Age Is a Risk Factor for Postoperative Complications Following Excisional Laminectomy for Intradural Extramedullary Spinal Tumors.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: The incidence of intradural extramedullary (IDEM) spinal tumors is increasing. Excisional laminectomy for removal and decompression is the standard of care, but complications associated with patient age are unreported in the literature. Our objective is to identify if age is a risk factor for postoperative complications after excisional laminectomy of IDEM spinal tumors. METHODS: A retrospective analysis was performed on the 2011 to 2014 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database for patients undergoing excisional laminectomy of IDEM spinal tumors. Age groups were determined by interquartile analysis. Chi-squared tests, t tests, and multivariate logistic regression models were employed to identify independent risk factors. Institutional review board approval was not needed. RESULTS: A total of 1368 patients met the inclusion criteria for the study. Group 1 (age ≤ 44) contained 372 patients, group 2 (age 45-54) contained 314 patients, group 3 (age 55-66) contained 364 patients, and group 4 (age > 66) contained 318 patients. The univariate analysis showed that mortality and unplanned readmission were highest among patients in group 4 (1.26%, P = .011, and 10.00%, P = .039, respectively). Postoperative wound complications were highest among patients in group 1 (2.15%, P = .009), and postoperative venous thromboembolism and cardiac complications were highest among patients in group 3 (4.4%, P = .007, and 1.10%, P = .032, respectively). Multivariate logistic regression revealed that elderly age was an independent risk factor for postoperative venous thromboembolism (group 3 vs group 1; odds ratio = 6.739, confidence interval = 1.522-29.831, P = .012). CONCLUSIONS: This analysis revealed that increased age is an independent risk factor for postoperative venous thromboembolism in patients undergoing excisional laminectomy for IDEM spinal tumors.

The Perioperative Efficacy and Safety of Antifibrinolytics in Adult Spinal Fusion Surgery: A Systematic Review and Meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Compare outcomes of adult patients undergoing spinal fusion surgery who receive and do not receive perioperative antifibrinolytics to reduce operative blood loss. SUMMARY OF BACKGROUND DATA: The clinical potential for antifibrinolytics such as tranexamic acid and epsilon aminocaproic acid to significantly reduce blood loss during adult spinal fusion surgery remains underexplored. Outcomes for assessment included operative blood loss, and other surgical, clinical, and haematological outcomes. METHODS: We followed the recommended Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Electronic database searches identified 2041 for screening. Data were extracted and analyzed using meta-analysis of proportions. RESULTS: A total of 11 randomized controlled trials with a total of 937 adult spinal fusion surgery patients were included for analysis. There were 472 (50%) patients who were treated with antifibrinolytics, with 345 of 472 (73%) and 127 of 472 (27%) receiving tranexamic acid and epsilon aminocaproic acid respectively. The use of antifibrinolytics was associated with significantly lower intraoperative (MD -127.08 mL; P = 0.002) and total blood loss (MD -229.76 mL; P < 0.00001), as well as incidence of blood transfusion (OR 0.58; P = 0.04). There was no significant difference with antifibrinolytic use in terms of many surgical parameters, including surgery duration (P = 0.50), overall complications (P = 0.21), and length of stay (P = 0.88). Finally, postoperative haemoglobin was significantly greater (MD 0.30 g/dL; P = 0.02) following antifibrinolytic use, with other haematological parameters mostly unaffected. CONCLUSION: Based on the highest level comparative evidence available, the possibility for blood loss reduction in adult spinal fusion surgery with the use of perioperative antifibrinolytics is not unreasonable, as it appears both efficacious and safe. In addition to further, larger investigations to validate the associations found in this study, practical aspects such as cost-benefit analysis, and long-term follow-up will further enhance our understanding. LEVEL OF EVIDENCE: 1.

Resumption of Antithrombotic Agents in Chronic Subdural Hematoma: A Systematic Review and Meta-analysis.

BACKGROUND: The clinical decision whether and when to resume antithrombotics in patients with chronic subdural hematomas (CSDH) postoperatively is limited by a lack of quality evidence exploring this topic. Our study aims to assess the available evidence of patient complication outcomes, specifically hemorrhagic and thromboembolic events, following the resumption or non-resumption of antithrombotic agents postoperatively in CSDH patients already on these agents before CSDH. METHODS: We followed recommended PRISMA guidelines for systematic reviews. Electronic database searches were performed to identify included studies. Data were extracted and analyzed using meta-analysis. RESULTS: Eight studies were included for analysis. The most common indication for antithrombotic treatment before onset of CSDH was atrial fibrillation (29.6%), followed by prosthetic heart valve (16.6%), recent myocardial infarction (14.1%), prior stroke or transient ischemic attack (11.6%), and finally venous thromboembolism (8.3%). The overall hemorrhagic complication rate was 14.8% in the resumption group versus 18.6% in the no resumption group (P = 0.591). This did not differ between early (<2 weeks) versus late (>1 month) resumption (15% vs. 18.6%, P = 0.97). The rate of thromboembolism however was statistically lower in those who resumed antithrombotics (2.9% vs. 6.8%, P<0.001). There was a non-significant trend towards higher thromboembolic rates with early resumption (5.3% vs. 2.1%, P = 0.23). CONCLUSIONS: The decision to resume antithrombotics postoperatively in the clinical management of CSDH patients is a complex one and should therefore be a highly individualized process. Our meta-analysis demonstrates that in selected cases, it is feasible to resume early antithrombotic treatment without additional hemorrhagic or thromboembolic risk.

Anterior lumbar interbody fusion (ALIF) as an option for recurrent disc herniations: a systematic review and meta-analysis.

BACKGROUND: Recurrent intervertebral disc herniation is a relatively common occurrence after primary discectomy for lumbar intervertebral disc herniation. For recurrent herniations after repeat discectomies, a growing body of evidence suggests that fusion is effective in appropriately selected cases. Theoretically, anterior lumbar interbody fusion (ALIF) allows for comprehensive discectomy, less trauma to spinal nerves and paraspinal muscles and avoidance of the disadvantages of repeat posterior approaches. However, ALIF has also been associated with risk of vascular injury and retrograde ejaculation. This current systematic review and meta-analysis aims to assess the viability of ALIF as a surgical treatment for recurrent disc herniations. METHODS: Seven studies were identified from six electronic databases and secondary reference lists. Pre-defined endpoints were extracted from the included studies and meta-analyzed. RESULTS: For the 181 patients from included studies, ALIF resulted in significant average improvements in Oswestry Disability Index (ODI) scores (50.49%, P<0.001), Visual Analogue Scale (VAS) back pain scores (47.85%, P<0.001) and VAS leg pain scores (37.00%, P<0.001). Average blood loss was acceptable at 122 mL (P<0.001) and average operation duration was 89 minutes (P<0.001). Average hospital stay was 5.28 days (P<0.001). Only 22 perioperative complications were reported, with subsidence the most commonly reported complication. CONCLUSIONS: Pooled evidence suggests that ALIF is a feasible approach for the treatment of recurrent disc herniations, demonstrating significant improvements in back and leg pain and minimal complications. These findings warrant further investigation in large prospective registries and multi-center studies.