Publications by authors named "Alexander Vaccaro"
Study Design: Retrospective cohort study.
Objective: To determine hospital length of stay (LOS) and long-term opioid consumption among patients who received inpatient multimodal analgesia following lumbar spine surgery, as opposed to those who received opioids alone.
Summary Of Background Data: Opioids have long been the historical choice for managing postoperative pain.
Study Design: Retrospective cohort.
Objective: To analyze the annual trends in the most prevalent topics, journals, and geographic regions of the top 100 spine surgery articles, as determined by altmetric attention scores (AASs). We also describe the relationship between AAS and traditional article metrics.
Background And Objectives: A few studies have compared the value (outcomes per dollar spent) provided by transforaminal endoscopic discectomy (TED) vs microdiscectomy (MD) for lumbar disc herniations. Here, we attempt to address this gap using a novel Operative Value Index (OVI), which combines a procedure-specific patient-reported outcome with intraoperative cost data based on time-driven activity-based costing.
Methods: MD (n = 95) and TED (n = 23) performed by neurosurgeons at our institution from 2017 to 2022 were retrospectively identified.
Article Synopsis
- A retrospective cohort study aimed to compare three socioeconomic status (SES) indexes and their association with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion.
- The study involved identifying adult patients who underwent these surgeries at a medical center from 2014 to 2020, analyzing their preoperative conditions and outcomes based on SES classifications derived from community-level indexes.
- Results indicated that while patients from lower SES communities had worse preoperative outcomes, the community-wide SES indexes were ineffective in predicting surgical outcomes post-surgery.
Study Design: Retrospective cohort.
Objective: To explore the relationship between symptomatic pseudoarthrosis requiring revision after lumbar fusion and antidepressant use.
Summary Of Background Data: Approximately 25% of patients undergoing spine surgery are taking antidepressants.
Background Context: Previous research has demonstrated an association between socioeconomic status (SES) and patient health, specifically noting that patients of lower SES have poor health outcomes. Understanding how social factors, including socioeconomic status (SES), relate to disparities in health outcomes is critical to closing gaps in equitable care to patients. While several studies have examined the effect of SES on postoperative spine outcomes, there is limited spine literature evaluating SES in the context of barriers to spine care.
View Article and Find Full Text PDFObjective: A quarter of spine surgery patients take antidepressants. Basic science research has suggested serotonergic antidepressants impair platelet function. This has been supported by only a small number of works in the setting of spine surgery.
View Article and Find Full Text PDFObjective: Venous thromboembolism (VTE) is a serious postoperative adverse event after spine surgery. In patients with pain refractory to typical multimodal analgesia regimens after spine surgery, whom are often chronic opioid users, perioperative ketamine is an alternative analgesic that has grown in popularity. The aim of this study is to assess the risk of VTE in chronic opioid users undergoing spine surgery.
View Article and Find Full Text PDFBackground: The purpose of this study is to determine the impact of community-level socioeconomic status (SES) on surgical outcomes and patient-reported outcome measures (PROMs) following revision lumbar fusion.
Methods: Adult patients who underwent revision lumbar fusion surgery from 2011-2021 were grouped by Distressed Community Index (DCI) into Prosperous, Comfortable, Mid-tier, and At-Risk/Distressed cohorts. Demographics, surgical information, and PROMs were compared based on DCI community status.
The prevalence of depression and anxiety in patients with metastatic disease to the spine.
J Craniovertebr Junction Spine
September 2024
Article Synopsis
- The study highlights that about 20% of patients with metastatic spine disease experience depression, while approximately 17% struggle with anxiety, emphasizing the need for mental health awareness in this population.
- Data was collected from patients over 18 years old who underwent treatment for metastatic spinal disease from 2017 to 2022, revealing a significant number of both depression and anxiety diagnoses among them.
- The findings suggest that spine surgeons should actively screen for mental health issues in patients with spinal metastases to ensure timely referrals for psychological support.
Study Design: Retrospective cohort study.
Objective: To compare peri- and postoperative infection rates among patients with mild to moderate penicillin allergies who receive cefazolin vs vancomycin as prophylaxis for lumbar fusion. Additionally, we sought to determine if patients receiving cefazolin exhibited any clinical symptoms suggestive of drug-induced hypersensitivity reactions, and to compare those rates to patients who received vancomycin.
Initial feasibility evaluation of the RISES system: An innovative and activity-based closed-loop framework for spinal cord injury rehabilitation and recovery.
J Rehabil Assist Technol Eng
October 2024
Article Synopsis
- - The study investigated the safety and feasibility of a new spinal electrical stimulation technology called RISES, which allows real-time adjustments to stimulation settings while collecting various data.
- - Four participants with spinal cord injuries (SCIs) were tested, and results showed no serious adverse effects, with stable skin integrity, vital signs, and pain levels; however, fatigue increased post-stimulation.
- - The trial compared open-loop and closed-loop stimulation methods, finding that while open-loop sessions had longer stimulation durations, there were no significant differences in setup time or other health measures between the two methods.
Article Synopsis
- This study examined trends in spinal cord injury (SCI) admissions in the U.S. over the past decade, focusing on patients under and over 70 years old.
- Data from 8,137 patients revealed that while falls decreased among the elderly, vehicle accidents increased, showing a shift in causes of SCI.
- Notably, while complete injuries diminished overall and recovery rates improved for certain injuries, the mortality rates for elderly patients dropped significantly in both hospital stays and one-year follow-ups.
Article Synopsis
- Total disc replacement (TDR) is an alternative to anterior cervical discectomy and fusion (ACDF), and this study compares their costs as we shift towards value-based healthcare.
- Using time-driven activity-based costing (TDABC), researchers reviewed the costs of both procedures, analyzing direct and indirect costs through observation and data collection from various departments.
- The results showed that TDRs had significantly higher total intraoperative costs ($12,026) compared to ACDFs ($6,776), with the majority of the cost difference attributed to more expensive supply items, particularly implants.
Background: Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States.
Methods: In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons.
Article Synopsis
- Lumbar disc herniation (LDH) involves the displacement of disc material, causing symptoms like radiculopathy and significant healthcare utilization.
- Current treatments include epidural steroid injections (ESIs) and lumbar discectomy, but ESIs have limited long-term benefits and potential risks, while discectomy can lead to complications and recurrent issues.
- Emerging treatments in development aim to provide better, less invasive options for LDH, including sustained-release ESIs and new methods to reduce disc material without surgery.
Background Context: Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in nontertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are noninferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed.
View Article and Find Full Text PDFStudy Design: Broad narrative review.
Objectives: To review and summarize the evolution of spinopelvic fixation (SPF) and its implications on clinical care.
Methods: A thorough review of peer-reviewed literature was performed on the historical evolution of sacropelvic fixation techniques and their respective advantages and disadvantages.
Article Synopsis
- The study aims to identify key challenges in managing traumatic spinal cord injuries (TSCI) in developing countries, focusing on various care stages including injury prevention and hospital care.
- The research involved a systematic review of 82 articles, highlighting issues such as personal and financial impacts of TSCI, lack of trained staff, and delays in treatments across different care levels.
- The conclusion emphasizes the need for targeted research on injury prevention and pre-hospital care, urging the development of tailored strategies that enhance education and resource distribution in these regions.
Study Design: Systematic Review and meta-analysis.
Objective: To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e.
Article Synopsis
- The study aimed to assess whether the baseline prognostic nutritional index (PNI) could predict surgical outcomes in patients with native spine infections.
- Researchers analyzed records of adult patients diagnosed with spine infections from 2017-2022, calculating their PNI based on serum albumin and lymphocyte count to categorize them into high or low PNI groups.
- Results showed that patients with low PNI were more likely to require surgery and experience complications compared to those with high PNI, suggesting that PNI is a valuable indicator for assessing the severity of spinal infections and potential need for surgery.
Objective: To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021.
Summary Of Background Data: A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention.
Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.
Global Spine J
November 2024
Study Design: Literature review with clinical recommendations.
Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders.
Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice.