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. 2021 May 15:36:100889.
doi: 10.1016/j.eclinm.2021.100889. eCollection 2021 Jun.

The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis

Shane Shahrestani  1   2 , Joshua Bakhsheshian  1 , Xiao T Chen  3 , Andy Ton  3 , Alexander M Ballatori  3 , Ben A Strickland  1 , Djani M Robertson  4 , Zorica Buser  3 , Raymond Hah  3 , Patrick C Hsieh  1 , John C Liu  1 , Jeffrey C Wang  3
Affiliations

The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis

Shane Shahrestani et al. EClinicalMedicine. .

Abstract

Background: Modifiable risk factors (MRFs) represent patient variables associated with increased complication rates that may be prevented. There exists a paucity of studies that comprehensively analyze MRF subgroups and their independent association with postoperative complications in patients undergoing cervical spine surgery. Therefore, the purpose of this study is to compare outcomes between patients receiving cervical spine surgery with reported MRFs.

Methods: Retrospective analysis of the Nationwide Readmissions Database (NRD) from the years 2016 and 2017, a publicly available and purchasable data source, to include adult patients undergoing cervical fusion. MRF cohorts were separated into three categories: substance abuse (alcohol, tobacco/nicotine, opioid abuse); vascular disease (hypertension, dyslipidemia); and dietary factors (malnutrition, obesity). Three-way nearest-neighbor propensity score matching for demographics, hospital, and surgical characteristics was implemented.

Findings: We identified 9601 with dietary MRFs (D-MRF), 9654 with substance abuse MRFs (SA-MRF), and 9503 with vascular MRFs (V-MRF). Those with d-MRFs had significantly higher rates of medical complications (9.3%), surgical complications (8.1%), and higher adjusted hospital costs compared to patients with SA-MRFs and V-MRFs. Patients with d-MRFs (16.3%) and V-MRFs (14.0%) were independently non-routinely discharged at a significantly higher rate compared to patients with SA-MRFs (12.6%) (p<0.0001 and p = 0.0037). However, those with substance abuse had the highest readmission rate and were more commonly readmitted for delayed procedure-related infections.

Interpretation: A large proportion of patients who receive cervical spine surgery have potential MRFs that uniquely influence their postoperative outcomes. A thorough understanding of patient-specific MRF subgroups allows for improved preoperative risk stratification, tailored patient counseling, and postoperative management planning.

Funding: None.

Keywords: Drug abuse; Hypertension; Malnutrition; Obesity; Spine.

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Conflict of interest statement

Disclosures outside of submitted work: ZB-consultancy: Cerapedics, Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrics (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Research committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee- committee member; JCW- Royalties – Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options – Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors - AO Foundation (20,000 honorariums for board position, plus travel for board meetings), Society for Brain Mapping and Therapeutics, American Orthopaedic Association, Editorial Boards - Spine, The Spine Journal, Clinical Spine Surgery, Global Spine Journal; Fellowship Funding (paid directly to institution): AO Foundation. All the other authors have no conflicts to declare.

Figures

Fig. 1
Fig. 1
Patient selection flowchart.
Fig. 2
Fig. 2
Missing variables, which were imputed using the MICE algorithm. Yellow encoded missing data and blue encoded data that was not missing.
See this image and copyright information in PMC

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References

    1. Lee M.J., Konodi M.A., Cizik A.M., Weinreich M.A., Bransford R.J., Bellabarba C. Risk factors for medical complication after cervical spine surgery: a multivariate analysis of 582 patients. Spine. 2013;38:223–228. - PMC - PubMed
    1. Lee M.J., Hacquebord J., Varshney A., Cizik A.M., Bransford R.J., Bellabarba C. Risk factors for medical complication after lumbar spine surgery: a multivariate analysis of 767 patients. Spine. 2011;36:1801–1806. - PMC - PubMed
    1. Ishikura H., Ogihara S., Oka H., Maruyama T., Inanami H., Miyoshi K. Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: a multicenter observational study. PLoS One. 2017;12 - PMC - PubMed
    1. Pan Z., Huang K., Huang W., Kim K.H., Wu H., Yu Y. The risk factors associated with delirium after lumbar spine surgery in elderly patients. Quant Imaging Med Surg. 2019;9:700–710. - PMC - PubMed
    1. Zhang L., Cao H., Chen Y., Jiao G. Risk factors for venous thromboembolism following spinal surgery: a meta-analysis. Medicine (Baltimore) 2020;99:e20954. - PMC - PubMed

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