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Study Design: Retrospective cohort study.Objective: The aim of this study was to evaluate the safety of two-level cervical disc replacement (CDR) in the outpatient setting.Summary Of Background Data: Despite growing interest in CDR, limited data exist evaluating the safety of two-level CDR in the outpatient setting.Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for all two-level anterior cervical discectomy and fusion (ACDF) and CDR procedures between 2015 and 2018. Demographics, comorbidities, and 30-day postoperative complication rates of outpatient two-level CDR were compared to those of inpatient two-level CDR and outpatient two-level ACDF. Radiographic data are not available in the NSQIP.Results: A total of 403 outpatient CDRs were compared to 408 inpatient CDRs and 4134 outpatient ACDFs. Outpatient CDR patients were older and more likely to have pulmonary comorbidities compared to inpatient CDR (P < 0.03). Outpatient CDR patients were less likely to have an American Society of Anesthesiologists class ≥2 and have hypertension compared to outpatient ACDF patients (P < 0.0001). Outpatient CDR had a lower 30-day readmission rate (0.5% vs. 2.5%, P = 0.02) and lower 30-day reoperation rate (0% vs. 1%, P = 0.047) compared to inpatient CDR. Outpatient CDR had a lower readmission rate (0.5% vs. 2.1%, P = 0.03) compared to outpatient ACDF, but there was no difference in reoperation rates between the two procedures (0% vs. 0.8%, P = 0.07). Outpatient CDR had an overall complication rate of 0.2%, inpatient CDR had a complication rate of 0.9%, and outpatient ACDF had a complication rate of 1.3%. These differences were not significant.Conclusion: To our knowledge, this is the largest multicenter study examining the safety of two-level outpatient CDR procedures. Outpatient two-level CDR was associated with similarly safe outcomes when compared to inpatient two-level CDR and outpatient two-level ACDF. This suggests that two-level CDR can be performed safely in the outpatient setting.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Secondary analysis of a large administrative database.Objective: The objectives of this study are to: 1) identify the incidence and cause of 90-day readmissions following primary elective lumbar spine surgery, 2) offer insight into potential risk factors that contribute to these readmissions, and 3) quantify the cost associated with these readmissions.Summary Of Background Data: As bundled-payment models for the reimbursement of surgical services become more popular in spine, the focus is shifting toward long-term patient outcomes in the context of 90-day episodes of care. With limited data available on national 90-day readmission statistics available, we hope to provide evidence that will aid in the development of more cost-effective perioperative care models.Methods: Using ICD-9 coding, we identified all patients 18 years of age and older in the 2014 Nationwide Readmissions Database (NRD) who underwent an elective, inpatient, primary lumbar spine surgery. Using multivariate logistic regression, we identified independent predictors of 90-day readmission while controlling for a multitude of confounding variables and completed a comparative cost analysis.Results: We identified 169,788 patients who underwent a primary lumbar spine procedure. In total 4268 (2.5%) were readmitted within 90 days. There was no difference in comorbidity burden between cohorts (readmitted vs. not readmitted) as quantified by the Elixhauser Comorbidity index. Independent predictors of increased odds of 90-day readmission were: anemia, uncomplicated diabetes and diabetes with chronic complications, surgical wound disruption and acute myocardial infarction at the time of the index admission, self-pay status, and an anterior surgical approach. Implant complications were identified as the primary related cause of readmission. These readmissions were associated with a significant cost increase.Conclusion: There are clearly identifiable risk factors that increase the odds of hospital readmission within 90 days of primary lumbar spine surgery. An overall 90-day readmission rate of 2.5%, while relatively low, carries significantly increased cost to both the patient and hospital.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective cohort study.Objective: The aim of this study was to evaluate the effect of metabolic syndrome (MetS) on 30-day morbidity and mortality following elective lumbar spinal fusion.Summary Of Background Data: MetS is a variable combination of hypertension, obesity, elevated fasting plasma glucose, and dyslipidemia.MetS has been associated with an increased risk of postoperative morbidity and mortality in multiple surgical settings. To our knowledge, the effect of MetS on 30-day outcomes following elective lumbar spinal fusion has not been well studied.Methods: An analysis of ACS-NSQIP data was performed between 2006 and 2013. Patients undergoing elective posterior lumbar fusion were identified. Emergency procedures, infections, tumor cases, and revision surgeries were excluded. Patients were defined as having MetS if they had a history of hypertension requiring medication, diabetes, and a body mass index (BMI) ≥30 kg/m.Results: One thousand five hundred ninety (10.2%) patients with MetS were identified. A mild increase in major (P = 0.040) and minor complications (P = 0.003) in patients with MetS was noted. MetS was associated with increased rates of pulmonary complications (1.9% compared with 1.0%; P = 0.001), sepsis (1.7% compared with 0.9%; P = 0.005), and acute post-op renal failure (0.4% compared with 0%; P < 0.001). Multivariate analysis confirmed MetS to be an independent predictor of pulmonary complications [odds ratio (OR) 1.51; 95% confidence interval (95% CI 1.00-2.27); P = 0.048], sepsis (OR 1.56; 95% CI 1.01-2.42; P = 0.039), and acute postoperative renal failure (OR 6.95; 95% CI 2.23-21.67; P = 0.001). MetS status was associated with a mild increase in total hospital length of stay (4.38 compared with 3.81 days; P < 0.001).Conclusion: While MetS is a predictor of postoperative acute renal failure, it only slightly increases the risk of overall complications and is not associated with increased rates of 30-day reoperations or readmissions following elective lumbar fusion.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study.Objective: To evaluate hospital outcomes in dialysis-dependent patients undergoing elective lumbar surgeries.Summary Of Background Data: Because of their overall poor health status and concomitant comorbidity burden, spinal surgery in dialysis-dependent patients represents a significant challenge to spine surgeons. Large studies evaluating their immediate postoperative outcomes in elective lumbar surgery are lacking.Methods: Utilizing the National Inpatient Sample, an estimated 1834 dialysis-dependent patients undergoing elective lumbar spine surgery for degenerative lumbar conditions were compared to an estimated 2,522,594 non-dialysis-dependent patients undergoing the same procedures between 2002 and 2012. Our primary outcomes measures included postoperative complication rates, hospital length of stay, and total hospital costs.Results: Mean age of dialysis-dependent patients was 64.2 years compared to 59.9 in the non-dialysis-dependent cohort (P < 0.001). Dialysis-dependent patients had substantially higher inpatient mortality rates (1.8% vs 0.1%; P < 0.001), major complication rates (8.1% vs 1.1%; P < 0.001), and an increased need for blood transfusion (18.3% vs 12.5%; P < 0.001). Multivariate analysis revealed that dialysis dependence independently increased odds of in-hospital mortality (odds ratio = 8.30; 95% confidence interval 5.78-11.93; P < 0.001) and odds of a major postoperative complication (odds ratio = 3.63; 95% confidence interval 3.49-3.89; P < 0.001). Dialysis dependence was associated with an increased mean length of stay of 3.3 days (P < 0.001) and a significant increase in hospital costs when stratified by procedure type.Conclusion: Dialysis dependence is associated with poorer immediate postoperative outcomes and increased hospital costs when compared to non-dialysis-dependent patients. In addition, an increased need for postoperative transfusion should be anticipated in this patient population. Further studies are warranted to confirm these findings.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Up to 68% of the elderly population has spinal deformity which is a growing concern given that average lifespan is increasing. Adult spinal deformity surgeries are generally very taxing and come with significant morbidity. It is of interest to see how adult spinal surgery outcomes compare between the age groups of 65-74.9 and 75+ years of age. PURPOSE Compare outcomes and complications between 65-74.9 and 75+ year olds undergoing surgery for spinal deformity. STUDY DESIGN/SETTING Retrospective study of a prospectively collected database at one center. PATIENT SAMPLE All patients 65years and older who underwent deformity surgery of the thoracolumbar spine with a minimum of 24 months' follow-up (range 25–186 months). OUTCOME MEASURES Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), radiographic outcomes, postoperative complications and need for additional surgery. METHODS Patients were divided based on age into 65-74.9 or 75+ groups. Radiographic parameters were measured preop, postop, and at 2years. VAS and ODI were collected preop, 1 year, and 2years. Comorbidities included were based on the Charlson Comorbidity Index (CCI) and compared to the incidence of complications and need for further surgery. RESULTS A total of 176 patients were included in this study. A total of 130 were aged 65-74.9 and 46 were older than 75. Average follow-up was 69.1 months (25–186 months). No demographic differences other than age and BMI (65–74.9:BMI 27.3, 75+:BMI 23.0, p=.003) were of significance. Both age groups had improvements in their radiographic parameters postop which was maintained at 2years except that there was an overall increase in thoracic kyphosis. In the 65-74.9 group, 47.9% with 0-2 comorbidities had a complication whereas 54.5% with ≥3 comorbidities had a complication. In the 0-2 group, 37.8% required additional surgery compared to 45.5% in the ≥3 comorbidities group. In the 75+ group 61.9% with 0-2 comorbidities had a complication whereas 50.0% with ≥3 comorbidities had a complication. In the 0-2 group, 38.1% required additional surgery compared to 50.0% in the ≥3 comorbidities group. Comparing the different age groups with similar comorbidity burden in regards to complications and need for additional surgery yielded no statistically significant difference between groups. The 65-74.9 group had a 2.6 decrease in their VAS at 2years whereas the 75+ group had a 2.5 decrease. A 15.4 improvement in the preop ODI was seen at 2years in the 65-74.9 group whereas the 75+ group also had a 15.4 improvement. The preop and 2-year VAS and ODI scores were not found to have a statistically significant difference between groups. CONCLUSIONS Analysis of our study population indicates that there is not a statistically significant difference between the outcomes and complications of deformity surgery in patients 75 years and older when compared to a younger elderly population. It also does not appear that a ≥3 comorbidity burden has a significant impact on the complications or need for additional surgery in our elderly spinal deformity surgery population. [ABSTRACT FROM AUTHOR]