Risk Factors for Venous Thromboembolism in Children Undergoing Orthopedic Surgery.

Venous thromboembolism (VTE) is an uncommon but highly morbid and potentially preventable complication in children. This study aimed to characterize the incidence of, and risk factors for, VTE in children undergoing orthopedic surgery. A retrospective analysis was performed using the 2012 to 2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database.

Safety and Efficacy of Achilles Repair Using the Mini-Open Approach in Supine Versus Prone Position: A Retrospective Study.

Purpose Surgical repair of the Achilles tendon is a common procedure in cases of acute rupture. Open Achilles tendon surgery with a traditional extensile approach is most often performed in the prone position, but this can lead to numerous complications. The mini-open approach for repair in the supine position may avoid the risks of the prone position.

What Are the Risk Factors for Infection After Operative Treatment of Peritalar Fracture Dislocations?

Objective: To assess the risk factors associated with deep infection after operative treatment of peritalar fracture dislocations.

Design: A retrospective study was performed to identify patients who had operative treatment of a peritalar fracture dislocation over an 11-year period (2008-2019).

Setting: Level 1 trauma center.

Pediatric Supracondylar Humerus Fracture Outcomes by Pediatric and Nonpediatric Orthopedists.

Pediatric supracondylar humerus fractures are common and often require surgical intervention by an orthopedic surgeon, who may or may not have pediatric subspecialty training. This study used a large national database to assess for potential differences in perioperative outcomes for pediatric supracondylar humerus fractures treated by pediatric and nonpediatric orthopedists. A retrospective comparative cohort analysis was performed using data from the National Surgical Quality Improvement Project-Pediatric (NSQIP-P) database 2012 to 2017.

Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty.

Current literature suggests a correlation between preoperative coagulopathies and postsurgical adverse events (AEs). However, this correlation has not been specifically assessed in the total hip arthroplasty (THA) and the total knee arthroplasty (TKA) populations. Patients who underwent primary THA and TKA with coagulopathy data were identified from the 2011-2015 American College of Surgeons National Surgical Quality Improvement Program database.

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events.

Background: Although less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.

Methods: Using data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery.

Preoperative laboratory testing for total hip arthroplasty: Unnecessary tests or a helpful prognosticator.

Background: The last decade has seen increasing initiatives to improve health care delivery while decreasing financial expenditures, as particularly exemplified by the implementation of bundled payments for lower extremity arthroplasty, which hold the providers responsible for the both the quality and cost of these procedures. In this context, the utility of routine preoperative laboratory testing is unknown. The present study characterizes the associations, if any, between preoperative sodium, blood urea nitrogen (BUN), and creatinine values and the occurrence of general health adverse outcomes following total hip arthroplasty (THA).

Characteristics and Predictors of HCAHPS Nonresponse After Spine Surgery.

Study Design: Retrospective cohort study.

Objective: To assess nonresponder biases for the HCAHPS survey following spine surgery.

Summary Of Background Data: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported patient satisfaction survey.

Admission NarxCare Narcotics Scores are not Associated With Adverse Surgical Outcomes or Self-reported Patient Satisfaction Following Elective Spine Surgery.

Study Design: Retrospective cohort study OBJECTIVE.: The aim of this study was to investigate how elective spine surgery patient preoperative opioid use (as determined by admission NarxCare narcotics use scores) correlated with 30-day perioperative outcomes and postoperative patient satisfaction.

Summary Of Background Data: The effect of preoperative narcotics usage on postoperative outcomes and patient satisfaction following spine surgery has been of question.

Management of Degenerative Spondylolisthesis: Analysis of a Questionnaire Study, Correlation With a National Sample, and Perioperative Outcomes of Treatment Options.

Background: Surgical treatment for lumbar degenerative spondylolisthesis has been shown to provide better long-term outcomes than conservative treatment. However, there is variation in surgical approaches employed by surgeons. This study investigates current surgical practice patterns and compares perioperative outcomes of 3 common surgical treatments for this pathology.

High Publication Rate of Abstracts Presented at Lumbar Spine Research Society Meetings.

Background: Although publication rates from multiple orthopedic research conferences have been published in the literature, the publication rates of abstracts presented at the Lumbar Spine Research Society (LSRS) meetings have never been reported. The purpose of this study is to evaluate the publication rates from the LSRS annual meeting years 2008-2012 and then to compare those rates with that of other spine research society meetings.

Methods: Podium presentations from 2008 to 2012 and poster presentations from 2010 to 2012 were reviewed.

Adverse Events Following Posterior Lumbar Fusion: A Comparison of Spine Surgeons Perceptions and Reported Data for Rates and Risk Factors.

Background: Postoperative complications and risks factors for adverse events play an important role in both decision making and patient expectation setting. The present study serves to contrast surgeons' perceived and reported rates of postoperative adverse events following posterior lumbar fusion (PLF) and to assess the accuracy of predicting the impact of patient factors on such outcomes.

Methods: A survey investigating perceived rates of adverse events and the impact of patient risk factors on them following PLF for degenerative conditions was distributed to spine surgeons at the Lumbar Spine Research Society (LSRS) 2016 annual meeting.

What Is the Adverse Event Profile After Prophylactic Treatment of Femoral Shaft or Distal Femur Metastases?

Background: Prophylactic surgical treatment of the femur is commonly offered to patients with metastatic disease who have a high risk of impending pathologic fracture. Prophylactic fixation is associated with improved functional outcomes in appropriate patients selected based on established criteria, but the perioperative complication profile has received little attention. Given the substantial comorbidity in this population, it is important to characterize surgical risks for surgeons and patients to improve treatment decisions.

Incidence and considerations of 90-day readmissions following posterior lumbar fusion.

Background Context: Posterior lumbar fusion (PLF) is a commonly performed procedure. The evolution of bundled payment plans is beginning to require physicians to more closely consider patient outcomes up to 90 days after an operation. Current quality metrics and other databases often consider only 30 postoperative days.

Predicting Adverse Outcomes After Total Hip Arthroplasty: A Comparison of Demographics, the American Society of Anesthesiologists class, the Modified Charlson Comorbidity Index, and the Modified Frailty Index.

Introduction: No known study has compared the predictive power of the American Society of Anesthesiologists (ASA) class, modified Charlson Comorbidity Index, modified Frailty Index, and demographic characteristics for general health complications after total hip arthroplasty (THA).

Methods: Comorbidity indices and demographics from National Surgical Quality Improvement Program THA patients were evaluated for discriminative ability in predicting adverse outcomes using the area under the curve analysis from the receiver operating characteristic curves. Perioperative outcomes included any adverse event, severe adverse events, minor adverse events, extended hospital stay, and discharge to higher-level care.

Dialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery.

Background Context: The prevalence of dialysis-dependent patients in the United States is growing. Prior studies evaluating the risk of perioperative adverse events for dialysis-dependent patients are either institutional cohort studies limited by patient numbers or administrative database studies limited to inpatient data.

Purpose: The present study uses a large, national sample with 30-day follow-up to investigate dialysis as risk factor for perioperative complications independent of patient demographics or comorbidities.

General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons' Perceptions and Reported Data for Rates and Risk Factors.

Study Design: Survey study and retrospective review of prospective data.

Objectives: To contrast surgeons' perceptions and reported national data regarding the rates of postoperative adverse events following anterior cervical discectomy and fusion (ACDF) and to assess the accuracy of surgeons in predicting the impact of patient factors on such outcomes.

Methods: A survey investigating perceived rates of perioperative complications and the perceived effect of patient risk factors on the occurrence of complications following ACDF was distributed to spine surgeons at the Cervical Spine Research Society (CSRS) 2015 Annual Meeting.

Longer Operative Time Is Associated With Increased Adverse Events After Anterior Cervical Diskectomy and Fusion: 15-Minute Intervals Matter.

Little is known about the impact of operative time, as an independent and interval variable, on general health perioperative outcomes following anterior cervical diskectomy and fusion. Therefore, patients undergoing a 1-level anterior cervical diskectomy and fusion were identified in the American College of Surgeons National Surgical Quality Improvement Program. Operative time (as an interval variable) was tested for association with perioperative outcomes using a multivariate regression that was adjusted for differences in baseline characteristics.

Missing data treatments matter: an analysis of multiple imputation for anterior cervical discectomy and fusion procedures.

Background Context: The presence of missing data is a limitation of large datasets, including the National Surgical Quality Improvement Program (NSQIP). In addressing this issue, most studies use complete case analysis, which excludes cases with missing data, thus potentially introducing selection bias. Multiple imputation, a statistically rigorous approach that approximates missing data and preserves sample size, may be an improvement over complete case analysis.

Evaluating the effect of growing patient numbers and changing data elements in the National Surgical Quality Improvement Program (NSQIP) database over the years: a study of posterior lumbar fusion outcomes.

Background Context: The use of national databases in spinal surgery outcomes research is increasing. A number of variables collected by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) changed between 2010 and 2011, coinciding with a rapid increase in the number of patients included per year. However, there has been limited study evaluating the effect that these changes may have on the results of outcomes studies.

The Rothman Index Is Associated With Postdischarge Adverse Events After Hip Fracture Surgery in Geriatric Patients.

Background: The Rothman Index is a comprehensive measure of overall patient status in the inpatient setting already in use at many medical centers. It ranges from 100 (best score) to -91 (worst score) and is calculated based on 26 variables encompassing vital signs, routine laboratory values, and organ system assessments from nursing rounds from the electronic medical record. Past research has shown an association of Rothman Index with complications, readmission, and death in certain populations, but it has not been evaluated in geriatric patients with hip fractures, a potentially vulnerable patient population.

Discriminative Ability for Adverse Outcomes After Surgical Management of Hip Fractures: A Comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index.

Objectives: The Charlson comorbidity index (CCI), Elixhauser comorbidity measure (ECM), and modified frailty index (mFI) have been associated with mortality after hip fracture. The present study compares the clinically informative discriminative ability of CCI, ECM, and mFI, as well as demographic characteristics for predicting in-hospital adverse outcomes after surgical management of hip fractures.

Methods: Patients undergoing hip fracture surgery were selected from the 2013 National Inpatient Sample.

Discrepancies in the Definition of "Outpatient" Surgeries and Their Effect on Study Outcomes Related to ACDF and Lumbar Discectomy Procedures: A Retrospective Analysis of 45,204 Cases.

Study Design: This is a retrospective study.

Objective: To study the differences in definition of "inpatient" and "outpatient" [stated status vs. actual length of stay (LOS)], and the effect of defining populations based on the different definitions, for anterior cervical discectomy and fusion (ACDF) and lumbar discectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Outpatient elective posterior lumbar fusions appear to be safely considered for appropriately selected patients.

Background Context: There has been growing interest in performing posterior lumbar fusions (PLFs) in the outpatient setting to optimize patient satisfaction and reduce cost. Although still done in only a small percentage of cases, this has been more possible because of advances in surgical techniques and anesthesia. However, data on the perioperative course of outpatient compared with inpatient PLF in a large sample size are scarce.

The Rothman Index as a predictor of postdischarge adverse events after elective spine surgery.

Background Context: The Rothman Index (RI) is a comprehensive rating of overall patient condition in the hospital setting. It is used at many medical centers and calculated based on vital signs, laboratory values, and nursing assessments in the electronic medical record. Previous research has demonstrated an association with adverse events, readmission, and mortality in other fields, but it has not been investigated in spine surgery.