Browsing by Author "Fisher, Max R"

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    ItemOpen Access
    Impact of Enhanced Recovery After Surgery (ERAS) Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery
    (Spine, 2024-01-01) Yung, Anthony; Onafowokan, Oluwatobi O; Das, Ankita; Fisher, Max R; Cottrill, Ethan J; Prado, Isabel P; Ivasyk, Iryna; Wu, Caroline M; Tretiakov, Peter S; Lord, Elizbeth L; Jankowski, Pawel P; Orndorff, Douglas G; Schoenfeld, Andrew J; Shaffrey, Christopher I; Passias, Peter G
    Objective: We analyze the recovery pattern of Adult Structural Spine Disorder (ASD) patients who underwent corrective surgery with Enhanced Recovery After Surgery protocol (ERAS+), including physical and psychological prehabilitation components, compared to non-ERAS protocol (ERAS-) up to 2-years after surgery. Summary of Background Data: Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles. Methods: Inclusion criteria were operative patients with ASD >18yrs with complete baseline, 90 days perioperative, and 2-year postoperative data. We assessed differences in baseline demographics, surgical details, baseline Health-Related Quality of Life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope (SS), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), lumbar lordosis (LL), T2–T12 kyphosis, and maximum Cobb angle. Additionally, HRQL measures included the PCS, ODI, NDI, EQ-5D, SRS-22r total and domain scores, NRS-Back, and NRS-Leg. We used multivariable logistic regression and ANCOVA to adjust for confounding. Results: 471 patients with ASD met inclusion criteria, with 59 designated ERAS+. Those individuals ERAS+ were older (64.1±13.0 vs 58.0±16.0;p=0.005), had a higher CCI, (2.4±1.8 vs 1.4±1.6;p<0.001), and exhibited a higher modified ASD frailty index (8.2±5.4vs6.3±4.9;p=0.019). Adjusted analysis demonstrated the ERAS+ cohort demonstrated lower likelihood of overall reoperations (OR:0.3; 95%CI:0.13-0.89), and a lower likelihood of overall adverse events (OR:0.4;CI95%:0.19-0.93). ERAS+ was more likely to achieve the MCID in the SRS-22r Total scores at 6 months(OR:3.1;CI95%:1.2-8.4), self-image domain at 6 months (OR:9.0;CI95%:1.6-50.0), in the pain domain at 6 months (OR:3.5;CI95%:1.01-11.9) and 1 year postoperatively (OR:2.6;CI95%:1.03-6.7), and in the SF-36’s physical component summary scores (PCS) at 1 year (OR:2.1;CI95%:1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P > 0.05). Conclusion: Our work is the first to evaluate HRQL metrics and complication over two-years following ASD correction with ERAS. Despite presenting with more severe baseline frailty and higher comorbidity profiles, patients with ASD who underwent corrective surgery with an ERAS protocol experienced fewer short-term adverse events, and improved HRQL. We believe ERAS following ASD surgery leads to faster functional recovery, reduced postoperative deconditioning, and improved quality of life.
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    ItemOpen Access
    Response to Letter to the Editor on "Critical Analysis of Radiographic and Patient Reported Outcome Following Anterior/Posterior Staged vs. Same Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity".
    (Spine, 2024-09) Onafowokan, Oluwatobi O; Monas, Arie; Yung, Anthony; Fisher, Max R; Das, Ankita; Cottrill, Ethan J; Prado, Isabel P; Wu, Caroline M; Passias, Peter G
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    Response to Letter to the Editor on "Other Factors that Can Affect Wound Healing with Elective Lumbar Spine Surgery and Perioperative Nutritional Supplementation in Patients".
    (Spine, 2024-09) Yung, Anthony; Onafowokan, Oluwatobi O; Fisher, Max R; Das, Ankita; Cottrill, Ethan J; Prado, Isabel P; Wu, Caroline M; Passias, Peter G
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    So Close yet So Far: The impact of undercorrection of cervical sagittal alignment during adult cervical deformity surgery - An Incremental correction analysis.
    (Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2024-10) Das, Ankita; Yung, Anthony; Onafowokan, Oluwatobi; Mir, Jamshaid; Fisher, Max R; Williamson, Tyler K; Cottrill, Ethan J; Buser, Zorica; Tretiakov, Peter S; Than, Khoi D; Shah, Neil V; Shaffrey, Christopher I; Passias, Peter G

    Background

    To compare degrees of cSVA correction and to theorize possible minimum and maximum thresholds of cSVA correction for patients to benefit clinically.

    Methods

    657 operative ACD patients in a retrospective cohort study of a prospectively enrolled database with complete baseline and two year radiographic and HRQL data were examined. Patients were grouped into an optimally corrected cohort (OC; postop cSVA ≤ 4 cm) and an undercorrected cohort (UC; postop cSVA > 4 cm) based on postoperative radiographs.

    Results

    265 patients met inclusion criteria (mean age 58.2 ± 11.4 years, BMI 28.9 ± 7.5, CCI 0.9 ± 1.3). 11.2 % of patients were UC, while 88.8 % of patients were OC. UC cohort experienced a significantly greater occurrence of radiographic complications (47.8 % v. 27.6 %, p = 0.046). UC also demonstrated a significantly greater rate of severe 6 M DJK (p < 0.001) and 1Y DJK (26.1 % v. 2.7 %, p < 0.001). In terms of HRQLs, the OC cohort demonstrated significantly greater 2Y EQ5D-Health values (76.9 v. 46.7, p = 0.012). Being UC was a significant predictor of moderate-high 1Y mJOA score (OR 3.0, CI 95 % 1.2-7.3, p = 0.015) Still, in terms of CIT, the threshold for DJF risk increased significantly (p = 0.026) when the cSVA were surgically corrected greater than 5 cm.

    Conclusion

    Undercorrection of cSVA yielded worse clinical outcomes and posed a significant risk for radiographic complications. Although undercorrection does not seem to be efficacious, surgical correction beyond certain thresholds should still be respected as there is a risk for DJK on either end of the spectrum.
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    Treatment of adult spine deformity: A retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft.
    (Acta neurochirurgica, 2024-11) Onafowokan, Oluwatobi O; Uzosike, Akachimere C; Sharma, Abhinav; Galetta, Matthew; Lorentz, Nathan; Montgomery, Samuel; Fisher, Max R; Yung, Anthony; Tahmasebpour, Paritash; Seo, Lauren; Roberts, Timothy; Lafage, Renaud; Smith, Justin; Jankowski, Pawel P; Sardar, Zeeshan M; Shaffrey, Christopher I; Lafage, Virginie; Schoenfeld, Andrew J; Passias, Peter G
    BACKGROUND  : The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor.

    Methods

    This was a retrospective cohort study. ASD patients were stratified by use of intra-operative BMP (BMP +) or not (BMA + I) and surveyed for the development of complications and mechanical failure. Quality of life gained following the procedure was evaluated using quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions. Multivariable analyses (ANCOVA) and logistic regression were used to adjust for confounding.

    Results

    512 patients were included (60% BMP +). At baseline, BMP + patients were older (62.5 vs 60.8 years, p < 0.010). Radiographic and quality-of-life metrics did not differ at follow up timepoints (all p > 0.05). BMP use was associated with higher supplemental rod use (OR: 7.0, 1.9 - 26.2, p = 0.004), greater number of levels fused (OR: 1.1, 1.03 - 1.17, p = 0.003) and greater neurological complications (OR: 5.0, 1.3 - 18.7, p = 0.017). Controlling for rod use and levels fused, BMP use was not associated with a lower risk of mechanical complications (OR 0.3, 95% CI: 0.2 - 3.0, p = 0.353), rod breakage (OR: 3.3, 0.6 - 18.7, p = 0.182) or implant failure (OR: 0.3, 0.04 - 1.51). At 2 years, the BMP + cohort exhibited higher overall costs ($108,062 vs $95,144, p = 0.002), comparable QALYs (0.163 vs 0.171, p = 0.65) and higher cost per QALY (p = 0.001) at two years.

    Conclusions

    In this analysis, BMP-2 application was not associated with superior outcomes when compared to a less costly biologic alternative (bone marrow aspirate + cancellous bone chips + i-Factor) following ASD surgery. The use of BMP-2 in ASD surgery appears to have reduced cost-efficacy at two years postoperatively.