RESUMO
STUDY DESIGN: Retrospective study. OBJECTIVE: To elucidate an association between preoperative lumbar epidural corticosteroid injections (ESI) and infection after lumbar spine surgery. SUMMARY OF BACKGROUND DATA: ESI may provide diagnostic and therapeutic benefit; however, concern exists regarding whether preoperative ESI may increase risk of postoperative infection. METHODS: Patients who underwent lumbar decompression alone or fusion procedures for radiculopathy or stenosis between 2000 and 2017 with 90 days follow-up were identified by ICD/CPT codes. Each cohort was categorized as no preoperative ESI, less than 30 days, 30 to 90 days, and greater than 90 days before surgery. The primary outcome measure was postoperative infection requiring reoperation within 90 days of index procedure. Demographic information including age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI) was determined. Comparison and regression analysis was performed to determine an association between preoperative ESI exposure, demographics/comorbidities, and postoperative infection. RESULTS: A total of 15,011 patients were included, 5108 underwent fusion and 9903 decompression only. The infection rate was 1.95% and 0.98%, among fusion and decompression patients, respectively. There was no association between infection and preoperative ESI exposure at any time point (1.0%, Pâ=â0.853), ESI within 30 days (1.37%, Pâ=â0.367), ESI within 30 to 90 days (0.63%, Pâ=â0.257), or ESIâ>â90 days (1.3%, Pâ=â0.277) before decompression surgery. There was increased risk of infection in those patients undergoing preoperative ESI before fusion compared to those without (2.68% vs. 1.69%, Pâ=â0.025). There was also increased risk of infection with an ESI within 30 days of surgery (5.74%, Pâ=â0.005) and when givenâ>â90 days (2.9%, Pâ=â0.022) before surgery. Regression analysis of all patients demonstrated that fusion (Pâ<â0.001), BMI (Pâ<â0.001), and CCI (Pâ=â0.019) were independent predictors of postoperative infection, while age, sex, and preoperative ESI exposure were not. CONCLUSION: An increased risk of infection was found in patients with preoperative ESI undergoing fusion procedures, but no increased risk with decompression only. Fusion, BMI, and CCI were predictors of postoperative infection.Level of Evidence: 3.
Assuntos
Corticosteroides/uso terapêutico , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Comorbidade , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Radiculopatia/cirurgia , Reoperação , Estudos Retrospectivos , TiazóisRESUMO
STUDY DESIGN: A retrospective review of all elective single-level lumbar fusions performed at a single orthopedic specialty hospital (OSH) and tertiary referral center (TRC). OBJECTIVE: This study compared the perioperative outcomes for lumbar fusion procedures performed at an OSH and TRC. SUMMARY OF BACKGROUND DATA: The role of an OSH for lumbar fusion procedures has not been defined. METHODS: A large institutional database was searched for single-level lumbar fusions performed between 2013 and 2016. Comparisons were made between procedures performed at the OSH and TRC in terms of operative time, total operating room (OR) time, length of stay (LOS), inpatient rehabilitation utilization, postoperative 90-day readmission, reoperation, and mortality rates. RESULTS: A total of 101 patients at the OSH and 481 at the TRC were included. There was no difference in gender, age, age adjusted Charlson comorbidity Index (AACCI), body mass index, mean number of concomitant levels decompressed, and use of interbody fusion between OSH and TRC patients. The mean operative time (149.5 vs. 179.7âminutes, Pâ<â0.001), total OR time (195.1 vs. 247.9âminutes, Pâ<â0.001), and postoperative LOS (2.61 vs. 3.73 days, Pâ<â0.001) were significantly shorter at the OSH. More patients required postoperative inpatient rehabilitation at the TRC (7.1% vs. 2%, Pâ<â0.001). There was no difference in 90-day readmission or reoperation rates. There was one mortality at the TRC and two patients required transfer from the OSH to the TRC due to medical complications. Regression analysis demonstrated that procedures performed at the TRC (Pâ<â0.001), total OR time (Pâ=â0.004), AACCI (Pâ<â0.001), current smokers (Pâ=â0.048), and number of decompressed levels (Pâ=â0.032) were independent predictors of LOS. CONCLUSION: Lumbar fusion procedures may be safely performed at both the OSH and TRC. OSH utilization may demonstrate safe reduction in operative time, total OR time, and postoperative LOS in the appropriately selected patients. LEVEL OF EVIDENCE: 3.
Assuntos
Procedimentos Cirúrgicos Eletivos , Vértebras Lombares/cirurgia , Fusão Vertebral , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Hospitais , Humanos , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
Routine preoperative stress radiographs have been advocated, in part, to determine "full correctability" of deformities before proceeding with unicompartmental knee arthroplasty (UKA) despite limited data supporting their utility. Fifty consecutive patients undergoing medial UKA with robotic navigation were studied. In 20° of flexion, significantly greater correctability was achieved after removal of osteophytes by an additional 1.8°, with a mean corrected alignment of 2.5° varus. Seventy-four percent of knees were not correctable to neutral alignment or more. In conclusion, preoperative stress radiographs have overstated value in patients undergoing medial UKA since the full extent of correctability of varus deformity cannot be determined until after removal of osteophytes and since most deformities are not fully correctable to neutral in UKA.