2024
Prediction Models for Risk Assessment of Surgical Site Infection after Spinal Surgery: A Systematic Review
Lauinger A, Blake S, Fullenkamp A, Polites G, Grauer J, Arnold P. Prediction Models for Risk Assessment of Surgical Site Infection after Spinal Surgery: A Systematic Review. North American Spine Society Journal (NASSJ) 2024, 100518. DOI: 10.1016/j.xnsj.2024.100518.Peer-Reviewed Original ResearchSurgical site infectionPreoperative risk modelSpinal surgerySite infectionAdverse eventsAssessment of surgical site infectionACS NSQIP surgical risk calculatorPostoperative surgical site infectionNSQIP surgical risk calculatorRate of adverse eventsSpine surgery patientsRisk of adverse eventsStratify patient riskSurgical risk calculatorField of spine surgeryClinical prediction toolSpine surgeryRisk modelSurgery patientsSurgeryAddressing factorsPatient riskClinical utilitySystematic reviewUnique susceptibility
2023
Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading “gold standard”
Rudisill K, Ratnasamy P, Maloy G, Grauer J. Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading “gold standard”. Journal Of The American Academy Of Orthopaedic Surgeons 2023, 31: 938-944. PMID: 37332184, DOI: 10.5435/jaaos-d-22-01029.Peer-Reviewed Original ResearchConceptsElixhauser Comorbidity IndexSurgeon specialtySpinal fusionComorbidity indexSmoking statusGold standardIliac crest autograftPatient ageIndependent predictorsPatient factorsNonsurgical factorsCrest autograftSpine surgeryBone graftingSpine fusionIliac crestBone graftAutograftYounger ageSurgeryInsurance factorsSpinal boneCommon procedureInsurance plansAge
2022
Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021
Ratnasamy P, Rudisill K, Maloy G, Grauer J. Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021. Spine 2022, 48: e342-e348. PMID: 36728785, PMCID: PMC10300227, DOI: 10.1097/brs.0000000000004560.Peer-Reviewed Original ResearchConceptsSingle-level cervical disc arthroplastyCervical disc arthroplastyKaplan-Meyer survival analysisPredictive patient factorsCervical spine pathologySingle-level ACDFAnterior cervical discectomyAnterior cervical surgeryCervical spine surgerySpine reoperationCervical surgeryCervical discectomyPatient factorsPredictive factorsSpine surgeryACDFDisc arthroplastySpine pathologyEpidemiologic studiesOrthopaedic surgeonsCommercial insuranceSurvival analysisMultivariate analysisSurgeryYounger agePostoperative spine surgical site infections: high rate of failure of one-stage irrigation and debridement
Dhodapkar M, Galivanche A, Halperin S, Elaydi A, Rubio D, Grauer J. Postoperative spine surgical site infections: high rate of failure of one-stage irrigation and debridement. The Spine Journal 2022, 23: 484-491. PMID: 36549456, DOI: 10.1016/j.spinee.2022.12.005.Peer-Reviewed Original ResearchConceptsSurgical site infectionElective spine surgerySpine surgeryInitial managementRate of SSIInfection characteristicsSpine surgical site infectionPostoperative surgical site infectionRetrospective case-control studyPresence of bacteremiaRisk stratification toolCase-control studySingle academic institutionTimes greater oddsDevastating complicationSite infectionMultivariable analysisStratification toolSurgical managementSurgical variablesIndex procedureSurgical interventionRisk factorsInclusion criteriaLarge cohort
2021
Long-term Corticosteroid Use Independently Correlates With Complications After Posterior Lumbar Spine Surgery.
Kebaish KJ, Galivanche AR, Varthi AG, Ottesen TD, Rubin LE, Grauer JN. Long-term Corticosteroid Use Independently Correlates With Complications After Posterior Lumbar Spine Surgery. Orthopedics 2021, 44: 172-179. PMID: 34039214, DOI: 10.3928/01477447-20210416-01.Peer-Reviewed Original ResearchConceptsLong-term corticosteroid usePosterior lumbar spine surgeryPosterior lumbar surgeryLumbar spine surgeryPerioperative adverse outcomesCorticosteroid useAdverse eventsLumbar surgerySpine surgeryPropensity matchingAdverse outcomesNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseMinor adverse eventsEffect of immunosuppressionImprovement Program databaseLong-term corticosteroidsSerious adverse eventsBody mass indexMultiple surgical specialtiesAnesthesiologists classComparable patientsPerioperative outcomesSurgical factorsMore patientsPostoperative bracing practices after elective lumbar spine surgery: A questionnaire study of U.S. spine surgeons
Pathak N, Scott MC, Galivanche AR, Burroughs PJ, Moore HG, Hilibrand AS, Malpani R, Justen M, Varthi AG, Grauer JN. Postoperative bracing practices after elective lumbar spine surgery: A questionnaire study of U.S. spine surgeons. North American Spine Society Journal (NASSJ) 2021, 5: 100055. PMID: 35141620, PMCID: PMC8820027, DOI: 10.1016/j.xnsj.2021.100055.Peer-Reviewed Original ResearchElective lumbar surgeryLumbar surgerySpine surgerySpine surgeonsElective lumbar spine surgeryMajority of respondentsElective spine surgeryUse of orthosesLumbar spine surgeryLateral interbody fusionNon-fusion surgeryDuration of useChi-square testType of braceEvidence-based practiceInterbody fusionLumbar fusionSurgeon respondentsSurgeryMost surgeonsSacral orthosisSurgeonsOrthosesOne-way analysisDemographic informationSpine Surgery HCAHPS Patient Satisfaction Survey Results Inversely Correlate with Survey Response Time
Kebaish KJ, Mercier MR, Duy PQ, Malpani R, Galivanche AR, Grauer JN. Spine Surgery HCAHPS Patient Satisfaction Survey Results Inversely Correlate with Survey Response Time. Spine 2021, 46: 1264-1270. PMID: 34435990, DOI: 10.1097/brs.0000000000003974.Peer-Reviewed Original ResearchConceptsHCAHPS surveySurgery patientsSpinal surgery patientsSpine surgery patientsPatient satisfaction surveyHospital Consumer AssessmentPatient satisfaction metricsAcademic medical centerMultivariate regression analysisLower scoresSurvey response timeAnesthesiologists classPatient demographicsPostoperative outcomesRetrospective reviewFunctional statusSpine surgeryBACKGROUND DATAMedical CenterPatient experienceDay 22Day 43Healthcare providersDay 0Reported satisfaction
2020
Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery
Ottesen TD, Bagi PS, Malpani R, Galivanche AR, Varthi AG, Grauer JN. Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery. North American Spine Society Journal (NASSJ) 2020, 5: 100041. PMID: 35141608, PMCID: PMC8820029, DOI: 10.1016/j.xnsj.2020.100041.Peer-Reviewed Original ResearchBody mass indexPosterior cervical spine surgeryCervical spine surgeryAdverse eventsBMI categoriesBMI spectrumSpine surgeryNational Surgical Quality Improvement Program databaseRisk-adjusted multivariate regressionsQuality Improvement Program databaseHigher body mass indexLower body mass indexOutcomes of patientsImprovement Program databaseNormal-weight subjectsCategory of patientsSpine surgery outcomesUnderweight patientsPatient demographicsBMI groupsMass indexAdverse outcomesSurgery outcomesProgram databaseInclusion criteriaPatients' and Physicians' Knowledge of Radiation Exposure Related to Spine Surgery.
Scott MC, Galivanche AR, Mets EJ, Pathak N, Kahan JB, Burroughs PJ, Varthi AG, Rubin LE, Grauer JN. Patients' and Physicians' Knowledge of Radiation Exposure Related to Spine Surgery. Spine 2020, 45: e1507-e1515. PMID: 32858741, DOI: 10.1097/brs.0000000000003650.Peer-Reviewed Original ResearchConceptsSpine surgeryMagnetic resonance imagingRadiation exposureOutpatient settingPhysicians' knowledgeLumbar radiographsO-armCT imagingIntraoperative radiation exposureCross-sectional imagingCross-sectional surveyPhysician estimatesSpine proceduresBACKGROUND DATACare settingsIntraoperative fluoroscopyLumbar imagingPatientsSurgeryResonance imagingIntraoperative CTSurgeonsAwareness/knowledgeIntraoperative imagingRobotic spine surgeryCharacteristics and Predictors of HCAHPS Nonresponse After Spine Surgery.
Malpani R, Adrados M, Mercier MR, McLynn RP, Galivanche AR, Pathak N, Grauer JN. Characteristics and Predictors of HCAHPS Nonresponse After Spine Surgery. Spine 2020, 45: e448-e456. PMID: 31609883, PMCID: PMC7113123, DOI: 10.1097/brs.0000000000003287.Peer-Reviewed Original ResearchConceptsSpine surgery patientsSpine surgeryHCAHPS surveyPerioperative outcomesAdverse eventsPatient characteristicsSurgery patientsSingle institutionMultivariate analysisLonger hospital lengthHigher American SocietyMajor adverse eventsMinor adverse eventsRetrospective cohort studyMinority of patientsPatient satisfaction surveyHospital Consumer AssessmentSatisfaction surveyNonresponder biasHospital lengthPatient demographicsCohort studyHospital readmissionRetrospective analysisBACKGROUND DATAUnderweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery
Ottesen TD, Malpani R, Galivanche AR, Zogg CK, Varthi AG, Grauer JN. Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery. The Spine Journal 2020, 20: 1085-1095. PMID: 32194246, PMCID: PMC7380546, DOI: 10.1016/j.spinee.2020.03.007.Peer-Reviewed Original ResearchConceptsAnterior cervical spine surgeryBody mass indexCervical spine surgeryNational Surgical Quality Improvement Program databaseSuper morbidly obese patientsQuality Improvement Program databaseWorld Health Organization categoriesMorbidly obese patientsImprovement Program databaseObese patientsAdverse eventsAdverse outcomesSpine surgeryUnderweight patientsPostoperative infectionProgram databaseSurgeons National Surgical Quality Improvement Program databaseMultivariate analysisAnterior cervical spine proceduresOverweight/obese categoriesThirty-day adverse eventsHigher body mass indexLower body mass indexAdverse outcome categoriesNormal BMI patients
2019
Admission NarxCare Narcotics Scores are not Associated With Adverse Surgical Outcomes or Self-reported Patient Satisfaction Following Elective Spine Surgery.
Galivanche AR, Mercier MR, Adrados M, Pathak N, McLynn RP, Anandasivam NS, Varthi AG, Rubin LE, Grauer JN. Admission NarxCare Narcotics Scores are not Associated With Adverse Surgical Outcomes or Self-reported Patient Satisfaction Following Elective Spine Surgery. Spine 2019, 44: 1515-1522. PMID: 31356498, DOI: 10.1097/brs.0000000000003120.Peer-Reviewed Original ResearchConceptsMultivariate logistic regressionPatient satisfactionAdverse eventsNarcotic scoreSurvey response rateSpine surgeryResponse rateLogistic regressionSelf-reported patient satisfactionElective spine surgeryPreoperative opioid usePostoperative patient satisfactionTime of admissionAdverse surgical outcomesSpine surgery casesHospital Consumer AssessmentHCAHPS survey resultsDifferent narcoticsNarcotic usagePerioperative outcomesNarcotic utilizationOpioid usePatient characteristicsPostoperative outcomesNarcotic groupPatient-related Factors and Perioperative Outcomes Are Associated with Self-Reported Hospital Rating after Spine Surgery.
Mets EJ, Mercier MR, Hilibrand AS, Scott MC, Varthi AG, Grauer JN. Patient-related Factors and Perioperative Outcomes Are Associated with Self-Reported Hospital Rating after Spine Surgery. Clinical Orthopaedics And Related Research® 2019, 478: 643-652. PMID: 31389897, PMCID: PMC7145058, DOI: 10.1097/corr.0000000000000892.Peer-Reviewed Original ResearchConceptsOverall hospital experienceMultivariate logistic regression analysisPatient-related factorsAdverse eventsHospital ratingSpine surgeryLogistic regression analysisPerioperative outcomesPatient factorsQuality of careSurgical variablesHospital experienceHCAHPS scoresHCAHPS surveyPatient demographicsAnnual reimbursementAnesthesiologists class IIMinor adverse eventsNumerous patient factorsOnly surgical factorMajor adverse eventsSpine surgery populationSingle academic institutionHospital Consumer AssessmentPotential confounding variablesCardiac Complications Related to Spine Surgery: Timing, Risk Factors, and Clinical Effect.
Bovonratwet P, Bohl DD, Malpani R, Haynes MS, Rubio DR, Ondeck NT, Shultz BN, Mahal AR, Grauer JN. Cardiac Complications Related to Spine Surgery: Timing, Risk Factors, and Clinical Effect. Journal Of The American Academy Of Orthopaedic Surgeons 2019, 27: 256-263. PMID: 30897607, DOI: 10.5435/jaaos-d-17-00650.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overDatabases, FactualFemaleHeart ArrestHumansIncidenceIntraoperative ComplicationsLength of StayMaleMiddle AgedMonitoring, PhysiologicMultivariate AnalysisMyocardial InfarctionOrthopedic ProceduresPatient ReadmissionPerioperative PeriodPostoperative ComplicationsRisk FactorsSpineTime FactorsYoung AdultConceptsCardiac complicationsSpine surgeryRisk factorsPostoperative periodNational Surgical Quality Improvement Program databaseSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramQuality Improvement Program databaseSurgical Quality Improvement ProgramPerioperative cardiac complicationsHigh-risk patientsImprovement Program databaseInsulin-dependent diabetesLarge cohort studyQuality Improvement ProgramPreoperative anemiaPostoperative lengthCohort studyPerioperative periodPrimary outcomeClinical effectsCardiac arrestMyocardial infarctionProgram databaseAmerican College
2018
Incidence and considerations of 90-day readmissions following posterior lumbar fusion
Cui JJ, Gala RJ, Ondeck NT, McLynn RP, Bovonratwet P, Shultz B, Grauer JN. Incidence and considerations of 90-day readmissions following posterior lumbar fusion. The Spine Journal 2018, 19: 631-636. PMID: 30219360, DOI: 10.1016/j.spinee.2018.09.004.Peer-Reviewed Original ResearchConceptsPosterior lumbar fusionDays of dischargeReadmission ratesBaseline readmission ratesHuman Investigation CommitteeAdmission ratesDay readmissionLumbar fusionUtilization Project Nationwide Readmissions DatabaseAverage daily admission rateBaseline admission rateBundled payment plansNationwide Readmissions DatabaseHospital admission dataAverage admission rateDaily admission ratesCalendar yearCurrent quality metricsPLF patientsPatient demographicsPostoperative dayRetrospective studyPatient counselingPatient outcomesSpine surgeryDialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery
Ottesen TD, McLynn RP, Zogg CK, Shultz BN, Ondeck NT, Bovonratwet P, Bellamkonda KS, Rubin LE, Grauer JN. Dialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery. The Spine Journal 2018, 18: 2033-2042. PMID: 30077772, DOI: 10.1016/j.spinee.2018.04.007.Peer-Reviewed Original ResearchConceptsElective spine surgeryNon-dialysis patientsDialysis-dependent patientsPerioperative adverse eventsAdverse eventsDialysis patientsSpine surgeryUnplanned readmissionCohort studyPatient demographicsRisk factorsNational Surgical Quality Improvement Program databaseRisk-adjusted multivariate regressionsQuality Improvement Program databaseOperating roomDialysis-independent patientsInstitutional cohort studyMinor adverse eventsRetrospective cohort studyElective spinal surgeryImprovement Program databaseIndependent risk factorMajor adverse eventsPercentage of complicationsAdministrative database studyIncidence, Risk Factors, and Impact of Clostridium difficile Colitis After Spine Surgery
Bovonratwet P, Bohl DD, Russo GS, Ondeck NT, Singh K, Grauer JN. Incidence, Risk Factors, and Impact of Clostridium difficile Colitis After Spine Surgery. Spine 2018, 43: 861-868. PMID: 28953711, DOI: 10.1097/brs.0000000000002430.Peer-Reviewed Original ResearchConceptsClostridium difficile colitisDifficile colitisIndependent risk factorSpine surgical proceduresRisk factorsSpine surgerySurgical proceduresPosterior lumbar fusion proceduresPost-hospitalization followSpine surgery patientsHigh-risk patientsLarge cohort studyLumbar fusion proceduresPre-existing infectionLarge national databasePostoperative lengthCohort studyNSQIP databasePostoperative periodSurgery patientsPrimary outcomeRetrospective studyDifficile infectionClinical impactInfection diagnosisFrequency and Acceptability of Adverse Events After Anterior Cervical Discectomy and Fusion
Wilson JR, Radcliff K, Schroeder G, Booth M, Lucasti C, Fehlings M, Ahmad N, Vaccaro A, Arnold P, Sciubba D, Ching A, Smith J, Shaffrey C, Singh K, Darden B, Daffner S, Cheng I, Ghogawala Z, Ludwig S, Buchowski J, Brodke D, Wang J, Lehman RA, Hilibrand A, Yoon T, Grauer J, Dailey A, Steinmetz M, Harrop JS. Frequency and Acceptability of Adverse Events After Anterior Cervical Discectomy and Fusion. Clinical Spine Surgery A Spine Publication 2018, 31: e270-e277. PMID: 29708891, DOI: 10.1097/bsd.0000000000000645.Peer-Reviewed Original ResearchConceptsAnterior cervical discectomyAdverse eventsCervical discectomyPrimary specialtyPractice locationAdjacent segment diseaseSpinal cord injuryUS surgeonsWrong-level surgeryFuture quality improvementComplication eventsAcceptable complicationsUncommon complicationEsophageal injuryLevel surgeryCord injurySegment diseaseSpine surgerySurgeon experienceOrthopaedic surgeonsSurgeons' opinionsComplicationsDiscectomyMajority of respondentsSurgeons
2017
Results of Database Studies in Spine Surgery Can Be Influenced by Missing Data
Basques BA, McLynn RP, Fice MP, Samuel AM, Lukasiewicz AM, Bohl DD, Ahn J, Singh K, Grauer JN. Results of Database Studies in Spine Surgery Can Be Influenced by Missing Data. Clinical Orthopaedics And Related Research® 2017, 475: 2893-2904. PMID: 27896677, PMCID: PMC5670041, DOI: 10.1007/s11999-016-5175-7.Peer-Reviewed Original ResearchMeSH KeywordsComorbidityData AccuracyData CollectionData MiningDatabases, FactualDecision Support TechniquesHumansLength of StayLogistic ModelsMultivariate AnalysisOdds RatioOperative TimeOrthopedic ProceduresPostoperative ComplicationsPredictive Value of TestsProcess Assessment, Health CareRetrospective StudiesRisk AssessmentRisk FactorsSpinal DiseasesSpineTime FactorsTreatment OutcomeUnited StatesConceptsACS-NSQIP databaseAdverse eventsPreoperative laboratory valuesRisk factorsSpine surgeryOperating room timeLaboratory valuesSpine studiesACS-NSQIPDatabase studyRoom timeReference rangeQuality Improvement Program databasePerioperative laboratory valuesVariable reference rangesAnterior cervical discectomyImprovement Program databaseMost risk factorsLength of stayLarge database studiesDifferent risk factorsEffect sizeCervical discectomyMedical comorbiditiesGreater effect sizeThe Rothman Index as a predictor of postdischarge adverse events after elective spine surgery
McLynn RP, Ondeck NT, Cui JJ, Swanson DR, Shultz BN, Bovonratwet P, Grauer JN. The Rothman Index as a predictor of postdischarge adverse events after elective spine surgery. The Spine Journal 2017, 18: 1149-1156. PMID: 29155251, DOI: 10.1016/j.spinee.2017.11.008.Peer-Reviewed Original ResearchConceptsElective spine surgeryPostdischarge adverse eventsMinor adverse eventsMajor adverse eventsAdverse eventsRothman IndexSpine surgeryMedical CenterOverall patient conditionRothman Index scoresHigh-risk patientsRate of readmissionRetrospective cohort studyLarge academic medical centerPostoperative day 30Body mass indexLength of stayAcademic medical centerPresent studyElectronic medical recordsLater scoresAnesthesiologists classHospital lengthPerioperative outcomesCohort study