P116. Swallowing function following anterior cervical discectomy and fusion with and without anterior plating

P116. Swallowing function following anterior cervical discectomy and fusion with and without anterior plating

Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231 of heterotopic ossification of the ...

58KB Sizes 0 Downloads 12 Views

Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231 of heterotopic ossification of the ligaments or vertebral bodies. At 6 months, none of the patients reported chronic dysphagia. There were no device failures out to last follow-up. Eighty-six percent of patients were able to return to the same level of work as prior to surgery. CONCLUSIONS: For patients undergoing single and multi-level cervical fusion, integrated interbody fusion with compressive/lag fixation appears to be a viable alternative. Previously, studies with static integrated interbody fixation devices have not reported as well as ACP with regards to fusion and clinical outcomes. The benefit of a lag design to provide better fixation and more accurate maintenance of the lordotic curve of the cervical spine was seen in our series. Patients reported they were well satisfied with their results and experienced significant pain relief. The opportunity to either revise a previous ACDF with ACP or add to a pre-existing ACDF offers greater flexibility to treat the pathology at the index level rather than approach as a global construct. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.538

P114. Incidence and predictors of prolonged length of stay and readmissions following cervical disc arthroplasty Nikita Lakomkin, BA1, Vadim Goz, MD2, Darrel S. Brodke, MD3, W. Ryan Spiker, MD4; 1 Nashville, TN, US; 2 University of Utah, Salt Lake City, UT, US; 3 University Orthopaedic Center, Salt Lake City, UT, US; 4 University of Utah Orthopaedics, Salt Lake City, UT, US BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) has emerged as a viable alternative to discectomy and fusion in the treatment of degenerative disc disease, offering advantages in range of motion and more rapid return to work. While the number of disc replacements has rapidly increased in recent years, little is known regarding the rates and predictors of suboptimal postoperative outcomes. PURPOSE: The purpose of this study was to identify the incidence and specific causes of readmissions and prolonged length of stay (LOS) following CDA. STUDY DESIGN/SETTING: Analysis of prospectively collected registry data. PATIENT SAMPLE: Patients undergoing cervical disc arthroplasty. OUTCOME MEASURES: Postoperative complications, prolonged LOS, and 30-day readmissions. METHODS: The 2012-2017 National Surgical Quality Improvement Program (NSQIP) database was employed to identify all patients undergoing cervical disc arthroplasty. A variety of variables, including demographics, comorbidities, operative characteristics, postoperative complications, LOS and 30-day readmissions were collected. Patients were considered to experience a prolonged LOS if they remained in the hospital for 2 or more days (>90th percentile). Bivariate statistical analysis followed by multivariable regression modeling was employed to identify significant predictors of readmissions and prolonged LOS. Specific causes of readmissions were identified for all patients who were readmitted within 30 days following surgery. RESULTS: A total of 3,221 patients undergoing CDA were identified. Of these, 472 (14.7%) experienced a prolonged LOS. A total of 36 (1.1%) patients were readmitted within 30 days following surgery. The most common causes of readmission were infectious complications (n=4), followed by orthopedic adverse events, such as vertebral fracture (n=1), displacement of the prosthesis (n=1) and neck pain (n=2). Postoperative superficial wound infection (OR=73.8; p<0.001), ASA classification (OR=2.0; p=0.048) and BMI (OR=1.06; p=0.02) were significant predictors of readmission. Female sex (OR=1.76; p<0.001), diabetes (OR=1.50; p=0.02), postoperative wound dehiscence (OR=13.11; p=0.04), ASA score (OR=1.43; p=0.001) and operative time (OR=1.01; p<0.001) were significantly associated with prolonged LOS. CONCLUSIONS: Wound complications, including superficial wound infection and dehiscence, were significantly associated with prolonged

S211

LOS and were among the most common causes of readmission following CDA. Meticulous infection prophylaxis, which has been adopted in other areas of orthopedics such as hip and knee arthroplasty, may be beneficial in improving outcomes in this patient population. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.539 P115. Evaluation of PROMIS physical function in anterior cervical discectomy and fusion Dil V. Patel, BS1, Joon S. Yoo, BA2, Benjamin Khechen, BA3, Brittany E. Haws, MD1, Sailee S. Karmarkar, BS3, Eric H. Lamoutte, BS3, Kern Singh, MD1; 1 Rush University Medical Center, Chicago, IL, US; 2 Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: As Patient-Reported Outcomes Measurement Information System (PROMIS) becomes increasingly utilized, it is important to assess its validity procedure-specific populations. PURPOSE: This study aims to evaluate the utility of PROMIS physical function (PF) domain as compared to legacy measures of patient reported outcomes (PROs) among patients undergoing an anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 57 patients undergoing a primary, 1-3 level ACDF. OUTCOME MEASURES: PROMIS PF, NDI, VAS Neck and Arm, SF-12. METHODS: Patients undergoing a primary, 1-3 level ACDF were retrospectively identified from a prospectively-maintained surgical registry. PROMIS PF and legacy PRO scores were obtained at preoperative and 6week, 12-week, and 6-month postoperative visits. Legacy PROs included Neck Disability Index (NDI), Short Form-12 (SF-12) physical composite, Visual Analog Scale (VAS) neck pain and VAS arm pain. Postoperative improvements in PROs were assessed using paired t-tests. Correlations between PROMIS and legacy PROs were tested using Pearson correlation coefficient with strength of association interpreted as follows: jrj=0.1-0.3, weak; jrj=0.3-0.5, moderate; jrj=0.5-1.0, strong. RESULTS: A total of 57 ACDF patients were included in this analysis. PROMIS PF scores significantly improved at 12 weeks and 6 months postoperatively, but not at 6 weeks. NDI, VAS neck pain, and VAS arm pain scores demonstrated significant improvement at all postoperative timepoints. SF-12 scores exhibited significant improvement at the 6-month follow up visit. Significant correlations between PROMIS PF and NDI and SF-12 were identified at all preoperative and postoperative timepoints. PROMIS PF exhibited strong correlations with VAS neck pain at postoperative timepoints and a moderate correlation preoperatively. CONCLUSIONS: Patients undergoing a primary 1-3 level ACDF experience significant improvements in PROMIS PF scores at 12-week and 6month postoperative visits, but not at 6-weeks. PROMIS PF exhibits strong correlations to NDI and SF-12 at all preoperative and postoperative timepoints. These results suggest that PROMIS PF accurately measures physical function and may be used in lieu of legacy physical function instruments for patients undergoing ACDF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.540

P116. Swallowing function following anterior cervical discectomy and fusion with and without anterior plating Dil V. Patel, BS1, Joon S. Yoo, BA2, Brittany E. Haws, MD1, Benjamin Khechen, BA3, Arash Sayari, BS, MD1, Eric H. Lamoutte, BS3, Sailee S. Karmarkar, BS3, Kern Singh, MD1; 1 Rush University Medical Center, Chicago, IL, US; 2 Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US

Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.

S212

Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231

BACKGROUND CONTEXT: Anterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. PURPOSE: To quantify the effect of anterior plating on SWAL-QOL scores and radiographic swelling assessments following a primary, singlelevel ACDF. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: A total of 68 patients who underwent a primary, single-level ACDF from 2014-2017. OUTCOME MEASURES: SWAL-QOL scores, radiographic swelling. METHODS: Patients were retrospectively reviewed and grouped by those receiving a stand-alone cage (cage) or cage with anterior plating (plate). SWAL-QOL scores were recorded preoperatively and 6-week and 12-week postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anteriorposterior diameter of each involved vertebral body. A tracheal air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. RESULTS: A total of 68 primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between cage and plate cohorts. Additionally, no differences were observed in postoperative SWAL-QOL scores. Swelling index was greater for the plate cohort at 6-weeks but was similar between groups at 12-weeks. The air index was similar at all time points. CONCLUSIONS: The results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable between cohorts. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.541 P117. The use of patient-reported outcomes measurement information system (PROMIS) in spine surgery: a systematic review Kelsey Young, BA1, Catherine Himo Gang, MPH1, Avani S. Vaishnav, MBBS1, Bridget Jivanelli, MS, BA2, Michael E. Steinhaus, MD1, Francis C. Lovecchio, MD1, Sheeraz A. Qureshi, MD, MBA2, Steven J. McAnany, MD3, Han Jo Kim, MD1, Sravisht Iyer, MD4; 1 Hospital for Special Surgery, New York, NY, US; 2 New York, NY, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: PROMIS was developed to provide a time-saving, easy to administer patient outcome questionnaire that was adaptable to a variety of medical and surgical subspecialties. Numerous authors have examined the effectiveness of PROMIS in various areas of spine surgery. PURPOSE: To assess the correlation of PROMIS with legacy patientreported outcome measures in spine surgery STUDY DESIGN/SETTING: Systematic review. OUTCOME MEASURES: Correlation coefficient (r) of PROMIS PF, Pin, PIf, PB with legacy outcomes. METHODS: A systematic search of the Pubmed, EMBASE, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed yielding 254 unique studies reporting on “PROMIS” in “spine.” Each study was independently reviewed. Fifty-four studies were selected for review, and 16 studies were selected for inclusion.

RESULTS: The pooled sample size yielded a total of 4,344 patients. In the cervical population, PROMIS physical function (PF), pain intensity (PIn), pain interference (PIf) and pain behavior (PB) all strongly correlated with the NDI (average jrj=0.64-0.76). PROMIS PF also strongly correlated with the mJOA (average jrj=0.66). Among patients with lumbar pathology and adult spinal deformities, the PF, PIn, PIf, PB, and social roles satisfaction (SR) all strongly correlated with the ODI (jrj=0.66-0.76). PF, PI, and anxiety (AX) also strongly correlated with the SRS-22/SRS-30. When comparing PROMIS to legacy measures of global health, PROMIS PF was strongly correlated with the SF-12 (jrj=0.67), while PROMIS AX and depression (D) correlated with the GAD and PHQ-8 measures. On average, all individual PROMIS domains required less time to complete (49.6-56 seconds) compared to ODI (176 seconds), NDI (190.3 seconds), SF-12 (214 seconds), and SF-36 PF (99 seconds). Responsiveness of PROMIS PF (ES=0.85, SRM=0.88), PIf (ES=1.14, SRM=0.92), and PB (ES=0.895) was comparable to ODI (ES=1.02, SRM=1.06), NDI (ES=0.75, SRM=0.96) and SF-12 (ES=0.675) CONCLUSIONS: PROMIS PF, PIn, PIf and PB demonstrated strong correlations with NDI, mJOA, ODI, SRS, and SF-12 measures in various spine patient populations. Decreased time to completion and comparable responsiveness of PROMIS suggests that it may be used to assess patientreported outcomes in spinal surgery patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.542

P118. Which NDI domains best predict change in physical function in patients undergoing cervical spine surgery? Michael E. Steinhaus, MD1, Sravisht Iyer, MD2, Francis C. Lovecchio, MD1, Dan Stein, BS1, Thomas Ross, RN, MS3, Jingyan Yang, PhD1, Virginie Lafage, PhD1, Todd J. Albert, MD1, Han Jo Kim, MD1; 1 Hospital for Special Surgery, New York, NY, US; 2 Rush University Medical Center, Chicago, IL, US; 3 New York, NY, US BACKGROUND CONTEXT: Physical function is a critical aspect of patient-reported outcomes and is measured by multiple instruments. While the Neck Disability Index (NDI) is a popular and widely validated outcome measure in cervical spine disease, to what extent its individual domains predict changes in physical function remains unknown. PURPOSE: To examine the impact of individual NDI domains on changes in physical function in patients undergoing cervical spine surgery. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Adult patients undergoing cervical spine surgery, excluding those undergoing surgery for instability due to trauma. OUTCOME MEASURES: Absolute change in outcome measures (PROMIS PF, SF-36 PCS, NDI) from pre- to postoperatively, correlation of NDI individual domains with PROMIS PF and SF-36 PCS (preoperatively, postoperatively, and change from pre- to postoperatively). METHODS: Patients undergoing cervical spine surgery between 20162018 were prospectively enrolled. Patients completed questionnaires (NDI, SF-36 PCS, and PROMIS PF) preoperatively and at 6 months postoperatively. Patient demographics, including age, body mass index (BMI), Charlson Comorbidity Index (CCI) and underlying diagnoses were collected. Comparisons between NDI scores preoperatively versus postoperatively were conducted using Student paired t-test. Correlations of NDI individual items and PROMIS/SF-36 were assessed using Pearson correlation. A stepwise linear regression analysis was performed to identify NDI items that are independently predictive of PROMIS PF and SF-36 PCS. RESULTS: A total of 137 patients were included in the study, with mean age 56.9 years (range, 24.4-84.9). Each of the NDI domains as well as PROMIS PF and SF-36 PCS demonstrated significant improvement following cervical spine surgery (p<0.001). Changes in all NDI domains demonstrated significant negative correlation with changes in PROMIS PF, with recreation (R=-0.537, p<0.001), work (R=-0.514, p<0.001), and pain intensity (R=-0.488, p<0.001) having the greatest negative

Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.