Peter G Passias

NYU Langone Medical Center, New York, New York, United States

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Publications (96)

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    Rafael De la Garza Ramos · Peter G Passias · Frank Schwab · [...] · Daniel M Sciubba
    [Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective study of an administrative database. Objective: The objective was to investigate the incidence, risk factors, and mortality rate of reintubation after adult spinal deformity (ASD) surgery. Background data: There are limited data regarding the occurrence of reintubation after ASD surgery. Materials and methods: The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify adult patients who underwent elective surgery for scoliosis. Patients who required reintubation were identified and compared with controls (no reintubation). A multivariable logistic regression analysis was performed to identify independent factors associated with reintubation. Results: A total of 9734 patients who underwent surgery for ASD were identified, and 182 required reintubation [1.8%; 95% confidence interval (CI), 1.6%-2.1%] on average 2 days after surgery (range, 0-28 d). After multivariable analysis, the strongest independent risk factors associated with reintubation included postoperative acute respiratory failure [odds ratio (OR), 12.0; 95% CI, 8.6-16.6], sepsis (OR, 6.9; 95% CI, 3.5-13.6), and deep vein thrombosis (OR, 5.7; 95% CI, 3.0-10.9); history of chronic lung disease (OR, 1.6; 95% CI, 1.1-2.3) and fusion of 8 or more segments (OR, 1.5; 95% CI, 1.1-2.2) were also independent risk factors. Mortality rates were significantly higher in reintubated patients (7.3%) compared with that in nonreintubated patients (0.2%, P<0.001). More importantly, reintubation was an independent risk factor for inpatient mortality (OR, 9.8; 95% CI, 4.1-23.5; P<0.001). Conclusions: The reintubation rate after ASD surgery is approximately 1.8%. Patients with a history of chronic lung disease and patients undergoing fusion of 8 or more segments may be at an increased risk for reintubation; other associated factors included acute respiratory failure, sepsis, and deep vein thrombosis. Patients who required postoperative airway management after ASD surgery were 9.8 times more likely to die during their hospital stay compared with controls.
    Full-text Article · Jun 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Background: In a bundled payment system, a single payment covers all costs associated with a single episode of care. Spine surgery may be well suited for bundled payments because of clearly defined episodes of care, but the impact on current practice has not been studied. We sought to examine how a theoretical bundled payment strategy with financial disincentives to resource utilization would impact practice patterns. Methods: A multiple-choice survey was administered to spine surgeons describing eight clinical scenarios. Respondents were asked about their current practice, and then their practice in a hypothetical bundled payment system. Respondents could choose from multiple types of implants, bone grafts, and other resources utilized at the surgeon's discretion. Results: Forty-three respondents completed the survey. Within each scenario, 24%-49% of respondents changed at least one aspect of management. The proportion of cases performed without implants was unchanged for four scenarios and increased in four by an average of 8%. Use of autologous iliac crest bone graft increased across all scenarios by an average of 18%. Use of neuromonitoring decreased in all scenarios by an average of 21%. Differences in costs were not statistically significant. Conclusions: Financial disincentives to resource utilization may result in some changes to surgeons' practices but these appear limited to items with less clear benefits to patients. Choices of implants, which account for the majority of intra-operative costs, did not change meaningfully. A bundling strategy targeting peri-operative costs solely related to surgical practice may not yield substantive savings while rationing potentially beneficial treatments to patient care. Level of evidence: 5.
    Article · May 2016 · International Journal of Spine Surgery
  • Shearwood McClelland · Bryan J. Marascalchi · Peter G. Passias · [...] · Thomas J. Errico
    [Show abstract] [Hide abstract] ABSTRACT: Study Design. Retrospective cohort study Objective. To assess factors potentially impacting the operative approach chosen for CSM patients on a nationwide level. Summary of Background Data. Cervical spondylotic myelopathy (CSM) is one of the most common spinal disorders treated by spine surgeons, with operative management consisting of three approaches: anterior-only, posterior-only, or combined anterior-posterior. It is unknown whether the operative approach used differs based on patient demographics and/or insurance status. Methods. The Nationwide Inpatient Sample from 2001-2010 was used for analysis. Admissions having a diagnosis code of 721.1 and a primary procedure code of 81.02/81.03, 81.32/81.33, 81.02/81.03 or 81.32/81.33 (combined anterior and posterior fusion/refusion at C2 or below), and 3.09 (decompression of the spinal canal including laminoplasty) were included. Analysis was adjusted for several variables including patient age, race, sex, primary payer for care, and admission source/type. Results. Multivariate analyses revealed that non-Caucasian race [Black (OR = 1.39;95%CI = 1.32-1.47;p < 0.0001), Hispanic (OR = 1.51;95%CI = 1.38-1.66;p < 0.0001), Asian/Pacific Islander (OR = 1.40;95%CI = 1.15-1.70;p = 0.0007), Native American (OR = 1.33;95%CI = 1.02-1.73;p = 0.037)] and increasing age (OR = 1.03; p < 0.0001) were predictive of receiving posterior-only approaches. Female sex (OR = 1.39;95%CI = 1.34-1.43;p < 0.0001), private insurance (OR = 1.19;95%CI = 1.14-1.25;p < 0.0001), and non-trauma center admission type (OR = 1.29-1.39;95%CI = 1.16-1.56;p < 0.0001) were independently predictive of increased likelihood of receiving an anterior-only approach. Hispanic race (OR = 1.35;95%CI = 1.14-1.59;p = 0.0004) and admission source [another hospital (OR = 1.65;95%CI = 1.20-2.27;p = 0.0023), other health facility (OR = 1.68;95%CI = 1.13-2.51;p = 0.011)] were the only variables predictive of increased combined anterior-posterior approaches; Native American race (OR = 0.32;95%CI = 0.13-0.78;p = 0.013) decreased the likelihood of a combined anterior-posterior approach. Conclusions. Private insurance status, female sex, and Caucasian race independently predict receipt of anterior-only CSM approaches, while non-Caucasian race (Black, Hispanic, Asian/Pacific Islander, Native American) and non-private insurance predict receiving posterior-only CSM approaches. Given recent literature demonstrating posterior-only approaches as predictive of increased mortality in CSM (Kaye et al., 2015), our findings indicate that for CSM patients, non-Caucasian race may significantly increase mortality risk, while private insurance status may significantly decrease the risk of mortality. Further prospective study will be needed to more definitively address these issues. Level of Evidence: 3 Copyright
    Article · May 2016 · Spine
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    [Show abstract] [Hide abstract] ABSTRACT: Prolonged length of stay (PLOS) has been associated with increased hospital resource utilization and worsened patient outcomes in multiple studies. In this study, we defined and identified factors associated with PLOS after posterior surgery for cervical spondylotic myelopathy in patients over the age of 65. PLOS was defined as length of stay beyond the “prolongation point” (that is, the day after which discharge rates begin to decline). Using the United States Nationwide Inpatient Sample database, 2742 patients met inclusion criteria, out of whom 16.5% experienced PLOS (stay beyond 6 days). After multivariate analysis, increasing age was independently associated with PLOS (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06). Multiple comorbid conditions were associated with PLOS, including alcohol abuse (OR 3.85, 95% CI 1.87–7.94), congestive heart failure (OR 1.72, 95% CI 1.11–2.64), obesity (OR 1.70, 95% CI 1.14–2.55), and deficiency anemia (OR 1.44, 95% CI 1.01–2.05); the strongest associated operative parameter was blood transfusion (OR 2.39, 95% CI 1.75–3.28). Major complications independently associated with PLOS were deep vein thrombosis (OR 18.32, 95% CI 6.50–51.61), myocardial infarction (OR 8.98, 95% CI 2.92–27.56), pneumonia (OR 6.67, 95% CI 3.17–14.05), acute respiratory failure (OR 6.27, 95% CI 3.43–11.45), hemorrhage/hematoma (OR 5.04, 95% CI 2.69–9.44), and implant-related complications (OR 2.49, 95% CI 1.24–4.98). Average total hospital charges for patients who experienced PLOS were $122,965 US dollars, compared to $76,870 for the control group (p < 0.001). Mortality for patients who experienced PLOS was 2.7% versus 0.5% for patients who did not epxerience PLOS (p < 0.001). In conclusion, patients over the age of 65 who underwent posterior surgery for cervical myelopathy and stayed over 6 days in hospital were defined as having PLOS. Hospital charges and mortality rates were significantly higher for patients who experienced PLOS. Potentially modifiable and/or preventable risk factors were also identified.
    Full-text Article · May 2016 · Journal of Clinical Neuroscience
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    Peter G Passias · Cheongeun Oh · Cyrus M Jalai · [...] · Christopher P Ames
    [Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective review of prospective multicenter database. Objective: Use predictive modeling to identify patient characteristics, radiographic, and surgical variables that predict reaching an outcome threshold of sub-optimal cervical alignment following adult spinal deformity (ASD) surgery. Summary of background data: Cervical deformity (CD) after ASD correction has been defined with the following criteria: T1S-CL>20°, C2-C7 SVA>40 mm, and/or C2-C7 kyphosis>10°. While studies have analyzed CD predictors, few have defined and identified predictors of optimal cervical alignment following thoracolumbar surgery. Methods: Inclusion criteria were surgical ASD patients with baseline and 2-year follow-up. Post-operative cervical alignment (CA) and malalignment (nonCA) at 2-years was defined with the following radiographic criteria: 0°≤T1S-CL≤20°, 0mm≤C2-C7 SVA≤40 mm, or C2-C7 lordosis>0°. Three thresholds classifying malalignment were defined: (T1) missing 1 criterion, (T2) missing 2 criteria, (T3) missing 3 criteria. Multivariable logistic stepwise regression models with bootstrap resampling procedure were performed for demographic, surgical, and radiographic variables. The model was validated with ROC and AUC. Results: 225 surgical ASD patients were included. At 2-years 208 patients (92.4%) were grouped as CA in T3, while 17 (7.6%) were nonCA. Patients were similar in age (CA: 56.10 vs. nonCA: 55.78 years, p = 0.150), BMI (CA: 26.93 vs. nonCA: 26.94 kg/m, p = 0.716), and gender (CA: 76.5% vs. nonCA: 87.0%, p = 0.194). The final predictive model included C2 slope, C2-T3 CL, T1S-CL, C2-C7 CL, Pelvic Tilt, C2-S1 SVA, PI-LL, and SPO number. In this model (AUC 89.22% [97.49%-80.96%]), the following variables were identified as predictors of nonCA: increased SPO use (OR: 1.336, p = 0.017), and C2-T3 angle (OR: 1.048, p = 0.005). Conclusions: This study created a statistical model that predicts poor 2-year post-operative cervical malalignment in ASD patients. T3 (patients not meeting all 3 alignment criteria) was the most effective threshold for modeling nonCA, and included increased baseline C2-T3 angle and increased Smith-Peterson osteotomies during index. Level of evidence: 3.
    Full-text Article · Apr 2016 · Spine
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    Cyrus M. Jalai · Peter G. Passias · Virginie Lafage · [...] · Christopher P. Ames
    [Show abstract] [Hide abstract] ABSTRACT: Purpose Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years. Methods Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2–C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2–C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year). Results Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients’ CD rates at 1 and 2 years were 78.9, and 63.0 %, respectively. Non-Op CD rates were 21.1 and 37.0 % at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p < 0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2–T3 SVA, and global SVA compared to Non-Ops (p < 0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p < 0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019). Conclusions In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.
    Full-text Article · Apr 2016 · European Spine Journal
  • P. G. Passias · A. Soroceanu · S. Yang · [...] · V. Lafage
    Article · Apr 2016 · The Journal of Bone and Joint Surgery
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    [Show abstract] [Hide abstract] ABSTRACT: Objective: Although previous reports suggest that surgery can improve the pain and disability of cervical spinal deformity (CSD), techniques are not standardized. Our objective was to assess for consensus on recommended surgical plans for CSD treatment. Methods: 18 CSD cases were assembled, including a clinical vignette, cervical imaging (x-rays, CT/MRI), and full-length standing x-rays. Fourteen deformity surgeons (10 orthopedic, 4 neurosurgery) were queried regarding recommended surgical plan. Results: There was marked variation in treatment plans across all deformity types. Even for the least complex deformities (moderate mid-cervical apex kyphosis), there was lack of agreement on approach (50% combined anterior-posterior, 25%, anterior-only, 25% posterior-only), number of anterior (range: 2-6) and posterior (range: 4-16) fusion levels, and types of osteotomies. As the kyphosis apex moved caudally (cervical-thoracic junction/upper thoracic spine) and for cases with chin-on-chest kyphosis, >80% of surgeons agreed on a posterior-only approach and >70% recommended a pedicle subtraction osteotomy (PSO) or vertebral column resection (VCR), but the range in number of anterior (4-8) and posterior (4-27) fusion levels was exceptionally broad. Cases of cervical/cervical-thoracic scoliosis had the least agreement for approach (48% posterior-only, 33% combined anterior-posterior, 17% anterior-posterior-anterior or posterior-anterior-posterior, 2% anterior-only) and had broad variation in number of anterior (2-5) and posterior (6-19) fusion levels, and recommended osteotomies (41% PSO/VCR). Conclusions: Among a panel of deformity surgeons, there was marked lack of consensus on recommended surgical approach, osteotomies and fusion levels for CSD. Further study is warranted to assess whether specific surgical treatment approaches are associated with better outcomes.
    Full-text Article · Apr 2016 · World Neurosurgery
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    [Show abstract] [Hide abstract] ABSTRACT: Purpose The resection point of a lumbar three-column osteotomy (3CO) creates separation of the spino-pelvic complex. This study investigates the impact of patients’ baseline deformity and level of 3CO resection on the distribution of correction between the trunk and the pelvis following osteotomy closure. Methods Patients who underwent single lumbar 3CO, upper instrumented vertebra (UIV) T1–T10, and 6 month follow-up were included. The truncal and pelvic closures were calculated based on the vertebrae adjacent to the osteotomy level and the impact of radiographic parameters and level of 3CO on the closures were analyzed. Results 113 patients were included. Patients who experienced more pelvic correction had significantly higher Pelvic Tilt and lower Sagittal Vertical Axis at baseline. Patients who underwent more caudal osteotomies with higher pelvic compensation with modest SVA sustained more pelvic correction. Conclusions The osteotomy closure is driven by patient’s specific deformity. More caudal osteotomy level leads to greater pelvic tilt improvement. Level of evidence: III
    Full-text Article · Mar 2016 · European Spine Journal
  • C. M. Jalai · N. Worley · G. W. Poorman · [...] · P. G. Passias
    [Show abstract] [Hide abstract] ABSTRACT: Purpose Studies have examined infection rates following spine surgery and their relationship to post-operative complications and increased length of stay. Few studies, however, have investigated predictors of infection, specifically in the setting of operative intervention for cervical spondylotic myelopathy (CSM). This study aims to identify the incidence and factors predictive of infection amongst this cohort. Methods This study performed a retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients included those treated surgically for CSM (ICD-9 code 721.1) from 2010 to 2012. Patient demographics and surgical data were collected with outcome variables including the occurrence of one of the following surgical site infections (SSIs) within 30 days of index operation: superficial SSI, deep incisional SSI, and organ/space SSI. Results 3057 patients were included in this analysis. Overall infection rate was 1.15 % (35/3057), of which 54.3 % (19/35) were superficial SSIs, 28.6 % (10/35) were deep incisional SSI, and 20 % (7/35) were peri-spinal SSI. Logistic regression revealed factors associated with SSI included: higher BMI [OR 1.162 (CI 1.269–1.064), p = 0.001] and operative time ≥208 min [OR 4.769 (CI 20.220–1.125), p = 0.034]. Conclusions The overall SSI rate for the examined CSM cohort was 1.15 %. This study identified increased BMI and operative time ≥208 min as predictors of infection in surgical CSM patients. This information should be carefully considered in delivering patient education and future efforts to optimize risk in CSM patients indicated for surgical intervention.
    Article · Mar 2016 · European Spine Journal
  • [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82-0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.
    Article · Mar 2016 · Journal of neurosurgery. Spine
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    Peter G. Passias · Eric O. Klineberg · Cyrus M. Jalai · [...] · Shay Bess
    [Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective review of prospective multicenter database. Objective: Identify factors influencing readmission, reoperation, and the impact on health related quality of life outcomes (HRQoL's) in adult spinal deformity (ASD) surgery. Summary of background data: Many ASD patients experience complications requiring readmission. It is important to identify baseline/operative factors leading to rehospitalizations and reoperation, which may impact outcomes. Methods: Inclusion criteria: ASD surgical patients (age > 18years, major coronal Cobb≥20°, SVA≥5 cm, PT≥25° and/or TK > 60°) with complete baseline, 1-, and 2-year follow-up. Patients were grouped on the basis of readmission occurrence (yes/no) and type (medical [no reoperation] vs. surgical [revision surgery]). Readmissions caused by infections requiring surgical treatment (e.g. deep infections) were considered reoperations. Univariate and multivariate analyses determined readmission and reoperation predictors. Repeated measures mixed models evaluated readmission impact on HRQoL's at 1- and 2-years. Results: 334 patients were included: 76 (22.8%) readmissions, involving 65 (85.5% of 76) reoperations (surgical readmission) and 11 (14.5% of 76) medical readmissions. The most common surgical readmission indication (n = 65) was implant complications (36.9%; rod breakage n = 13); the most common medical readmission indication was infection (36.4%, n = 4), treated with antibiotics. Non-infectious medical readmission (n = 7) included: pleural effusion, DTV, intra-operative blood loss, neurologic, and unspecified. Readmission predictors: increased number of major peri-operative complications (OR 5.13, p = 0.014), infection presence (OR 25.02, p = 0.001), implant complications (OR 6.12, p < 0.001), and radiographic complications (DJK, PJK, pseudoarthrosis, sagittal/coronal imbalance) (OR 16.94, p < 0.001). HRQoL analysis revealed overall improvement of the full cohort (p < 0.01), though the 76 readmitted improved less overall and at each time point p < 0.001) except in 6-week MCS (p = 0.14). Conclusions: Major peri-operative, implant, radiographic, and infection complications during index were associated with increased readmission odds. Implant complications most frequently caused surgical readmissions. Readmitted patients improved in outcome scores, although less compared to the non-readmitted cohort, yet displayed reduced 6-week SF-36 MCS. Level of evidence: 3.
    Full-text Article · Mar 2016 · Spine
  • Angel E. Macagno · Saqib Hasan · Cyrus M. Jalai · [...] · Peter G. Passias
    [Show abstract] [Hide abstract] ABSTRACT: Background/aims: Surgical techniques for effective high-grade spondylolisthesis (HGS) remain controversial. This study aims to evaluate radiographic/clinical outcomes in HGS patients treated using modified "Reverse Bohlman" (RB) technique. Methods: Review of consecutive HGS patients undergoing RB at a single university-center from 2006 to 2013. Clinical, surgical, radiographic parameters collected. Results: Six patients identified: five with L5-S1 HGS with L4-L5 instability and one had an L4-5 isthmic spondylolisthesis and grade 1 L5-S1 isthmic spondylolisthesis. Two interbody graft failures and one L5-S1 pseudoarthrosis. Postoperative improvement of anterolisthesis (62.3% vs. 49.6%, p = 0.003), slip angle (10 vs. 5°, p = 0.005), and lumbar lordosis (49 vs. 57.5°, p = 0.049). Conclusions: RB technique for HGS recommended when addressing adjacent level instability/slip.
    Article · Mar 2016 · Journal of Orthopaedics
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction Minimally invasive surgical (MIS) techniques are gaining popularity in the treatment of adult spinal deformity (ASD). The premise is that MIS techniques will lead to equivalent outcomes and a reduction in perioperative complications when compared with open techniques. Potential issues with MIS techniques are a limited capacity to correct lumbar lordosis, unknown long-term efficacy, and the potential need for revision surgery. This study compares reoperation rates and reasons for reoperation following MIS, hybrid, and open surgery for ASD through multicenter database analysis. Methods We retrospectively analyzed a prospective multicenter ASD database comparing open and MIS correction techniques. Inclusion criteria were: age > 18 years with minimum 20° coronal lumbar Cobb angle, a minimum of three levels fused, and minimum 2-year follow-up. Patients were propensity matched for preoperative sagittal vertebral axis (SVA), pelvic incidence–lumbar lordosis (PI–LL), and number of levels fused. We included 189 patients from three propensity-matched subgroups of 63 patients each: (1) MIS: lateral or transforaminal lumbar interbody fusion (LIF) and percutaneous pedicle instrumentation, (2) Hybrid: MIS LIF with open posterior segmental fixation (PSF), and (3) OPEN: open posterior fixation ± osteotomies. Results With propensity matching, there were significant differences between groups in pre-op SVA or PI–LL (p > 0.05). The MIS group had significantly fewer levels fused (5.4) (0–14) than the OPEN group (7.4) (p = 0.002) (0–17). The rate of revision surgery was significantly different between the groups with a higher rate of revision (27 %) amongst the HYB group versus MIS = 11.1 %, and OPEN = 12.0 %. The most common reason for reoperation in the OPEN and HYB groups was a postoperative neurological deficit (7.9 and 11.1 %), respectively. The most common reason for reoperation in the MIS group was pseudoarthrosis (7.9 %). Conclusions Reoperation rates were not statistically different among the MIS, and OPEN surgical groups, but differed significantly on multivariate analysis with HYB group. The incidence of reoperations was twice as high in the Hybrid group compared to OPEN and MIS.
    Article · Feb 2016 · European Spine Journal
  • Cyrus M. Jalai · Nancy Worley · Bryan J. Marascalchi · [...] · Peter G. Passias
    [Show abstract] [Hide abstract] ABSTRACT: Study Design. Retrospective multicenter database review. Objective. The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients. Summary of Background Data. Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients. Methods. A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95% CI]). Results. Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P<0.0001), as was the total complications rate (11.39% vs. 5.93%, P<0.0001) and charges ($57,449.94 vs. $49,951.11, P<0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P<0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P<0.001) and courses (5.77 vs. 4.28 days, P<0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P<0.001), had increased total complications rate (13.87% vs. 10.20%, P<0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P<0.001), digestive system (1.92 [2.40-1.54], P<0.001), and wound dehiscence (1.71 [2.56-1.15], P<0.001). Conclusion. Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes.
    Article · Feb 2016 · Spine
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    Rafael De la Garza-Ramos · Peter G Passias · Frank J Schwab · [...] · Daniel M Sciubba
    [Show abstract] [Hide abstract] ABSTRACT: Background: Some studies have suggested patients who undergo surgery in July have worse outcomes compared to patients treated during other months. The purpose of this study is to compare inpatient morbidity and mortality among patients who underwent adult spinal deformity (ASD) surgery in July with those who underwent surgery in other months. Methods: Admission data for patients who underwent ASD surgery were extracted from the Nationwide Inpatient Sample for the years 2002 to 2011. Only adult patients (over 21 years of age) and elective admissions to teaching hospitals were included. A multivariable regression analysis was performed to examine the independent effect of July admissions on overall complications, major complications, and inpatient mortality. Results: A total of 27,794 patients were identified, with 2,023 (7.8%) admitted in July and 25,771 (92.2%) in other months. Overall complication rates in July (43.1%) were not different from rates in other months (44.9%, p=0.468). Similarly, major complication rates were similar; 12.9% in July and 12.4% in other months (p=0.764). Mortality was not different between groups (p=0.807). After multivariable analysis, July admissions were not found to increase the odds of developing any complication (OR 0.94; 95% CI, 0.77 - 1.12; p=0.403), major complications (OR 1.04; 95% CI, 0.76 - 1.41; p=0.788) or inpatient mortality (OR 1.35; 95% CI, 0.31 - 5.84; p=0.684). Conclusion: In this study of a nationwide database, patients who underwent ASD surgery in July did not have increased odds of developing a complication or inpatient mortality compared to patients admitted in other months.
    Full-text Article · Jan 2016 · International Journal of Spine Surgery
  • Shenglin Wang · Ming Yan · Peter G Passias · Chao Wang
    [Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective case series of atlantoaxial rotatory fixed dislocation (AARFD). Objective: To describe clinical features and the surgical treatment of AARFD. Summary of background data: The classification and treatment strategy for atlantoaxial rotatory fixation (AARF) were previously described and remained controversial. AARF concomitant with atlantoaxial dislocation has different clinical features and treatment strategy with the most AARF. Due to deficiency of the transverse ligament or odontoid, the atlantoaxial remains instable even after the torticollis relieved or cured. Because of the rarity, treatment strategy for this special condition has not been specialized and fully explored in the literatures. Methods: 32 children with AARFD (sustained torticollis more than six weeks and ADI more than 5 mm) were retrospectively reviewed. Treatment methodology, pearls, and pitfalls of the treatment were discussed. Results: Thirty-two cases had sustained torticollis for an average of 5.7 months. ADI of them ranged from 8 to 22 mm, with a mean of 11.3 mm. Eight cases presented with signs and symptoms of spinal cord dysfunction. All 32 cases underwent surgery and had no spinal cord or vertebral artery injury. The surgery included posterior reduction and fusion (reducible dislocation and torticollis, 16 cases), and transoral release followed by posterior reduction and fusion (irreducible dislocation and torticollis, 16 cases). The average follow-up time was 42 months. Solid fusion and torticollis healing were achieved in 31 patients (96.9%) as detected radiologically. Two cases (6.3%, 2/32) suffered complications (CSF leakage and recurred torticollis followed by revision). Conclusion: AARFD had distinct clinical features relative to common presentations of AARF. Because of deficiency of the transverse ligament or odontoid and subsequent atlantoaxial dislocation, surgical treatments are applied for this condition, including transoral release and posterior C1-2 reduction and fusion. AARFD cases were successfully managed surgically without pre-operative traction, with few complications seen. Level of evidence: 4.
    Article · Dec 2015 · Spine
  • Eric O Klineberg · Peter G Passias · Cyrus M Jalai · [...] · Virginie Lafage
    [Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective review of a prospective multicenter database. Objective: Identify variables associated with extended length of stay (ExtLOS) and this impact on health related quality of life (HRQoL) scores in adult spinal deformity (ASD) patients. Summary of background data: ASD surgery is complex and associated with complications including extLOS. Though variables contributing to extLOS have been considered, specific complications and pre-disposing factors among ASD surgical patients remain to be investigated. Methods: Inclusion criteria: ASD surgical patients (age>18yrs, scoliosis≥20°, SVA≥5 cm, PT≥25° and/or TK>60°) with complete demographic, radiographic and HRQoL data at baseline, 6 weeks, and 2 years post-operative. ExtLOS was based on 75 percentile (≥9 days). Univariate and multivariate analyses identified predictors and evaluated effects on outcomes. Repeated measures mixed models analyzed impact of ExtLOS on HRQoL (ODI; SF-36 PCS/MCS; SRS22r Activity (AC), Pain (P), Appearance (AP), Satisfaction (S), Mental (M) and Total (T)). Results: 380 patients met inclusion criteria: 105 (27.6%) had extLOS (≥9 days), 275 (72.4%) did not. Average LOS was 8 days (range: 1-30 days). Age (OR 1.04), # levels fused (OR 1.12), # infections (OR 2.29), # neurologic complications (OR 2.51), Charlson Comorbidity Index Score (CCI) predicted ExtLOS (OR 3.92), and # intra-op complications predicted ExtLOS (OR 3.56). ExtLOS patients had more intra cardiopulmonary (pleural effusion: 1.9% vs. 0%), and operative complications (dural tear: 13.3% vs. 5.1%; excessive blood loss: 18% vs. 5.8%) (p < 0.022). At 2-years, both groups of patients experienced overall improvement in all HRQoL scores (p < 0.001). ExtLOS patients had significantly less overall improvement in all HRQoLs (p < 0.01) except for MCS (p = 0.17) and SRS M (p = 0.08). Conclusions: Extended LOS of ASD patients is affected by comorbidities (higher CCI) and number of intra-operative, but not peri-operative, complications. All patients improved overall in HRQoL scores, but extended LOS patients improved less overall at 2 years in comparison. Level of evidence: 3.
    Article · Dec 2015 · Spine
  • Michael C. Gerling · Dante Leven · Peter G. Passias · [...] · Thomas J. Errico
    [Show abstract] [Hide abstract] ABSTRACT: Study design: A retrospective subgroup analysis was performed on surgically treated patients from the lumbar spinal stenosis (SpS) arm of the Spine Patient Outcomes Research Trial (SPORT), randomized and observational cohorts. Objective: To identify risk factors for reoperation in patients treated surgically for SpS and compare outcomes between patients who underwent reoperation with those that did not. Summary of background data: SpS is one of the most common indications for surgery in the elderly; however, few long-term studies have identified risk factors for reoperation. Methods: A post-hoc subgroup analysis was performed on patients from the SpS arm of the Spine Patient Outcomes Research Trial (SPORT), randomized and observational cohorts. Baseline characteristics were analyzed between reoperation and no reoperation groups using univariate and multivariate analysis on data eight years post-operation. Results: Of the 417 study patients, 88% underwent decompression only, 5% non-instrumented fusion and 6% instrumented fusion. At the 8 year follow up, the reoperation rate was 18%; 52% of reoperations were for recurrent stenosis or progressive spondylolisthesis, 25% for complication or other reason and 16% for new condition. Of patients who underwent a reoperation, 42% did so within 2 yrs, 70% within 4 years and 84% within 6 years. Patients who underwent reoperation were less likely to have presented with any neurological deficit (43% reop vs. 57% no reop, p = 0.04). Patients improved less at follow-up in the re-operation group (p < 0.001). Conclusion: In patients undergoing surgical treatment for SpS, the reoperation rate at eight year follow-up was 18%. Patients with a reoperation were less likely to have a baseline neurological deficit. Patients who did not undergo reoperation had better patient reported outcomes at eight year follow up compared to those who had repeat surgery. Level of evidence: 2.
    Article · Dec 2015 · Spine
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    Full-text Article · Nov 2015 · Neurosurgery

Publication Stats

454 Citations

Institutions

  • 2015
    • NYU Langone Medical Center
      New York, New York, United States
  • 2013
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009-2011
    • Massachusetts General Hospital
      • • Bioengineering Laboratory
      • • Department of Orthopaedic Surgery
      Boston, Massachusetts, United States
    • Boston College, USA
      Boston, Massachusetts, United States
  • 2010
    • Hospital for Special Surgery
      • Department of Orthopaedic Surgery
      New York City, New York, United States