient demographics, previous surgery, levels instrumented, American Society of Anesthesiologists (ASA) score, and major medical comorbidities including diabetes, hypertension, malignancy, pulmonary disease or heart disease); intraoperative factors (complications, drain placement, estimated blood loss, blood transfusion, fluids administered, operating room time, and surgery time); and postoperative factors (drain removal, blood transfusion, complications, and discharge destination) were collected and analyzed with multivariable stepwise regression to determine predictors of LOS. "Postoperative complications" was excluded as an independent variable from the regression analysis because of its close relationship with LOS. No funding was received for the completion of this study, and there are no potential conflicts of interests. Our sample included 70 one-level, 26 two-level, and 7 three-level operations. Average LOS was 3.6 ± 1.8 days (mean+SD) with the range 0-12 days. Of this cohort, 79% (81 of 103) had a stay of four days or less. The only preoperative variables associated with increased LOS in the multivariable model were age (p = 0.038) and ASA score (p = 0.001). History of heart disease (p= 0.005) was significantly associated with a shorter hospital stay. Intraoperative complications included six dural tears and one pedicle fracture. No intraoperative factors were found to be associated with a longer LOS. Postoperative complications occurred in 32% of patients (33 of 103). Common complications included: anemia requiring transfusion(11), altered mental status (8), pneumonia (4), hardware complications requiring re-operation(3). Only one serious complication, renal failure, occurred. Average LOS for patients with a post-op complication was 5.1 ± 2.3 days vs. 2.9 ± 0.9 days for patients with no complication (p < 0.001). Discharge to a sub-acute or nursing facility (p < 0.001) was significantly associated with increased length of stay. Levels fused was not predictive of LOS, possibly due to the skew towards one-level cases in our sample. Patients that are older and have widespread systemic disease tend to stay in the hospital longer after surgery. Contrary to our expectations, no single comorbidity was predictive of longer hospital stays. Heart disease was associated with a shorter length of stay, but this may have been due to a more extensive preoperative workup and closer medical management. Intraoperative events did not affect LOS, however postoperative events did. This data should prove useful for counseling patients and setting expectations of patients and the health care team.
    The spine journal: official journal of the North American Spine Society 10/2013; 15(6). DOI:10.1016/j.spinee.2013.10.022 · 2.80 Impact Factor
Show more