Post-operative hyperglycemia and its association with surgical site infection after instrumented spinal fusion.
Spine surgery; Hyperglycemia; Spinal fusion; serum glucose; Surgical site infection
OBJECTIVE: To evaluate the correlation between postoperative hyperglycemia and surgical site infection among patients who underwent primary instrumented spinal fusion surgery. PATIENTS AND METHODS: We collected data on all eligible patients treated at our institution over the course of 2005-2017. We defined serum hyperglycemia using a primary threshold of serum glucose ≥140 mg/dL and used ≥115 mg/dL as a secondary test. We used logistic regression techniques to evaluate unadjusted results for serum hyperglycemia on revision surgeries for infection, followed by sequential adjustment for sociodemographic and procedural characteristics. RESULTS: We included 3664 patients. Surgical site infections occurred in 4%. Post-operative hyperglycemia was significantly associated with a higher rate of revision surgery for infection (p = 0.02). Following adjusted analysis, hyperglycemia remained a statistically significant predictor for revision surgery due to infection (OR 2.19; 95 % CI 1.13, 4.25). Similar results were evident when using the lower threshold of ≥115 mg/dL (OR 2.36; 95 % CI 1.06, 5.23). CONCLUSIONS: This study highlights the importance of measuring serum glucose after spinal fusion and the need for heightened surveillance and/or treatment in those who exhibit postoperative hyperglycemia. In this context, it could be advantageous to use a lower threshold for hyperglycemia (115 mg/dL) in order to trigger interventions for glycemic control.
Upadhyaya S; Lopez WY; Goh BC; Chen AF; Blucher JA; Beck A; Kang JD; Schoenfeld AJ
Clinical Neurology and Neurosurgery
2020
2020-07-20
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.clineuro.2020.106100" target="_blank" rel="noreferrer noopener">10.1016/j.clineuro.2020.106100</a>
Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients.
Opioid dependence; Spine surgery; Prediction; Anterior cervical discectomy and fusion; Lumbar disc herniation; Risk score
BACKGROUND CONTEXT: The opioid epidemic has increased scrutiny of health-care practices and care episodes, such as surgery, that increase the risk of opioid dependence. The Stopping Opioids after Surgery (SOS) score to predict sustained prescription opioid use was previously developed within a population of patients receiving general surgery, orthopedic, and urologic procedures. Notably, the performance for this score has not been assessed in a spine surgical cohort. PURPOSE: We sought to validate the SOS score in a series of patients undergoing cervical and lumbar spine surgery, including inpatient and outpatient cohorts. STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals. OUTCOME MEASURES: Sustained prescription opioid use was defined as opioid prescription without interruption for 90 days or longer following surgery. METHODS: The performance of the SOS score was assessed in the study population by calculating the c-statistic, receiver-operating curve, and observed rates of sustained prescription opioid use. RESULTS: Among 7,027 patients included in this study, 2,374 (33.8%) underwent anterior cervical discectomy and fusion and 4,653 (66.2%) underwent surgery for lumbar disc herniation. The median age was 46 (interquartile range=38.0-53.5). Overall, 604 patients (8.6%) had prolonged opioid prescription. The c-statistic of the risk score was 0.764. The sensitivity of the score at the low risk cutoff of 30 was 0.72. At the high-risk cutoff of 60, the specificity was 0.99. The observed risk (95% confidence interval) of prolonged opioid prescription was 3.6% (3.1-4.2) in the low-risk group (scores <30), 17.2% (15.6-18.7) in the intermediate-risk group (scores 30-60), and 46.0% (36.2-55.9) in the high-risk group (scores >60). CONCLUSIONS: We have validated the use of a clinically relevant bedside risk score for sustained prescription opioid use after spine surgery. The score's ease of use, combined with its exceptional performance, renders it a valuable tool for spine care providers in counseling patients and determining appropriate postdischarge management to prevent sustained opioid use.
Karhade Aditya V; Chaudhary Muhammad Ali; Bono Christopher M; Kang James D; Schwab Joseph H; Schoenfeld Andrew J
The Spine Journal: Official Journal Of The North American Spine Society
2019
2019-10
Journal Article
<a href="http://doi.org/10.1016/j.spinee.2019.05.001" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2019.05.001</a>
PMID: 31078697
Assessment of outcome following the use of recombinant human bone morphogenetic protein-2 for spinal fusion in the elderly population
Allografts; anterior cervical-spine; Bone morphogenetic protein-2; clinical article; ectopic bone; Elderly; graft; lumbar interbody fusion; Neurosciences & Neurology; off-label use; older-adults; Outcome Assessment (Health Care); perioperative complications; rhBMP-2; rhBMP-2; Spinal fusion; Spine surgery; Surgery; Surgery
INTRODUCTION: Although the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for spinal fusion has been fairly studied in the general population, relatively little research has been conducted on its use in the elderly patient demographic despite this population's growth. The authors sought to examine the clinical efficacy, complication rate, and cost-effectiveness of rhBMP-2 use in elderly patients undergoing spinal fusion surgery. EVIDENCE ACQUISITION: We conducted a systematic review of the published literature for elderly patients that underwent spinal fusion surgery with the use of rhBMP-2. A systematic search was performed utilizing the PUBMED and MEDLINE databases in order to identify all papers dealing with recombinant human Bone Morphogenic Protein-2 use in patients over the age of 60 years. EVIDENCE SYNTHESIS: Twenty-five papers were identified that met our inclusion criteria. While successful fusion, improvement in pain, and improved quality of life were encountered in elderly patients who were treated with fusions surgery along with rhBMP-2, there were several complications that were encountered including seroma formation, pleural effusions, and bone non-union. CONCLUSIONS: The literature demonstrated that BMP serves as a potent osteoinductive agent in the elderly with similar efficacy to bone auto graft. Although use of BMP showed mixed results and had higher initial costs, when taken into account with complication correction and costs, BMP usage appears to be more economically beneficial overall. Future studies are needed to clarify the clinical significance of the complications encountered in elderly patients treated with rhBMP-2. Future research can assist in developing recommendations which can minimize these risks in the elderly patient demographic.
Shweikeh F; Hanna G; Bloom L; Sayegh E T; Liu J; Acosta F L; Drazin D
Journal of Neurosurgical Sciences
2016
2016-06
Journal Article
n/a
An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions.
Female; Humans; Male; Middle Aged; Aged; Retrospective Studies; Treatment Outcome; Longitudinal Studies; treatment; ASIA = American Spinal Injury Association; Bacterial Infections/*complications/*epidemiology/therapy; CNS infection; Electronic Health Records/statistics & numerical data; Epidural Abscess/*complications/*epidemiology/therapy; management algorithm; MRSA = methicillin-resistant Staphylococcus aureus; SEA = spinal epidural abscess; spinal epidural abscess; spine surgery
OBJECT: Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. METHODS: An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. RESULTS: A total of 106 patients with bacterial SEA were identified. The mean +/- SD age of patients was 63.3 +/- 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean +/- SD follow-up time of 8.4 +/- 26 weeks (range 0-192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. CONCLUSIONS: Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36-72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.
Shweikeh Faris; Saeed Kashif; Bukavina Laura; Zyck Stephanie; Drazin Doniel; Steinmetz Michael P
Neurosurgical focus
2014
2014-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3171/2014.6.FOCUS14146" target="_blank" rel="noreferrer noopener">10.3171/2014.6.FOCUS14146</a>