Navigated versus conventional pediatric spinal deformity surgery: Navigation independently predicts reoperation and infectious complications.

Context: Literature on treating pediatric spinal deformity with navigation is limited, particularly using large nationally represented cohorts. Further, the comparison of single-institution data to national-level database outcomes is also lacking. Aim: (1) To compare navigated versus conventional posterior pediatric deformity surgery based on 30-day outcomes and perioperative factors using the National Surgical Quality Improvement Program (NSQIP) database and (2) to compare the outcomes of the NSQIP navigated group to those of fluoroscopy-only and navigated cases from a single-institution. Settings and Design: Retrospective cohort study. Subjects and Methods: Pediatric patients who underwent posterior deformity surgery with and without navigation were included. Primary outcomes were 30-day readmission, reoperation, morbidity, and complications. The second part of this study included AIS patients < 18 years old at a single institution between 2015 and 2019. Operative time, length of stay, transfusion rate, and complication rate were compared between single-institution and NSQIP groups. Statistical Analysis Used: Univariate analyses with independent t-test and Chi-square or Fisher's exact test was used. Multivariate analyses through the application of binary logistic regression models. Results: Part I of the study included 16,950 patients, with navigation utilized in 356 patients (2.1%). In multivariate analysis, navigation predicted reoperation, deep wound infection, and sepsis. After controlling for operative year, navigation no longer predicted reoperation. In Part II of the study, 288 single institution AIS patients were matched to 326 navigation patients from the NSQIP database. Operative time and transfusion rate were significantly higher for the NSQIP group. Conclusions: On a national scale, navigation predicted increased odds of reoperation and infectious-related events and yielded greater median relative value units (RVUs) per case but had longer operating room (OR) time and fewer RVUs-per-minute. After controlling for operative year, RVUs-per-minute and reoperation rates were similar between groups. The NSQIP navigated surgery group was associated with significantly higher operative time and transfusion rates compared to the single-institution groups.

Adjunct pelvic fixation in short-to-medium segment degenerative fusion constructs independently predicts readmission and morbidity.

Context: Despite increasing utilization of fusion to treat degenerative pathology, few studies have evaluated outcomes with pelvic fixation (PF). This is the first large-scale database study to compare multilevel fusion with and without PF for degenerative lumbar disease. Aim: The aim of this study was to compare the 30-day outcomes of multilevel lumbar fusion with and without PF. Settings and Design: This was a retrospective cohort study. Subjects and Methods: Lumbar fusion patients were identified using the National Surgical Quality Improvement Program database. Regression was utilized to analyze readmission, reoperation, morbidity, and specific complications and to evaluate for predictors thereof. Statistical Analysis Used: Student's t-test was used for continuous variables and Chi-squared or Fisher's exact test was used for categorical variables. Variables significant in the univariate analyses (P < 0.05) and PF were then evaluated for significance as independent predictors and control variables in a series of multivariate logistic regression analyses of primary outcomes. Results: We identified 38,413 patients. PF predicted 30-day readmission and morbidity. PF was associated with greater reoperation in univariate analysis, but not in multivariate analyses. PF predicted deep wound infections, organ-space infections, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, and sepsis. PF was also associated with a longer hospital stay. Age, obesity, steroids, and American Society of Anesthesiologists (ASA) class ≥ 3 predicted readmission. Obesity, steroids, bleeding disorder, preoperative transfusion, ASA class ≥3, and levels fused predicted reoperation. Age, African American race, decreased hematocrit, obesity, hypertension, dyspnea, steroids, bleeding disorder, ASA class ≥3, levels fused, and interbody levels fused predicted morbidity. Male gender and inclusion of anterior lumbar interbody fusion (ALIF) were protective of reoperation. Hispanic ethnicity, ALIF, and computer-assisted surgery (CAS) were protective of morbidity. Conclusions: Adjunctive PF was associated with a 1.5-times and 2.7-times increased odds of readmission and morbidity, respectively. ASA class and specific comorbidities predicted poorer outcomes, while ALIF and CAS were protective. These findings can guide surgical solutions given specific patient factors.

Comparison of value per operative time between anterior lumbar interbody fusion and lumbar disc arthroplasty: A propensity score-matched analysis.

Context: Despite the growing evidence demonstrating its effectiveness, lumbar disc arthroplasty (LDA) rates have not increased significantly in recent years. A likely contributing factor is uncertainties related to reimbursement and insurers' denial of coverage due to fear of late complications, reoperations, and unknown secondary costs. However, no prior study has compared the physician reimbursement rates of lumbar fusion and LDA. Aim: The aim of this study was to compare the relative value units (RVUs) per min as well as 30-day readmission, reoperation, and morbidity rates between anterior lumbar interbody fusion (ALIF) and LDA. Settings and Design: This was a retrospective cohort study. Subjects and Methods: The current study utilizes data obtained from the National Surgical Quality Improvement Program database. Patients who underwent ALIF or LDA between 2011 and 2019 were included in the study. Statistical Analysis Used: Propensity score matching analysis was performed according to demographic characteristics and comorbidities. Matched groups were compared through Fisher's exact test and independent t-test for categorical and continuous variables, respectively. Results: Five hundred and two patients who underwent ALIF were matched with 591 patients who underwent LDA. Mean RVUs per min was significantly higher for ALIF compared to LDA. ALIF was associated with a significantly higher 30-day morbidity rate compared to LDA, while readmission and reoperation rates were statistically similar. ALIF was also associated with higher frequencies of deep venous thrombosis (DVT) and blood transfusions. Conclusions: ALIF is associated with significantly higher RVUs per min compared to LDA. ALIF is also associated with higher rates of 30-day morbidity, DVT, and blood transfusions, while readmission and reoperation rates were statistically similar.