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The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis

Shahrestani, Shane and Bakhsheshian, Joshua and Chen, Xiao T. and Ton, Andy and Ballatori, Alexander M. and Strickland, Ben A. and Robertson, Djani M. and Buser, Zorica and Hah, Raymond and Hsieh, Patrick C. and Liu, John C. and Wang, Jeffrey C. (2021) The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis. EClinicalMedicine, 36 . Art. No. 100889. ISSN 2589-5370. PMCID PMC8257994. doi:10.1016/j.eclinm.2021.100889. https://resolver.caltech.edu/CaltechAUTHORS:20210819-233733434

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Abstract

Background: Modifiable risk factors (MRFs) represent patient variables associated with increased complication rates that may be prevented. There exists a paucity of studies that comprehensively analyze MRF subgroups and their independent association with postoperative complications in patients undergoing cervical spine surgery. Therefore, the purpose of this study is to compare outcomes between patients receiving cervical spine surgery with reported MRFs. Methods: Retrospective analysis of the Nationwide Readmissions Database (NRD) from the years 2016 and 2017, a publicly available and purchasable data source, to include adult patients undergoing cervical fusion. MRF cohorts were separated into three categories: substance abuse (alcohol, tobacco/nicotine, opioid abuse); vascular disease (hypertension, dyslipidemia); and dietary factors (malnutrition, obesity). Three-way nearest-neighbor propensity score matching for demographics, hospital, and surgical characteristics was implemented. Findings: We identified 9601 with dietary MRFs (D-MRF), 9654 with substance abuse MRFs (SA-MRF), and 9503 with vascular MRFs (V-MRF). Those with d-MRFs had significantly higher rates of medical complications (9.3%), surgical complications (8.1%), and higher adjusted hospital costs compared to patients with SA-MRFs and V-MRFs. Patients with d-MRFs (16.3%) and V-MRFs (14.0%) were independently non-routinely discharged at a significantly higher rate compared to patients with SA-MRFs (12.6%) (p<0.0001 and p = 0.0037). However, those with substance abuse had the highest readmission rate and were more commonly readmitted for delayed procedure-related infections. Interpretation: A large proportion of patients who receive cervical spine surgery have potential MRFs that uniquely influence their postoperative outcomes. A thorough understanding of patient-specific MRF subgroups allows for improved preoperative risk stratification, tailored patient counseling, and postoperative management planning.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.1016/j.eclinm.2021.100889DOIArticle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257994PubMed CentralArticle
ORCID:
AuthorORCID
Shahrestani, Shane0000-0001-7561-4590
Bakhsheshian, Joshua0000-0003-2983-6082
Buser, Zorica0000-0002-5680-0643
Additional Information:© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Received 14 March 2021, Revised 13 April 2021, Accepted 19 April 2021, Available online 15 May 2021. Funding: None. Data Sharing Statement: Data used in this study is publicly available for purchase through the Healthcare Cost and Utilization Project. Data used for this study is available upon reasonable request to the corresponding author. Contributors: Shane Shahrestani and Joshua Bakhsheshian contributed to the conception and design of the study, acquisition of data, analysis and interpretation of data, and drafting the article. Xiao Chen, Andy Ton, Alexander Ballatori, Ben Strickland, and Djani Robertson contributed to acquisition of data, analysis and interpretation of data, and drafting the article. Zorica Buser, Raymond Hah, Patrick Hsieh, John Liu, and Jeffrey Wang critically revised the study and provided research support and funding for data acquisition and analysis.
Subject Keywords:Malnutrition; Obesity; Hypertension; Drug abuse; Spine
PubMed Central ID:PMC8257994
DOI:10.1016/j.eclinm.2021.100889
Record Number:CaltechAUTHORS:20210819-233733434
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20210819-233733434
Official Citation:Shane Shahrestani, Joshua Bakhsheshian, Xiao T. Chen, Andy Ton, Alexander M. Ballatori, Ben A. Strickland, Djani M. Robertson, Zorica Buser, Raymond Hah, Patrick C. Hsieh, John C. Liu, Jeffrey C. Wang, The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis, EClinicalMedicine, Volume 36, 2021, 100889, ISSN 2589-5370, https://doi.org/10.1016/j.eclinm.2021.100889.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:110315
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:20 Aug 2021 16:59
Last Modified:20 Aug 2021 16:59

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