A comparison of cell salvage strategies in posterior spinal fusion for adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective case-control study. OBJECTIVE: To compare the efficacy of 3 blood management strategies in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) in reducing donor blood transfusion. SUMMARY OF BACKGROUND DATA: Although intraoperative cell salvage and predonated banked blood may be effective in reducing donor blood transfusion in the perioperative period, the optimal blood management strategy is unclear. A combined cell salvage strategy holds several potential advantages but has not yet been investigated. METHODS: Patients who underwent isolated PSF for AIS (n=167) were subdivided into 3 groups by perioperative blood management strategy: (1) intraoperative retransfusion of shed blood (cell saver) and predonated autologous banked blood (n=51); (2) cell saver alone (n=33); and (3) combined cell saver and postoperative collection and retransfusion of drained blood (Retransfusion drain) (n=83). Data collected included age, sex, diagnosis, body weight, number of levels fused, operative time, intraoperative and postoperative blood loss and retransfusion, preoperative and postoperative (72 h) hemoglobin and hematocrit (Hct), and amount of autologous and donor blood transfused in the perioperative period. RESULTS: Fewer patients in the cell saver and predonated blood (3.9%) and cell saver and retransfusion drain (1.2%) groups received donor transfusions than did those managed with cell saver alone (33%). There was no significant difference in the donor transfusion rate between cell saver/predonated blood and retransfusion groups. Mean postoperative Hct (72 h) was higher in the retransfusion group 3 than in the other 2 (group 3: 29.3%, group 1: 25.4%, group 2: 26.1%). There was no significant difference in the mean change in hemoglobin and Hct after surgery between the 3 groups. CONCLUSIONS: The present study demonstrates the efficacy of a combined intraoperative and postoperative cell salvage strategy in PSF for AIS, significantly reducing perioperative donor blood transfusions, maintaining physiological Hct, and conserving blood bank resources.

Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions.

Hill-Sachs lesions are a common finding in patients with glenohumeral instability. There have been numerous methods described for addressing Hill-Sachs deformity. One popular method includes transferring a portion of the infraspinatus muscle into the posterior-superior defect (remplissage) to prevent the lesion from engaging and the resultant instability. We present a method of arthroscopic remplissage whereby the lesion is addressed through transtendinous insertion of arthroscopic anchors. Once 2 anchors have been inserted, 1 limb of each suture is tied to the other anchor, the so-called pulley repair technique. This can be performed either under direct visualization in the subacromial space or blindly while the surgeon is viewing from the articular side. Once both limbs have been tied, the infraspinatus tendon nicely spans the defect, and there has been minimal morbidity to the tendon itself. We have found this method to be useful for addressing a large Hill-Sachs deformity.

Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patients.

BACKGROUND CONTEXT: The impact of patient factors and medical comorbidities on the risk of mortality and complications after spinal arthrodesis has not been well described. Prior works have been limited by small sample size, single center data, or the inability to be broadly generalized. PURPOSE: To determine if there is an association between the patient demographic factors, comorbidities, nutritional status, and surgical characteristics and the occurrence of mortality and complications after spinal arthrodesis. STUDY DESIGN: Retrospective review of prospectively collected data in the National Surgical Quality Improvement Program (NSQIP). PATIENT SAMPLE: Patients who underwent spinal arthrodesis and had data registered with the NSQIP between 2005 and 2010. OUTCOME MEASURES: Primary outcomes were death or any complication after spinal arthrodesis. Secondary measures were the development of a specific complication, including wound infection, thromboembolic disease, or cardiac arrest/myocardial infarction. METHODS: The data set of the NSQIP from 2005 to 2010 was queried to identify all patients who underwent spinal arthrodesis. Demographic information, body mass index (BMI), medical comorbidities, arthrodesis procedure, operative time, American Society of Anesthesiologists (ASA) classification, and preoperative albumin were recorded for all patients identified. Mortality, the development of postoperative complications, and the presence of specific complications were also abstracted. Risk factors for mortality and complications were initially evaluated using chi-square and univariate logistic regression analyses. The risk factors that maintained p values less than .2 in univariate analysis were then combined in a multivariate fashion that identified significant, independent, predictors of mortality and complications while controlling for other factors present in the model. Sensitivity analysis was also performed, discriminating between the impact of risk factors on major and minor complications and the relative contribution to overall risk of morbidity. Multivariate analysis resulted in odds ratios (ORs) with 95% confidence intervals (CIs) for each risk factor. Only those predictors with ORs and 95% CI exclusive of 1.0 and p values less than .05 were considered statistically significant. RESULTS: In all, 5,887 patients who underwent spinal arthrodesis were identified. The average age of patients was 55.9 (±14.5) years. Twenty-five (0.42%) patients died after surgery, whereas 608 (10%) sustained a complication. Wound infection was the most common specific complication occurring in 2% of the cohort. Age (p=.03) and pulmonary conditions (p=.002) were found to have a significant association with the risk of mortality. Age exceeding 80 years was found to carry the highest risk of mortality. Age, pulmonary conditions, BMI, history of infection, ASA classification more than 2, neurologic conditions, resident (i.e., trainee) involvement, and procedural times exceeding 309 minutes increased the risk of complications. Body mass index, ASA classification more than 2, resident involvement, and procedural times exceeding 309 minutes were associated with the risk of infection. Although limited to univariate analysis, serum albumin 3.5 g/dL or less increased the risk of mortality, complications, wound infection, and thromboembolic disease. The OR for postoperative mortality among patients with albumin 3.5 g/dL or less was 13.8 (95% CI, 4.6-41.6; p<.001). CONCLUSIONS: Several factors, including patients' age, BMI, ASA classification more than 2, pulmonary conditions, procedural times, and nutritional status likely influence the risk of postoperative morbidity to varying degrees. The risk factors identified here may be more generalizable to the American population as a whole because of the design and methodology of the NSQIP in comparison with previously published studies.

Publication rate of presentations at an annual military orthopaedic meeting.

Many research abstracts presented at orthopaedic conferences do not undergo a formal editorial, or peer-review process; however, abstracts are frequently referenced in textbooks and influence clinical practice. The purpose of this study was to determine the publication rate of abstracts formally presented at the Society of Military Orthopaedic Surgeons (SOMOS) annual meetings from 1998 to 2006 that went to full-text publication. Using Google Scholar and PubMed, a literature search was performed for each abstract presented at the annual SOMOS meeting in the years 1998-2006, to calculate the overall full-text publication rate, the average duration from presentation to publication, and the distribution of publications in the various journals. A total of 770 abstracts were presented at the annual SOMOS meetings. The overall full-text publication rate at a minimum of 3 years was 45.7% (352 publications). The average time from presentation to publication was 2.7 years. The published articles appeared in 65 peer-reviewed journals, with notable distribution in Spine (10.0%), The American Journal of Sports Medicine (9.4%), and The Journal of Bone and Joint Surgery (9.4%). The full-text publication rate of abstracts presented at the annual SOMOS meetings compares favorably with that of other major orthopaedic conferences in the United States. Nonetheless, more than half of abstracts presented at the SOMOS meetings remain unpublished.