Browsing by Author "Knapp, D Raymond"
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Item Open Access Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery.(Journal of neurosurgery. Spine, 2011-04) Fu, Kai-Ming G; Smith, Justin S; Polly, David W; Ames, Christopher P; Berven, Sigurd H; Perra, Joseph H; McCarthy, Richard E; Knapp, D Raymond; Shaffrey, Christopher I; Scoliosis Research Society Morbidity and Mortality CommitteeObject
Patients with varied medical comorbidities often present with spinal pathology for which operative intervention is potentially indicated, but few studies have examined risk stratification in determining morbidity and mortality rates associated with the operative treatment of spinal disorders. This study provides an analysis of morbidity and mortality data associated with 22,857 cases reported in the multicenter, multisurgeon Scoliosis Research Society Morbidity and Mortality database stratified by American Society of Anesthesiologists (ASA) physical status classification, a commonly used system to describe preoperative physical status and to predict operative morbidity.Methods
The Scoliosis Research Society Morbidity and Mortality database was queried for the year 2007, the year in which ASA data were collected. Inclusion criterion was a reported ASA grade. Cases were categorized by operation type and disease process. Details on the surgical approach and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Two large subgroups--patients with adult degenerative lumbar disease and patients with major deformity--were also analyzed separately. Statistical analyses were performed with the chi-square test.Results
The population studied comprised 22,857 patients. Spinal disease included degenerative disease (9409 cases), scoliosis (6782 cases), spondylolisthesis (2144 cases), trauma (1314 cases), kyphosis (831 cases), and other (2377 cases). The overall complication rate was 8.4%. Complication rates for ASA Grades 1 through 5 were 5.4%, 9.0%, 14.4%, 20.3%, and 50.0%, respectively (p = 0.001). In patients undergoing surgery for degenerative lumbar diseases and major adult deformity, similarly increasing rates of morbidity were found in higher-grade patients. The mortality rate was also higher in higher-grade patients. The incidence of major complications, including wound infections, hematomas, respiratory problems, and thromboembolic events, was also greater in patients with higher ASA grades.Conclusions
Patients with higher ASA grades undergoing spinal surgery had significantly higher rates of morbidity than those with lower ASA grades. Given the common application of the ASA system to surgical patients, this grade may prove helpful for surgical decision making and preoperative counseling with regard to risks of morbidity and mortality.Item Open Access Incidence of unintended durotomy in spine surgery based on 108,478 cases.(Neurosurgery, 2011-01) Williams, Brian J; Sansur, Charles A; Smith, Justin S; Berven, Sigurd H; Broadstone, Paul A; Choma, Theodore J; Goytan, Michael J; Noordeen, Hilali H; Knapp, D Raymond; Hart, Robert A; Zeller, Reinhard D; Donaldson, William F; Polly, David W; Perra, Joseph H; Boachie-Adjei, Oheneba; Shaffrey, Christopher IBackground
Unintended durotomy is a common complication of spinal surgery. However, the incidences reported in the literature vary widely and are based primarily on relatively small case numbers from a single surgeon or institution.Objective
To provide spine surgeons with a reliable incidence of unintended durotomy in spinal surgery and to assess various factors that may influence the risk of durotomy.Methods
We assessed 108,478 surgical cases prospectively submitted by members of the Scoliosis Research Society to a deidentified database from 2004 to 2007.Results
Unintended durotomy occurred in 1.6% (1745 of 108 478) of all cases. The incidence of unintended durotomy ranged from 1.1% to 1.9% on the basis of preoperative diagnosis, with the highest incidence among patients treated for kyphosis (1.9%) or spondylolisthesis (1.9%) and the lowest incidence among patients treated for scoliosis (1.1%). The most common indication for spine surgery was degenerative spinal disorder, and among these patients, there was a lower incidence of durotomy for cervical (1.0%) vs thoracic (2.2%; P = .01) or lumbar (2.1%, P < .001) cases. Scoliosis procedures were further characterized by etiology, with the highest incidence of durotomy in the degenerative subgroup (2.2% vs 1.1%; P < .001). Durotomy was more common in revision compared with primary surgery (2.2% vs 1.5%; P < .001) and was significantly more common among elderly (> 80 years of age) patients (2.2% vs 1.6%; P = .006). There was a significant association between unintended durotomy and development of a new neurological deficit (P < .001).Conclusion
Unintended durotomy occurred in at least 1.6% of spinal surgeries, even among experienced surgeons. Our data provide general benchmarks of durotomy rates and serve as a basis for ongoing efforts to improve safety of care.Item Open Access Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database.(Journal of neurosurgery. Pediatrics, 2011-01) Fu, Kai-Ming G; Smith, Justin S; Polly, David W; Ames, Christopher P; Berven, Sigurd H; Perra, Joseph H; Glassman, Steven D; McCarthy, Richard E; Knapp, D Raymond; Shaffrey, Christopher I; Scoliosis Research Society Morbidity and Mortality CommitteeObject
Currently, few studies regarding morbidity and mortality associated with operative treatment of spinal disorders in children are available to guide the surgeon. This study provides more detailed morbidity and mortality data with an analysis of 23,918 pediatric cases reported in the multicenter, multisurgeon Scoliosis Research Society morbidity and mortality database.Methods
The Scoliosis Research Society morbidity and mortality database was queried for the years from 2004 to 2007. The inclusion criterion was age 18 years or younger. Cases were categorized by operation type and diagnosis. Details on the surgical approach, use of neurophysiological monitoring, and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Statistical analysis was performed with chi-square testing, with a p value < 0.05 considered significant.Results
A total of 23,918 patients were included. The mean age was 13 ± 3.6 years (± SD). Spinal pathology included the following: scoliosis (in 19,642 patients), kyphosis (in 1455), spondylolisthesis (in 748), trauma (in 478), and other (in 1595 patients). The overall complication rate was 8.5%. Major complications included wound infections (2.7%), new neurological deficits (1.4%), implant-related complications (1.6%), and hematomas (0.4%). The most common medical complications were respiratory related (0.9%). Morbidity rates differed based on pathology, with patients undergoing treatment for kyphosis and spondylolisthesis having higher overall rates of morbidity (14.7% and 9.6%, respectively). Patients undergoing revision procedures (2034) or corrective osteotomies (2787) were more likely to suffer a complication or new neurological deficit. The majority of these deficits improved at least partially. Thirty-one deaths were reported for an overall rate of 1.3 per 1000. Respiratory complications were the most common cause of mortality (13 cases). Twenty-six of the deaths occurred in children undergoing scoliosis correction.Conclusions
Spinal surgery in children is associated with a range of complications depending on the type of operation. Mortality rates for all indications and operations were low. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications and new neurological deficits.Item Open Access Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis.(Journal of neurosurgery. Spine, 2010-05) Fu, Kai-Ming G; Smith, Justin S; Polly, David W; Perra, Joseph H; Sansur, Charles A; Berven, Sigurd H; Broadstone, Paul A; Choma, Theodore J; Goytan, Michael J; Noordeen, Hilali H; Knapp, D Raymond; Hart, Robert A; Zeller, Reinhard D; Donaldson, William F; Boachie-Adjei, Oheneba; Shaffrey, Christopher IObject
The purpose of this study was to evaluate the prospectively collected Scoliosis Research Society (SRS) database to assess the incidences of morbidity and mortality (M&M) in the operative treatment of degenerative lumbar stenosis, one of the most common procedures performed by spine surgeons.Methods
All patients who underwent surgical treatment for degenerative lumbar stenosis between 2004 and 2007 were identified from the SRS M&M database. Inclusion criteria for analysis included an age >or= 21 years and no history of lumbar surgery. Patients were treated with either decompression alone or decompression with concomitant fusion. Statistical comparisons were performed using a 2-sided Fisher exact test.Results
Of the 10,329 patients who met the inclusion criteria, 6609 (64%) were treated with decompression alone, and 3720 (36%) were treated with decompression and fusion. Among those who underwent fusion, instrumentation was placed in 3377 (91%). The overall mean patient age was 63 +/- 13 years (range 21-96 years). Seven hundred nineteen complications (7.0%), including 13 deaths (0.1%), were identified. New neurological deficits were reported in 0.6% of patients. Deaths were related to cardiac (4 cases), respiratory (5 cases), pulmonary embolus (2 cases), and sepsis (1 case) etiologies, and a perforated gastric ulcer (1 case). Complication rates did not differ based on patient age or whether fusion was performed. Minimally invasive procedures were associated with fewer complications and fewer new neurological deficits (p = 0.01 and 0.03, respectively).Conclusions
The results from this analysis of the SRS M&M database provide surgeons with useful information for preoperative counseling of patients contemplating surgical intervention for symptomatic degenerative lumbar stenosis.Item Open Access Morbidity and mortality in the surgical treatment of six hundred five pediatric patients with isthmic or dysplastic spondylolisthesis.(Spine, 2011-02) Fu, Kai-Ming G; Smith, Justin S; Polly, David W; Perra, Joseph H; Sansur, Charles A; Berven, Sigurd H; Broadstone, Paul A; Choma, Theodore J; Goytan, Michael J; Noordeen, Hilali H; Knapp, D Raymond; Hart, Robert A; Donaldson, William F; Boachie-Adjei, Oheneba; Shaffrey, Christopher IStudy design
Retrospective analysis of prospectively collected database.Objective
To analyze the rate of complications, including neurologic deficits, associated with operative treatment of pediatric isthmic and dysplastic spondylolisthesis.Summary of background data
Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon dis-orders. Several prior studies have suggested a high rate of complication associated with operative intervention. How-ever, most of these studies were performed with sufficiently small sample sizes such that the presence of one complication could significantly affect the overall rate. The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. This multicentered, multisurgeon database permits analysis of the surgical treatment of this relatively rare condition on an aggregate scale and provides surgeons with useful information for preoperative counseling.Methods
Patients who underwent surgical treatment for isthmic or dysplastic spondylolisthesis from 2004 to 2007 were identified from the SRS M&M database. Inclusion criteria for analysis included age ≤ 21 and a primary diagnosis of isthmic or dysplastic spondylolisthesis.Results
Of 25,432 pediatric cases reported, there were a total of 605 (2.4%) cases of pediatric dysplastic (n ∇ 62, 10%) and isthmic (n ∇ 543, 90%) spondylolisthesis, with a mean age of 15 years (range, 4-21). Approximately 50% presented with neural element compression, and less than 1% of cases were revisions. Surgical procedures included fusions in 92%, osteotomies in 39%, and reductions in 38%. The overall complication rate was 10.4%. The most common complications included postoperative neurologic deficit (n ∇ 31, 5%), dural tear (n ∇ 8, 1.3%), and wound infection (n ∇ 12, 2%). Perioperative deep venous thrombosis and pulmonary embolus were reported in 2 (0.3%) and 1 (0.2%) patients, respectively. There were no deaths in this series.Conclusion
Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders, representing only 2.4% of pediatric spine procedures in the present study. Even among experienced spine surgeons, surgical treatment of these spinal conditions is associated with a relatively high morbidity.Item Open Access Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee.(Spine, 2011-05) Smith, Justin S; Sansur, Charles A; Donaldson, William F; Perra, Joseph H; Mudiyam, Ram; Choma, Theodore J; Zeller, Reinhard D; Knapp, D Raymond; Noordeen, Hilali H; Berven, Sigurd H; Goytan, Michael J; Boachie-Adjei, Oheneba; Shaffrey, Christopher IStudy design
Retrospective review.Objective
Our objective was to assess the short-term complication rate in patients undergoing treatment of thoracolumbar fixed sagittal plane deformity (FSPD).Summary of background data
The reported morbidity and mortality for the surgical treatment of thoracolumbar FSPD is varied and based on studies with small sample sizes. Further studies are needed to better assess FSPD complication rate, and the factors that influence it.Methods
The Scoliosis Research Society (SRS) Morbidity and Mortality Database was queried to identify cases of thoracolumbar FSPD from 2004 to 2007. Complications were analyzed based on correction technique, surgical approach, surgeon experience (SRS membership status used as a surrogate), patient age, and history of prior surgery.Results
Five hundred and seventy-eight cases of FSPD were identified. Osteotomies were performed in 402 cases (70%), including 215 pedicle subtraction osteotomies (PSO), 135 Smith-Petersen osteotomies (SPO), 19 anterior discectomy with corpectomy procedures (ADC), 18 vertebral column resections (VCR), and 15 unspecified osteotomies. There were 170 complications (29.4%) in 132 patients. There were three deaths (0.5%). The most common complications were durotomy (5.9%), wound infection (3.8%), new neurologic deficit (3.8%), implant failure (1.7%), wound hematoma (1.6%), epidural hematoma (1.4%), and pulmonary embolism (1.0%). Procedures including an osteotomy had a higher complication rate (34.8%) than cases not including an osteotomy (17.0%, P < 0.001), and this remained significant after adjusting for the effects of patient age, surgeon experience, and history of prior surgery (P = 0.003, odds ratio = 2.070, 95% CI = 1.291-3.321). Not significantly associated with complication rate were patient age (P = 0.68), surgeon experience (P = 0.18), and history of prior surgery (P = 0.10). Complication rates were progressively higher from no osteotomy (17.0%), to SPO (28.1%), to PSO (39.1%), to VCR (61.1%).Conclusion
The short-term complication rate for treatment of FSPD is 29.4%. The complication rate was significantly higher in patients undergoing osteotomies, and more aggressive osteotomies were associated with progressively higher complication rates.