RESUMEN
Methods@#Patients who underwent PCDF from 2005 to 2018 were identified using the National Surgical Quality Improvement Program database. Regression analysis was utilized to compare primary outcomes between surgical settings and evaluate for predictors thereof. @*Results@#We identified 8,912 patients. Unadjusted analysis revealed that outpatients had lower readmission (4.7% vs. 8.8%, p =0.020), reoperation (1.7% vs. 3.8%, p =0.038), and morbidity (4.5% vs. 11.2%, p <0.001) rates. After adjusting for baseline differences, readmission, reoperation, and morbidity no longer statistically differed between surgical settings. Outpatients had lower operative time (126 minutes vs. 179 minutes) and levels fused (1.8 vs. 2.2) (p <0.001). Multivariate analysis revealed that age (p =0.008; odds ratio [OR], 1.012), weight loss (p =0.045; OR, 2.444), and increased creatinine (p <0.001; OR, 2.233) independently predicted readmission. The American Society of Anesthesiologists (ASA) classification of ≥3 predicted reoperation (p =0.028; OR, 1.406). Rehabilitation discharge (p <0.001; OR, 1.412), ASA-class of ≥3 (p =0.008; OR, 1.296), decreased hematocrit (p <0.001; OR, 1.700), and operative time (p <0.001; OR, 1.005) predicted morbidity. @*Conclusions@#The 30-day outcomes were statistically similar between surgical settings, indicating that PCDF can be safely performed as an outpatient procedure. Surrogates for poor health predicted negative outcomes. These results are particularly important as we continue to shift spinal surgery to outpatient centers. This importance has been highlighted by the need to unburden inpatient sites, particularly during public health emergencies, such as the coronavirus disease 2019 pandemic.
RESUMEN
Methods@#Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥18 years who underwent surgery for spinal deformity between 2011 and 2019 were identified and included. To ensure a homogenous patient cohort, those who underwent anterior-only and concurrent anterior-posterior fusions were excluded. Propensity score matching analysis was performed, and Mann-Whitney U test, Pearson chi-square test, or Fisher’s exact test were used to compare matched cohorts as appropriate. @*Results@#A total of 326 patients who underwent revision surgery were matched with 206 primary surgery patients via propensity score matching. Demographic characteristics, comorbidities, preoperative laboratory values, and readmission and reoperation rates were not significantly different between groups. The revision surgery group had significantly higher mean RVUs per minute than that of the primary surgery group (0.331 vs. 0.249, p <0.001), as well as rates of morbidity and blood transfusion. @*Conclusions@#Compared to primary surgery, revision surgery for ASD is associated with significantly higher RVUs per minute and total RVUs and higher rates of 30-day morbidity and blood transfusions. Readmission and reoperation rates are similar between surgeries.
RESUMEN
Numerous studies in the past have addressed the issue of ambulation in children with spina bifida. Some researchers have demonstrated the significant benefits of walking in patients with myelomeningocele. Those who walked as children had fewer fractures and pressure sores compared to those who used a wheelchair from early in life. They also were more independent and had a better ability to transfer. In order to encourage the achievement and maintenance of ambulatory skills, it is necessary to have realistic expectations for a patient with a given neurosegmental level. In order to guide those expectations one needs to know the patterns of ambulation. Due to the improvements in orthotic design, orthopaedic and neurosurgical procedures and possible change in outcome, there is a need to re-define the patterns of ambulation among myelomeningocele patients and compare those to the previously reported results. The study is a cross-sectional restrospective analysis of the ambulatory status of patients attending our myelomeningocele clinic at Blythedale Children's Hospital in Valhalla, NewYork over a one-year period from January to December of 1999. Patients and/or their parents have been interviewed over the telephone and the ambulation data was obtained. The clinic and hospital charts were reviewed. The neurological level was assigned based on the last neurological examination. Seventy-four patients were included in the study; 18% of patients had their lesions at the thoracic level, 22% at high-lumbar [L1-2], 12% at mid-lumbar [L3], 38% at low-lumbar [L4-5] and 10% at the sacral level. In the thoracic level group 15% of the patients were community ambulators, in the high-lumbar group 0%, in the mid-lumbar 33%, in the low-lumbar 71% and in the sacral level group 88%. The mean age for ambulation commencement for patients with thoracic level lesions was 5.7 years, for high-lumbar 4.1 years, for mid-lumbar 3.8 years, for low-lumbar 3.0 years and with sacral level lesions 1.2 years. Sixty percent of the thoracic level patients, 100% of the patients at high-lumbar levels, 40% of patients at a mid-lumbar level, and 20% at low-lumbar levels and none at sacral levels have ceased ambulation. The mean age for ambulation cessation for patients with thoracic level lesions was 12 years, for high-lumbar 8.9 years, for mid-lumbar 15 years, and for low-lumbar 11.6 years. No patients with sacral level lesions who acquired ambulation skills stopped walking in our study. Our results have demonstrated that the overall pattern of acquisition and loss of ambulatory skills among myelomeningocele patients has not changed substantially in the past several years, despite various technical advances in this field