Gilesstevens8860

STUDY DESIGN Retrospective review of the Healthcare Cost and Utilization Project's Kids' Inpatient Database. OBJECTIVE The aim of this study was to investigate variations in surgical case volume in the US for spinal arthrodesis for pediatric patients with scoliosis. SUMMARY OF BACKGROUND DATA Approximately 38,000 spinal arthrodesis procedures are performed each year in the United States for pediatric patients with scoliosis. https://www.selleckchem.com/products/scriptaid.html Anecdotally, pediatric spine surgeons report performing more scoliosis procedures during summer months and before national holidays than during other periods, but this has not been reported in the literature. A thorough understanding of seasonal variations in surgical volume may guide the allocation of health care resources. METHODS Using the Healthcare Cost and Utilization Project's Kids' Inpatient Database, we identified 32,563 patients aged less then 21 years with adolescent idiopathic scoliosis (54%), neuromuscular scoliosis (19%), congenital scoliosis (12%), early-onset scoliosis (1 according to predictable changes in surgical volume. LEVEL OF EVIDENCE 4.STUDY DESIGN A retrospective study (level of evidence level 4) OBJECTIVE. To evaluate the radiographic outcomes after XLIF and OLIF procedures especially the effect of indirect decompression to the ligamentum flavum and to evaluate the effect of facet degeneration to the radiographic outcomes of these procedures. SUMMARY OF BACKGROUND DATA Indirect decompression via lateral lumbar interbody fusion provides spinal canal area expansion. However, the effect to the ligamentum flavum area and thickness at the operated spinal level is unclear. METHODS Thirty-five patients (57 lumbar levels) underwent XLIF or OLIF with percutaneous pedicle screw fixation (PPS) without direct posterior decompression were retrospectively studied. Radiographic parameters including ligamentum flavum area (LFA), ligamentum flavum thickness (LFT), cross-sectional area (CSA) of thecal sac, posterior disc height, foraminal height, cage alignment and facet degeneration were measured on magnetic resonance image (MRI). Cage position was assessed with plain radiography. RESULTS All of the radiographic parameters were significantly improved. Comparing pre- and post-operative value, mean LFA decreased from 78.9 ± 24.9 mm to 66.9 ± 26.8 mm (-14.2%; p-value  less then  0.00625). Mean right LFT decreased from 2.9 ± 0.9 mm to 2.3 ± 0.7 (-17.0%; p-value  less then  0.00625). Mean left LFT decreased from 3.3 ± 1.6 mm to 2.6 ± 0.9 mm (-17.6%; p-value  less then  0.00625). Mean CSA of thecal sac increased from 93.1 ± 43.0 mm to 127.3 ± 52.5 mm (50.8%; p-value  less then  0.00625). All radiographic outcomes were not significant difference between lumbar levels that have grade 0-1 and grade 2-3 or between grade 2 and grade 3 facet degeneration. CONCLUSIONS Ligamentum flavum area and thickness were significantly reduced after lateral lumbar interbody fusion through both XLIF and OLIF. Unbuckling of the ligamentum flavum played an important role for improvement of spinal canal area after the indirect decompression. LEVEL OF EVIDENCE 4.STUDY DESIGN Retrospective database study OBJECTIVE. To assess the association between pLOS (≥4 days) and unplanned readmission in patients undergoing elective spine surgery by controlling the clinical and statistical confounders. SUMMARY OF BACKGROUND DATA Prolonged length of hospital stay (pLOS) has previously been cited as a risk factor for unplanned hospital readmission. This potentially modifiable risk factor has not been distinguished as an independent risk factor in a large-scale, multi-institutional, risk-adjusted study. METHODS Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database. A retrospective propensity score-matched analysis was used to reduce baseline differences between the cohorts. Univariate and multivariate analyses were performed to assess the degree of association between pLOS and unplanned readmission. RESULTS From the 99,575 patients that fit the inclusion criteria, propensity score matching yielded 16,920 well-matched pairs (mean standard propensity score difference=0.017). The overall 30-day unplanned readmission rate of these 33,840 patients was 5.5%. The mean length of stay was 2.0 ± 0.9 days and 6.0 ± 4.5 days (p ≤ 0.001) for the control and pLOS groups, respectively. In our univariate analysis, pLOS was associated with postoperative complications, especially medical complications (22.7% vs. 8.3%, p  less then  .001). Multivariate analysis of the propensity score-matched population, which adjusted identified confounders (p  less then  0.02 and ≥10 occurrences), showed pLOS was associated with an increased risk of 30-day unplanned readmission (OR 1.423, 95% CI 1.290-1.570), p  less then  .001). CONCLUSIONS Patients who undergo elective spine procedures who have any-cause pLOS (≥4 days) are at greater risk of having unplanned 30-day readmission compared with patients with shorter hospital stays. LEVEL OF EVIDENCE 4.STUDY DESIGN A retrospective cohort study. OBJECTIVE To investigate the 30-day recurrence rate after emergency lumbar discectomy. Secondary aims were to investigate the factors affecting the 30-day recurrence and readmission rates and clinical outcome. SUMMARY OF BACKGROUND DATA Excluding cauda equine syndrome (CES) due to massive intervertebral disc herniation, emergency surgery for lumbar disc herniation (LDH) is rarely required. The operation may, however, be performed for other reasons such as persistent or progressive motor paresis associated with radiculopathy or uncontrolled pain. Literature on these topics is scarce. METHODS All patients admitted for inpatient care after a visit to the emergency department (ED) due to acute low back pain and who had subsequently undergone an emergency lumbar discectomy during the 4-year study period were included in the study. Patients attending the ED who subsequently had a delayed discectomy formed the control group. Recurrence and readmission rates were analyzed and clinical outcome at 30 days post-surgery was assessed with the Oswestry Disability Index (ODI) and the visual analog pain scale (VAS).