The spine journal : official journal of the North American Spine Society
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Perioperative complications affect surgical outcomes. Classification systems of perioperative complications are well established and widely applied in many surgical fields other than spine surgery. ⋯ A comprehensive classification system for perioperative complications in spine surgery (considering four categories) is presented and validated. The categories therapeutic consequence (A-E) and decrease in neurological function correlate strongly with hospital stay.
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Recent studies suggest that prospective registration more accurately reflects the true incidence of adverse events (AEs). To our knowledge, no previous study has investigated prospectively registered AEs' influence on hospital readmission following spine surgery. ⋯ To the best of our knowledge, this is the first study to analyze prospectively registered AEs' association to readmission up to 2 years after complex spine surgery. We found that readmissions were more frequent than previously reported when including readmissions to any department or hospital. Factors related to major intraoperative blood loss were associated to increased odds of readmission. This should be considered during planning of postoperative observation and care.
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Dysphagia following anterior cervical discectomy and fusion (ACDF) is a common complication, the etiology of which has not been established. Given that one potential mechanism for dysphagia is local tissue edema, it is thought that a greater number of operative levels may result in higher dysphagia rates. However, prior reports comparing one-level to two-level ACDF have shown varying results. ⋯ The results of our study indicate that there is no difference in the degree of postoperative dysphagia in one- versus two-level ACDF. However, other variables associated with increased postoperative dysphagia in our population included younger age, male sex, procedural time >61.5 minutes, and worse preoperative dysphagia. Larger studies are required to confirm these findings and identify additional risk factors for postoperative dysphagia.
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Hospital readmission rates are an increasingly important focus. Identifying patients at risk for readmission can help decrease those rates and thus decrease the overall cost of care. ⋯ Analysis of a large multicentered, spine-specific database for elective cervical spine fusion surgery demonstrated an unplanned 90-day readmission rate of 5.4% for the anterior approach and 12.3% for the posterior approach. Factors associated with readmission for the anterior approach include male sex, American Society of Anesthesiologists class >2, increased length of stay, holding private insurance, and being ambulatory preoperatively. A history of previous spine surgery was associated with increased odds of readmission after the posterior approach.
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The contribution of Modic changes (MCs) in relation to spinal pain and degenerative changes has been evaluated frequently. However, most studies focus on lumbar spine. The association between MCs, neck pain, and cervical disc degeneration is not clear. ⋯ Modic changes were found to be associated with neck pain and with disc degeneration. Therefore, the large variation in prevalence that is reported is highly dependent on the nature of the studied population.