Spine Surgeon Specialty Does Not Influence Short-term Outcomes of Percutaneous Kyphoplasty
Key findings
- This study was the first to compare short-term outcomes of single-level percutaneous kyphoplasty according to surgeon specialty (neurosurgeon or orthopedic surgeon)
- Among 2,248 patients (54.7% operated on by neurosurgeons) the only difference in 30-day rates of postoperative complications was that bleeding requiring transfusion was significantly more common in the orthopedic cohort
- There was no difference between the two specialties in 30-day rates of unplanned hospital readmissions
- With the exception of inpatient status, all risk factors for postoperative complications and unplanned readmission differed between the two specialties
Percutaneous kyphoplasty (PKP), a common treatment for vertebral compression fractures, is performed by both neurosurgeons and orthopedic surgeons. No study has ever examined whether short-term outcomes differ according to surgeon specialty.
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Ziv Williams, MD, PhD, neurosurgeon, and Kejia Hu, MD, PhD, research associate, of the Department of Neurosurgery at Massachusetts General Hospital, and colleagues have found that differences between the two specialties are almost indistinguishable with regard to postoperative complications and unplanned readmissions. In BMC Surgery they also report risk factors that can help triage PKP patients for optimal follow-up.
Study Design
Using the National Surgical Quality Improvement Program database of the American College of Surgery, the researchers identified 2,248 patients who underwent single-level PKP between 2012 and 2014. Of those, 54.7% were operated on by neurosurgeons and the others by orthopedic surgeons.
Adverse Events
The researchers found that 230 patients (10.2%) had one or more postoperative complications. There was no difference between the two surgical specialty cohorts in overall complications, mortality, systemic complications or wound complications.
The orthopedic cohort had a higher occurrence of bleeding requiring transfusions within 72 hours postoperatively (1.7% vs. 0.7%, P = 0.04).
Predictors of Adverse Events
In multivariate regression models, independent predictors of postoperative complications were:
- Neurosurgery cohort: Inpatient status (OR = 1.87), dependent functional status (OR = 2.42), preoperative disseminated cancer (OR = 2.74), loss of >10% of body weight in last six months (OR = 3.87)
- Orthopedic cohort: Inpatient status (OR = 1.87), longer operative duration (OR = 1.01), preoperative systemic sepsis (OR = 3.69)
Unplanned Readmission
The researchers found that 214 patients (9.5%) had unplanned readmissions within 30 days postoperatively. There was no difference between the two specialties.
Predictors of Readmission
- Neurosurgery cohort: Preoperative anemia (OR = 1.99), disseminated cancer (OR = 2.16), steroid use for chronic disorder (OR = 2.20), blood transfusion (OR = 19.69)
- Orthopedic cohort: Inpatient status (OR = 2.19), preoperative kidney disorder (OR = 3.73), ASA 3 or 4 (OR = 2.14); operations in the lumbar region (OR = 0.59) were associated with decreased risk compared with those in the thoracic spine
Applying the Results to Practice
Spine surgery practices can use this information to determine which patients undergoing PKP need:
- In-depth preoperative medical evaluation
- Counseling about risks and types of adverse events to expect
- Rigorous early in-person or telephone follow-up
- Monitoring of surgical sites
- Coordinated post-discharge care via mid-level providers
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