Browsing by Author "Xu, A"
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Item Open Access Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery(Spine, 2024-01-01) Daher, M; Xu, A; Singh, M; Lafage, R; Line, BG; Lenke, LG; Ames, CP; Burton, DC; Lewis, SM; Eastlack, RK; Gupta, MC; Mundis, GM; Gum, JL; Hamilton, KD; Hostin, R; Lafage, V; Passias, PG; Protopsaltis, TS; Kebaish, KM; Schwab, FJ; Shaffrey, CI; Smith, JS; Bess, S; Klineberg, EO; Diebo, BG; Daniels, AHStudy Design. Retrospective analysis of prospectively-collected data Objective. This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery. Background. Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE). Methods. Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. LASSO regression was performed to identify five variables from demographic and peri-operative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristics (ROC) curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE plotted against EBL and EBVL to confirm the identified thresholds. Results. In total 552 patients were included with a mean age of 60.7±15.1 years, 68% females, mean CCI was 1.0±1.6, and 22% experienced AEs. LASSO regression identified ASA score, baseline hypertension, preoperative albumin, and use of intra-operative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in ROC curve which was used to identify a cut-off of 2.3 liters of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds-ratio: 2.1, 95% CI [1.2-3.6]) and 31% (odds-ratio: 1.7, 95% CI [1.1-2.8]), compared to 21% for those below the thresholds of EBL and EBVL, respectively. Conclusion. In complex ASD surgery, intraoperative EBL of 2.3 liters and an EBVL of 42% are associated with clinically-significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, healthcare system quality initiatives, and clinical perioperative bloodloss management strategies in patients undergoing complex spine surgery. Additionally, similar methodology could be performed in other specialties to establish procedure-specific clinically-relevant bloodloss thresholds.Item Open Access Severe hip and knee osteoarthritis worsens patient-reported disability in adult spinal deformity patients(Spine Journal, 2024-09-01) Balmaceno-Criss, M; Singh, M; Xu, A; Daher, M; Lafage, R; Lewis, SJ; Klineberg, EO; Eastlack, RK; Gupta, MC; Mundis, GM; Gum, JL; Hamilton, DK; Hostin, RA; Passias, PG; Protopsaltis, TS; Kebaish, KM; Kim, HJ; Shaffrey, CI; Smith, JS; Line, B; Lenke, LG; Ames, CP; Burton, DC; Bess, S; Schwab, FJ; Lafage, V; Diebo, BG; Daniels, AHBACKGROUND CONTEXT: The complex interplay between lower extremity osteoarthritis and sagittal alignment in adult spinal deformity patients is of growing clinical interest. PURPOSE: To quantify the sequential effects of lower extremity OA on PROMs in ASD patients. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: ASD patients with no prior history of thoracolumbar surgery, and available baseline PROMs and standing radiographs were included. OUTCOME MEASURES: Baseline demographics, spinopelvic alignment, and PROMs. METHODS: Included patients with PROMs, standing xrays, no prior thoracolumbar surgery, and bilateral Kellgren-Lawrence (KL) hip/knee grade at baseline. Patients grouped into Spine (KL <3 BL hips & knees), Spine-Hip (KL>3 BL hips, KL <3 BL knees), Spine-Knee (KL>3 BL knees, KL>3 BL hips), Spine-Hip-Knee (KL>3 BL hips & knees). Baseline demographics, spinopelvic alignment, and PROMs were compared. Multivariate regression with forward stepwise selection predicted PROMs with variables (demographic, radiographic, OA severity) with significant association identified on Pearson correlation RESULTS: Included 160 patients: 56 Spine, 32 Spine-Knee, 20 Spine-Hip, and 52 Spine-Hip-Knee. Spine-Hip-Knee patients were older (Spine=62.2, Spine-Knee=61.2, Spine-Hip=59.1, Spine-Hip-Knee=68.5; p<.001) but similar in sex, comorbidities, and frailty; p>.05. Spine-Hip-Knee patients had higher SVA (50.0,30.6,60.5,83.5), T1PA (25.2,20.4,20.3,27.8), GSA (3.7,2.3,4.3,7.5), and KA (0.0,2.1,2.9,10.5); p<.005. SRS total and VR12 PCS scores were similar but VR12-2b climbing stairs (1.73,1.91,1.55,1.40, p=.014) and SRS-8 back pain at rest (2.29,2.84,1.95,2.71, p=.012) were lower in Spine-Hip-Knee and Spine-Hip, respectively. ODI (42.75,35.88,50.30,44.59, p=.040) and ODI Pain (2.88,1.84,2.90,2.46, p=0.019) were higher in Spine-Hip patients; ODI lifting was higher in hip OA patients but not significant (2.95,2.69,3.45,3.35, p>.05). In multivariate analyses, KOA changed the prediction of ODI pain from R2 0.052 to 0.086 and SRS-8 from R2 0.077 to 0.147. HOA changed the prediction of VR12-2b from R2 0.113 to 0.140 and ODI Lifting from R2 0.175 to 0.202. Frailty impacted PROMs across all models (p<.001) and GSA changed ODI, ODI pain, and VR12-2b models (p<.05). CONCLUSIONS: Severe hip and knee OA worsen patient-reported disability and physical function in ASD patients. These results quantify the impact of lower limb arthritis on patient reported outcomes, and highlight the need for integrated assessment and management of both spinal alignment and joint health in patients. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.