Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Surgery: A Review of Current Literature and Meta-Analysis.

STUDY DESIGN: Systematic Review and Meta-analysis. OBJECTIVE: Postoperative urinary retention (POUR) is a common complication following lumbar spine surgery (LSS) and timely recognition is imperative to avoid long-term consequences. The aim of the current meta-analysis was to systematically review the literature in order to identify risk factors associated with POUR after LSS. METHODS: In accordance with PRISMA guidelines, a systematic review of the literature was performed using Pubmed, EMBASE, and MEDLINE database for articles on POUR following LSS. A meta-analysis was performed comparing patients with and without POUR; and the factors associated with this adverse event were analyzed. The pooled data were reported as mean differences with 95% confidence intervals (CI; P < .05). Heterogeneity among the studies was evaluated using the I2 statistic. RESULTS: The meta-analysis included 10 studies compromised of 30,300 patients. Based on our analysis, patients who were male, were older in age, underwent instrumented fusion, had diabetes mellitus, coronary artery disease, or benign prostatic hypertrophy had significantly higher risk of developing POUR. Additionally, patients in who developed POUR had significantly longer surgical times and higher volumes of intra-operative fluid administration, as compared with non-POUR patients. The POUR patients also had a significantly higher association with urinary tract infection. Prior surgery, BMI, length of stay, and smoking status did not reveal any statistical association with POUR. CONCLUSIONS: Risk factors associated with POUR following LSS include male gender, older age, longer surgical times, fusion procedures, larger volumes of intraoperative infusions, and associated comorbidities like DM, CAD, and BPH.

Risk Factors for Postoperative Ileus After Thoracolumbar and Lumbar Spinal Fusion Surgery: Systematic Review and Meta-Analysis.

OBJECTIVE: Postoperative ileus (POI) is a known complication after spine surgery. This study comprehensively reviews the existing literature and evaluates the risk factors associated with POI after thoracolumbar and lumbar fusion surgeries. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search was conducted for articles on ileus after the surgical treatment of spinal pathologies. Variables including gender, age, body mass index, comorbidities, approach, type of surgery performed, levels fused, anesthesia time, and length of stay were considered as the main outcomes of measurement. Meta-analyses were conducted using random models according to the between-study heterogeneity, estimated with I2. Sensitivity analysis was performed with heterogeneity greater than 50%. RESULTS: Ten articles compromising a total of 297,809 patients met the inclusion criteria. POI after lumbar surgery had a statistically significant association with increased age, surgical time, anesthesia time, estimated blood loss, and length of stay. The pooled mean differences were 1.70 years (95% confidence interval [CI]: 1.52-1.87, P < 0.0001), 83.02 minutes (CI: 41.20-124.84, P = 0.0001), 64.97 minutes (CI: 31.43-98.50, P = 0.0001), 439.04 cc (CI: 250.60-627.49, P < 0.001), and 2.97 days (CI: 2.54-3.40, P < 0.001), respectively. Furthermore, individuals who underwent spinal fusion had higher odds of POI if they were male (odds ratio [OR]: 1.33; CI: 1.06-1.67; P = 0.01), if an anterior approach was performed (OR: 1.97; CI: 1.29-3.01; P = 0.002), or if >3 vertebral levels were fused (OR: 3.99; CI: 1.28-12.44; P = 0.02). Body mass index did not show any association with POI. CONCLUSIONS: Risk factors associated with POI after spinal fusion surgery include male gender, older age, longer surgical times, higher estimated blood loss, longer lengths of stay, greater numbers of levels of fusion, and anterior surgical approach.

A Multi-Center Comparison of Orthopaedic Attending and Resident Learning Styles.

OBJECTIVE: Effective education of orthopedic residents requires an understanding of how they process information. To date however no literature has described resident learning styles based on the updated Kolb Learning Style Inventory (KLSI) v4.0. The purpose of this study is to identify common learning styles amongst orthopedic residents and attendings and evaluate the effect that race, gender, and resident/attending status have on learning styles. DESIGN: The KLSI v4.0 and a demographic survey were distributed to 103 orthopedic attendings and residents at two academic centers during the 2019 to 2020 academic year. Frequencies and descriptive statistics were reported. Learning styles based on gender, race, attending versus resident status, and institution were evaluated. A p-value < 0.05 was considered significant. SETTING: This is a multi-center study performed at two academic, university based orthopedic surgery departments. PARTICIPANTS: Orthopaedic surgery residents and attending surgeons. RESULTS: At both institutions, the combined response rate for the KLSI v4.0 was 66% and 68% for the demographic surgery. The three most common learning styles recorded were: Deciding (26.5%), Acting (17.6%), and Thinking (17.6%). Learning styles were compared by gender, race, attending and/or resident status, and institution with no statistically significant difference found between any of the comparisons (p > 0.05). CONCLUSION: The majority of orthopedic surgeons have Deciding, Acting, or Thinking learning styles, which are categorized by motivation to achieve goals, disciplined and logical reasoning, and the use of theories and models to solve problems. However, not all residents and attendings utilize these common learning styles. A mismatch in learning styles between residents and attendings could result in poor educational experiences. Understanding the learning styles of orthopedic surgeons has implications for improving evaluation interpretation, mentorship pairing, quality of life, and resident remediation.

Outcomes of Vertical Expandable Prosthetic Titanium Ribs in Children With Early-Onset Scoliosis Secondary to Cerebral Palsy.

Purpose Patients who have neuromuscular scoliosis, such as cerebral palsy (CP), often develop spinal deformities that negatively impact quality of life. The vertical expandable prosthetic titanium rib (VEPTR) was designed for thoracic insufficiency syndrome (TIS), but it has also been utilized in patients with CP with restrictive lung disease and spine deformity. Few studies report on VEPTRs in neuromuscular scoliosis; however, none reports on their utilization specifically in patients with CP. Our purpose was to assess if VEPTRs can improve spinal deformity and TIS in these patients. Methods A retrospective chart review was performed of all patients with CP and scoliosis treated with a VEPTR between 2008 and 2017. Eight patients were eligible for this study. The mean follow-up was four years. Outcomes evaluated were Cobb angle, pelvic obliquity, space available for lung ratio (SAL), T1-S1 height, and complication rates. A p-value of less than 0.05 was used for statistical significance. Results There were significant postoperative improvements in Cobb angle, pelvic obliquity, and T1-S1 height, but no statistical difference in SAL. Prior to final fusion, the mean number of VEPTR lengthening procedures was 3. The mean time from index surgery to final fusion was 3.7 years. The most common complications were infection (62.5%) and wound dehiscence (25%). Only 25% of patients did not have a complication. Conclusion VEPTRs demonstrated significant improvement in almost all parameters and may be valuable in improving TIS in patients with CP. The complication and reoperation rates were similar to those of VEPTRs used for other pathological conditions.