Browsing by Author "Hart, R"
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Item Open Access 166 Predictive Modeling of Length of Hospital Stay Following Adult Spinal Deformity Correction: Analysis of 653 Patients With an Accuracy of 75% Within 2 Days(Neurosurgery, 2016-08-01) Scheer, JK; Ailon, TT; Smith, JS; Hart, R; Burton, DC; Bess, S; Neuman, BJ; Passias, PG; Miller, E; Shaffrey, CI; Schwab, F; Lafage, V; Klineberg, E; Ames, CPINTRODUCTION: The length of stay (LOS) following adult spinal deformity (ASD) surgery is a critical time period allowing for recovery to levels safe enough to return home or to rehabilitation. Thus, the goal is to minimize it for conserving hospital resources and third-party payer pressure. Factors related to LOS have not been studied nor has a predictive model been created. The goal of this study was to construct a preadmission predictive model based on patients' baseline variables and modifiable surgical parameters.Item Open Access Clinical Impact Correlation of a Delphi-Based Proximal Junctional Kyphosis Severity Scale and HRQOL(Global Spine Journal, 2015-05-01) Lau, D; Funao, H; Clark, A; Smith, J; Bess, S; Shaffrey, C; Schwab, F; Lafage, V; Deviren, V; Hart, R; Kebaish, K; Ames, CIntroduction Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are adverse outcomes following adult spinal surgery (ASD) surgery. There is a lack of consensus regarding which patients (pts) require revision surgery. The Hart ISSG PJK severity scale correlates with the need for revision surgery. This study evaluates the Hart International Spine Study Group (ISSG) PJK severity scale and health-related quality of life (HRQOL) measures in pts with PJK. Patients and Methods All ASD pts with PJK and/or PJF who eventually underwent revision surgery were identified from two large academic medical centers. Pts were retrospectively assigned scores based on the Hart ISSG PJK severity scale: neurological status, focal pain, instrumentation problem, kyphosis severity/PLC integrity, UIV/UIV + 1 fracture, and level of UIV. Scores range from 0 to 15. Pre-PJK revision HRQOL measures included: Oswestry disability index (ODI), short-form 36 (SF-36), and Scoliosis Research Society questionnaire (SRS30). Scores were subcategorized into 0 to 2, 3 to 5, 6 to 8, 9 to 11, and 12 to 15, and differences in HRQOL outcomes were determined with linear regression. Correlation was assessed with a Pearson correlation coefficient. Results A total of 54 cases were included, out of which 31.5% were male, and the mean age was 64.9 years. The Hart ISSG PJK severity scale scores ranged from 4 to 15, with the median being 8. PJK/PJF occurred in the upper thoracic spine in 24.1% of the cases. 54.8% had fractures and 77.8% had instrumentation issues. Overall, 55.6% had neurological deficits, with 16.7% having weakness and/or myelopathy. All pts had preoperative pain (median VAS 9/10). While statistical significance on linear regression was not seen, there were obvious trends that correlated with the Hart ISSG PJK severity scale. Higher Hart ISSG PJK severity scale scores were associated with higher ODI (p = 0.283, r = 0.350), lower SRS30 function (p = 0.821, r = −0.323), and lower SRS mental (p = 0.646, r = −0.592). Conclusion The Hart ISSG PJK severity scale has been shown to be predictive in the decision making of when patients require revision surgery. Based on the current study, it may also correlate with functional outcomes, specifically ODI and SRS30 components.Item Open Access Clinically Significant Thromboembolic Disease in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 737 Patients(Global Spine Journal, 2018-05-01) Kim, HJ; Iyer, S; Diebo, BG; Kelly, MP; Sciubba, D; Schwab, F; Lafage, V; Mundis, GM; Shaffrey, CI; Smith, JS; Hart, R; Burton, D; Bess, S; Klineberg, EOStudy Design: Retrospective cohort study. Objectives: Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery. Methods: ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE. Results: A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, P <.01) and more likely to have osteoporosis (29% vs 15.1%, P =.037) and liver disease (6.5% vs 1.4%, P =.027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, P <.01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, P =.028). VTE patients had a longer hospital stay (10 vs 7 days, P <.05) and higher mortality rate (6.3% vs 0.7%, P <.01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE (r2 =.11, area under the curve = 0.74, P <.05). Conclusions: The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.Item Open Access Comparison of Best versus Worst Clinical Outcomes for Adult Spinal Deformity Surgery: A Prospective, Multicenter Assessment with Minimum 2-Year Follow-Up(Global Spine Journal, 2015-05-01) Smith, J; Shaffrey, C; Lafage, V; Schwab, F; Protopsaltis, T; Klineberg, E; Gupta, M; Hostin, R; Ming-Fu, K; Soroceanu, A; Hart, R; Burton, D; Bess, S; Ames, CIntroduction Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population. Patients and Methods This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age < 18 years and ASD. Propensity scores were used to match an op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI–LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met criteria, including 286 op and 403 non-op, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS (p > 0.001) and had worse deformity based on pelvic tilt, PI–LL, and C7SVA (p > 0.002). Before reaching minimum 2-year follow-up, 38 non-op patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up, all HRQL measures assessed significantly improved for op patients (p > 0.001), but none of these measures improved significantly for non-op patients (p < 0.11). Overall, 97 matched op–non-op pairs were identified based on propensity scores. At last follow-up, the 97 matched op patients had significant improvement in all HRQL measures assessed (p > 0.001), but the 97 matched non-op patients lacked significant improvement in any of the HRQL measures (p < 0.20). Paired op–non-op analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed (p > 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability.Item Open Access Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up(Global Spine Journal, 2015-05-01) Smith, J; Lafage, V; Shaffrey, C; Schwab, F; Hostin, R; Boachie-Adjei, O; Akbarnia, B; Klineberg, E; Gupta, M; Deviren, V; Hart, R; Burton, D; Bess, S; Ames, CIntroduction Adults with spinal deformity typically present with pain and disability. Aim Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population. Material and Methods This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS (p < 0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA (p ≤ 0.002). Before reaching minimum 2-year follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up all HRQL measures assessed significantly improved for op patients (p < 0.001), but none of these measures improved significantly for nonop patients (p ≥ 0.11). Total 97 matched op–nonop pairs were identified based on propensity scores. At last follow-up the 97 matched op patients had significant improvement in all HRQL measures assessed (p < 0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures (p ≥ 0.20). Paired op–nonop analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed (p < 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability.