Peter G Passias

Weill Cornell Medical College, New York City, New York, United States

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Publications (4)8.83 Total impact

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    ABSTRACT: Study Design. Retrospective analysis.Objective. To determine patient demographics, incidence of comorbidities and procedure-related complications, and identify risk factors associated with morbidity and mortality after spinal surgery for cauda equina syndrome (CES).Summary of Background Data. To our knowledge, no study has provided nationwide estimates of patient characteristics and procedure-related complication rates after spinal surgery for CES relative to an unaffected population.Methods. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for lumbar spinal fusion, decompression, or discectomy were included. The CES cohort included diagnoses of CES, and the unaffected cohort included lumbar spinal pathology diagnoses. Patient demographics, incidence of comorbidities and procedure-related complications, and risk factors associated with morbidity and mortality were compared.Results. Discharges for 11,207 CES and 689,799 unaffected patients were identified. Differences between cohorts were found for demographic and hospital data. Average comorbidity indices for the CES cohort were found to be increased (0.23 vs.0.13, p< 0.0001), as well as the incidence of total procedure-related complications (18.63% vs. 13.12%, p< 0.0001). In-hospital mortality rate was significantly increased for the CES cohort (0.30% vs. 0.08%, p< 0.0001). A number of comorbidities associated with additional risk for morbidity and mortality among the CES cohort were identified.Conclusion. Relative to an unaffected population undergoing similar treatment, CES patients were more likely to have increased associated comorbidities on presentation, as well as increased complication rates with a prolonged hospital course postoperatively. CES was found to carry an increased incidence of procedure-related complications as well as in-hospital mortality. A number of comorbidities associated with additional risk for morbidity and mortality among the CES cohort were identified. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality as well as direct future research to improve patient outcomes.
    Spine 12/2013; · 2.16 Impact Factor
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    ABSTRACT: Object Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine. Methods A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words "lateral mass screw" and "cervical pedicle screw." Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared. Results Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant. Conclusions Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.
    Journal of neurosurgery. Spine 09/2013; · 1.61 Impact Factor
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    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.
    Spine 02/2011; 37(3):247-55. · 2.16 Impact Factor
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    ABSTRACT: Despite increasing utilization of surgical spine fusions, a paucity of literature addressing perioperative complications after revision posterior spinal fusion (RPSF) versus primary posterior spine fusion (PPSF) of the thoracic and lumbar spine exists. To examine demographics of patients undergoing PPSF and RPSF of the thoracic and lumbar spine, assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death. Analysis of nationally representative data collected for the National Inpatient Sample (NIS). All discharges included in the NIS with a procedure code for posterior thoracic and lumbar spine fusion from 1998 to 2006. In-hospital mortality and morbidity. Data collected for each year between 1998 and 2006 for the NIS were analyzed. Discharges with a procedure code for thoracic and lumbar spine fusion were included in the sample. The prevalence of patient- as well as health care-related demographics was evaluated by procedure type (primary vs. revision). Frequencies of procedure-related complications and in-hospital mortality were analyzed. Independent predictors for in-hospital mortality were determined. We identified 222,549 PPSF and 12,474 RPSF discharges between 1998 and 2006. Patients undergoing PPSF were significantly younger (51.23 years; confidence interval [CI]=51.16, 51.31) and had lower average comorbidity indices (0.40; CI=0.39, 0.41) than those undergoing RPSF (52.69 years; CI=52.43, 52.97) and (0.44; CI=0.43, 0.45), p<.0001. The incidence of procedure-related complications was 16.02% among RPSF compared with 13.44% in PPSF patients (p<.0001). In-hospital mortality rates after PPSF were approximately twice those of RPSF (0.28% vs. 0.15%, p=.006). Adjusted risk factors for increased in-hospital mortality included PPSF compared with RPSF, male gender, and increasing age. A number of comorbidities, complications, and specific surgical indications increased the risk for perioperative death. Despite being performed in generally younger and healthier patients and having lower perioperative morbidity, PPSF procedures are associated with increased mortality compared with RPSF procedures. The findings of this study can be used for risk stratification, accurate patient consultation, and hypothesis formation for future research.
    The spine journal: official journal of the North American Spine Society 10/2010; 10(10):881-9. · 2.90 Impact Factor