Browsing by Author "Zuckerman, Scott L"

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    Effect of Resident and Fellow Involvement in Adult Spinal Deformity Surgery.
    (World neurosurgery, 2019-02) Zuckerman, Scott L; Lim, Jaims; Lakomkin, Nikita; Than, Khoi D; Smith, Justin S; Shaffrey, Christopher I; Devin, Clinton J

    Background

    Adult spinal deformity (ASD) operations are complex and often require a multisurgeon team. Simultaneously, it is the responsibility of academic spine surgeons to train future complex spine surgeons. Our objective was to assess the effect of resident and fellow involvement (RFI) on ASD surgery in 4 areas: 1) perioperative outcomes, 2) length of stay (LOS), 3) discharge status, and 4) complications.

    Methods

    Adults undergoing thoracolumbar spinal deformity correction from 2008 to 2014 were identified in the National Surgical Quality Improvement Program database. Cases were divided into those with RFI and those with attendings only. Outcomes were operative time, transfusions, LOS, discharge status, and complications. Univariate and multivariable regression modeling was used. Covariates included preoperative comorbidities, specialty, and levels undergoing instrumentation.

    Results

    A total of 1471 patients underwent ASD surgery with RFI in 784 operations (53%). After multivariable regression modeling, RFI was independently associated with longer operations (β = 66.01 minutes; 95% confidence interval [CI], 35.82-96.19; P < 0.001), increased odds of transfusion (odds ratio, 2.80; 95% CI, 1.81-4.32; P < 0.001), longer hospital stay (β = 1.76 days; 95% CI, 0.18-3.34; P = 0.030), and discharge to an inpatient rehabilitation or a skilled nursing facility (odds ratio, 2.02; 95% CI, 1.34-3.05; P < 0.001). However, RFI was not associated with any increase in major or minor complications.

    Conclusion

    RFI in ASD surgery was associated with increased operative time, the need for additional transfusions, longer LOS, and nonhome discharge. However, no increase in major, minor, or severe complications occurred. These data support the continued training of future deformity and complex spine surgeons without fear of worsening complications; however, areas of improvement exist.
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    In Reply: Incidence and Predictive Factors of Sepsis Following Adult Spinal Deformity Surgery.
    (Neurosurgery, 2018-07) Zuckerman, Scott L; Lakomkin, Nikita; Hadjipanayis, Constantinos G; Shaffrey, Christopher I; Smith, Justin S; Cheng, Joseph S
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    Incidence and Predictive Factors of Sepsis Following Adult Spinal Deformity Surgery.
    (Neurosurgery, 2018-11) Zuckerman, Scott L; Lakomkin, Nikita; Stannard, Blaine P; Hadjipanayis, Constantinos G; Shaffrey, Christopher I; Smith, Justin S; Cheng, Joseph S
    BACKGROUND:Surgery for adult spinal deformity (ASD) improves quality of life, yet morbidity is high. Sepsis is a challenging postoperative complication that can result in death and drive inpatient resources. OBJECTIVE:To identify the incidence and risk factors for development of sepsis within 30 days following ASD surgery. METHODS:Adult patients who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program database. Demographic and operative variables were extracted. The primary outcome was development of postoperative sepsis. Multivariable logistic regression modeling was used to identify independent risk factors for sepsis. RESULTS:A total of 6158 patients underwent ASD surgery. Of these, 156 (2.5%) developed sepsis postoperatively. Independent risk factors included operative time (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.003-1.005, P < .001), male sex (OR: 1.47, 95% CI: 1.05-2.05, P = .023), diabetes (OR: 1.59, 95% CI: 1.05-2.40, P = .027), functional dependency (OR: 1.82, 95% CI: 1.12-2.95, P = .015), weight loss (OR: 2.45, 95% CI: 1.04-5.78, P = .040), bleeding disorder (OR: 2.58, 95% CI: 1.34-4.93, P = .004), and ascites (OR: 56.11, 95% CI: 5.01-628.50, P = .001). This model demonstrated strong predictive capacity, with an area under the curve of 0.80. Patients who developed sepsis were significantly more likely to have a prolonged hospital stay (P < .001), be readmitted (P < .001), and die (P < .001). The median (range) time to sepsis was 9 d (0-30). CONCLUSION:In patients undergoing ASD surgery, male sex, diabetes, ascites, bleeding disorder, functional dependency, excessive weight loss and increased operative time independently predicted sepsis. This perioperative patient profile can be used for preoperative risk assessment, patient counseling, and postoperative management for patients undergoing ASD surgery.
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    Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study.
    (Global spine journal, 2022-10) Zuckerman, Scott L; Cerpa, Meghan; Lenke, Lawrence G; Shaffrey, Christopher I; Carreon, Leah Y; Cheung, Kenneth MC; Kelly, Michael P; Fehlings, Michael G; Ames, Christopher P; Boachie-Adjei, Oheneba; Dekutoski, Mark B; Kabeaish, Khaled M; Lewis, Stephen J; Matsuyama, Yukihiro; Pellisé, Ferran; Qiu, Yong; Schwab, Frank J; Smith, Justin S; AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group

    Study design

    Prospective cohort.

    Objective

    To prospectively evaluate PROs up to 5-years after complex ASD surgery.

    Methods

    The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria was Cobb angle of >80°, corrective osteotomy for congenital or revision deformity, and/or 3-column osteotomy. The following PROs were measured prospectively at intervals up to 5-years postoperative: ODI, SF36-PCS/MCS, SRS-22, NRS back/leg. Among patients with 5-year follow-up, comparisons were made from both baseline and 2-years postoperative to 5-years postoperative. PROs were analyzed using mixed models for repeated measures.

    Results

    Seventy-seven patients (28.3%) had 5-year follow-up data. Comparing baseline to 5-year data among these 77 patients, significant improvement was seen in all PROs: ODI (45.2 vs. 29.3, P < 0.001), SF36-PCS (31.5 vs. 38.8, P < 0.001), SF36-MCS (44.9 vs. 49.1, P = 0.009), SRS-22-total (2.78 vs. 3.61, P < 0.001), NRS-back pain (5.70 vs. 2.95, P < 0.001) and NRS leg pain (3.64 vs. 2.62, P = 0.017). In the 2 to 5-year follow-up period, no significant changes were seen in any PROs. The percentage of patients achieving MCID from baseline to 5-years were: ODI (62.0%) and the SRS-22r domains of function (70.4%), pain (63.0%), mental health (37.5%), self-image (60.3%), and total (60.3%). Surprisingly, mean values (P > 0.05) and proportion achieving MCID did not differ significantly in patients with major surgery-related complications compared to those without.

    Conclusions

    After complex ASD surgery, significant improvement in PROs were seen at 5-years postoperative in ODI, SF36-PCS/MCS, SRS-22r, and NRS-back/leg pain. No significant changes in PROs occurred during the 2 to 5-year postoperative period. Those with major surgery-related complications had similar PROs and proportion of patients achieving MCID as those without these complications.
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    The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery.
    (European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2021-11) Lenke, Lawrence G; Zuckerman, Scott L; Cerpa, Meghan; Shaffrey, Christopher I; Carreon, Leah Y; Cheung, Kenneth MC; Kelly, Michael P; Fehlings, Michael G; Ames, Christopher P; Boachie-Adjei, Oheneba; Dekutoski, Mark B; Kebaish, Khaled M; Lewis, Stephen J; Matsuyama, Yukihiro; Pellisé, Ferran; Qiu, Yong; Schwab, Frank J; Smith, Justin S; AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group

    Introduction

    Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.

    Objective

    To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.

    Design

    Retrospective analysis of a prospective, multicenter, international observational study.

    Methods

    The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.

    Results

    Seventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2-5 year window, while mean LEMS did not change significantly (-0.5, p = 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a major surgery-related complication, mean LEMS were significantly lower in patients with neurologic surgery-related complications at discharge (p = 0.041) and 6 months (p = 0.008) between the two groups as well as the change from baseline to 5 years (p = 0.041).

    Conclusions

    In 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up.