Incidence Of Revision Surgery Research Articles

Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure.

Septoplasty is an accepted and common surgical intervention to improve the nasal airway. However, the role of concomitant surgery on the inferior turbinate remains debated. This study aims to investigate if the inferior turbinate surgery at the time of septoplasty would impact on the likelihood of revision nasal surgery - septoplasty or septorhinoplasty. Retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction over 12 years (1998 - 2010) at Aberdeen Royal Infirmary. Patients were identified from the theatre log books and were excluded if they underwent any other nasal procedure. Data collected include demographics, type of primary surgery, and grade of surgeon along with revision nasal surgery in this cohort. 2168 eligible patients with a mean age of 39 years were investigated. Two groups were identified: Group A, with 788 patients who underwent septoplasty only, and Group B, in which 1380 patients underwent septoplasty with concomitant inferior turbinate reduction. The majority of operations were performed by the surgeons in training. The incidence of revision surgery was 5.1 % (21 revision septoplasties and 19 corrective septorhinoplasties) in Group A compared to 2.2 % (20 revision septoplasties and 10 corrective septorhinoplasties) in Group B. Based on this study, it would appear that concomitant inferior turbinate reduction may decrease the likelihood of revision nasal surgery.

Are routine postoperative radiographs necessary during the first year after posterior spinal fusion for idiopathic scoliosis? A retrospective cohort analysis of implant failure and surgery revision rates.

Radiographs are routinely obtained at postoperative visits during the first year after posterior spinal fusion (PSF) for idiopathic scoliosis (IS). The goal of this study was to determine how often radiographic findings change postoperative care. A total of 227 consecutive patients aged 10 to 21 years who underwent surgery for IS at our institution from 2004 to 2010 were identified. Charts were reviewed to determine the frequency of the following clinical symptoms during the first year after surgery: pain greater than expected, implant prominence, and sensory/motor disturbance. Radiographs were reviewed to identify implant failure and curve change. Logistic regression analysis was used to identify clinical symptoms associated with treatment deviation. During the first year after surgery, an average of 6 (range, 2 to 12) radiographs were obtained from patients during an average of 3 (range, 2 to 10) follow-up visits. Pain (14%) was the most common symptom. Neurologic symptoms (13%) and implant prominence (4%) were less common. Implant failure was identified in 4 subjects (2%), of which 3 required revision surgery. The incidence of revision surgery was 2.9/1000 radiographs (95% confidence interval, 0.6-8.3). Curve progression >5 degrees in the uninstrumented curve occurred in 2 patients (0.9%). Curve progression did not result in a change in treatment for any of the patients. Pain was the only clinical symptom associated with implant failure (P=0.0047). 169/227 patients did not have any symptoms and only one of these underwent revision surgery. The sensitivity of a clinical test, which uses the presence of pain to guide the need for radiographic evaluation and rule out implant failure, was 75%, specificity 87%, positive predictive value 10%, and negative predictive value 99.5%. After obtaining baseline postoperative radiographs, additional radiographs during the first year after surgery for IS may not be required in the absence of clinical symptoms. Reducing the number of radiographs taken during the first year after surgery for IS in patients without symptoms can reduce radiation exposure to patients and health care costs without affecting treatment. Level II, Diagnostic Study.

Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure

Septoplasty is an accepted and common surgical intervention to improve the nasal airway. However, the role of concomitant surgery on the inferior turbinate remains debated. This study aims to investigate if the inferior turbinate surgery at the time of septoplasty would impact on the likelihood of revision nasal surgery - septoplasty or septorhinoplasty. Retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction over 12 years (1998 - 2010) at Aberdeen Royal Infirmary. Patients were identified from the theatre log books and were excluded if they underwent any other nasal procedure. Data collected include demographics, type of primary surgery, and grade of surgeon along with revision nasal surgery in this cohort. 2168 eligible patients with a mean age of 39 years were investigated. Two groups were identified: Group A, with 788 patients who underwent septoplasty only, and Group B, in which 1380 patients underwent septoplasty with concomitant inferior turbinate reduction. The majority of operations were performed by the surgeons in training. The incidence of revision surgery was 5.1 % (21 revision septoplasties and 19 corrective septorhinoplasties) in Group A compared to 2.2 % (20 revision septoplasties and 10 corrective septorhinoplasties) in Group B. Based on this study, it would appear that concomitant inferior turbinate reduction may decrease the likelihood of revision nasal surgery.

Incidence of Revision Surgery in a Large Cohort of Patients With Thoracic Surgical Three-Column Paddle Leads: A Retrospective Case Review.

Spinal cord stimulation (SCS) revision surgery remains common, with a negative impact on cost-effectiveness and outcomes. The primary goal in this report was to retrospectively study the need for revision surgery in a large cohort of patients with newly implanted thoracic surgical three-column paddle leads, focusing on a method of implantation to reduce the need for revision surgery. Clinical outcomes were also assessed. The outcomes in 126 patients who received initial surgical paddle SCS implants for back and/or leg pain from 2008 to 2012 were retrospectively analyzed. A disinterested third party performed chart reviews and telephone interviews. A single surgeon with a consistent method performed all implants, with no lead anchoring. All three major commercial vendors were utilized. There were no paddle electrode lead revisions required for spontaneous fracture, migration, or infection at an average chart-review follow-up period of 20 months. With subsequent telephone interviews, a 65% clinical success rate was seen at 29 months. Significant suboptimal stimulation with body-position changes (SSBPC) was reported in less than 10% of patients. All results were vendor-independent. This report, the largest to date on patients with three-column paddle leads, shows low electrode revision rates with expected clinical success rates. Clinically relevant SSBPC was uncommon.

Long-Term Results of Total Lumbar Disc Replacement: A Prospective Analysis with 5 to 10 Years Follow-Up

Introduction The role of fusion of lumbar motion segments for the treatment of intractable low back pain (LBP) from degenerative disc disease (DDD) remains controversially debated. Total lumbar disc replacement (TDR) has been used as an alternative in a highly selected patient cohort. However, the amount of long-term follow-up (FU) data on TDR is limited. Materials and Methods Visual analog scale (VAS), Oswestry disability index (ODI) and patient satisfaction rates were acquired within the framework of an ongoing prospective clinical trial. The patient's professional activity/employment status, complications, and reoperations were recorded. A comparison was performed between mono- and bisegmental cases. Results The initial cohort consisted of 201 patients; 181 patients were available for final FU (90.0% FU rate) after a mean FU of 7.4 years (range, 5.0-10.8 years). VAS and ODI scores revealed a highly significant improvement from baseline levels at all postoperative stages ( p < 0.0001). VAS scores demonstrated a slight (VAS 2.6-3.3) but statistically significant deterioration from 48 months onward ( p < 0.05). Patient satisfaction rates remained stable throughout the entire postoperative course, with 63.6% of patients reporting a “highly satisfactory” or a “satisfactory outcome” (22.7%), while 13.7% of patients were not satisfied. The overall complication rate was 14.4% ( n = 26/181). The incidence of revision surgeries for general and/or device related complications was 7.2% ( n = 13/181). Results for two-level TDR were significantly inferior in comparison with one-level cases and were associated with higher complication (11.9 vs. 27.6%; p = 0.03) and inferior satisfaction rates ( p < 0.003). Conclusion Despite the fact that the current data comprise the early experiences and learning curve associated with a new surgical technique, the results demonstrate satisfactory and maintained mid- to long-term clinical results after a mean FU of 7.4 years. Patient safety was proven with acceptable complication and reoperation rates. Fear of excessive late complications or reoperations following the primary TDR procedure cannot be substantiated with the present data. In carefully selected cases, TDR can be considered a viable treatment alternative to lumbar fusion for which spine communities around the world seem to have accepted mediocre clinical results as well as obvious and significant drawbacks. Disclosure of Interest None declared

Evaluation of complication rates of pediatric cranial procedures in which a polyethylene glycol sealant was used.

Polyethylene glycol (PEG) sealant in conjunction with standard closure techniques is effective in preventing CSF leaks after cranial procedures in adult patients, but the safety of PEG sealant in the pediatric population has not been shown. The authors performed a retrospective analysis of pediatric neurosurgery patients (0-18 years of age) treated from 2005 to 2010 at The Johns Hopkins Hospital. There were 163 patients who underwent cranial surgery with the use of PEG sealant as an adjunct to standard closure techniques. There were 92 males and 71 females with an average age of 10.2 years. The incidences of revision surgery, CSF leak, meningitis, and neurological deficit were recorded. In the cohort's 90-day postoperative clinical course, the authors found that 4 patients (2.5%) required revision surgery, 2 patients (1.2%) developed a CSF leak, 4 patients (2.5%) developed a superficial skin infection, and 1 patient developed meningitis (0.6%) with no deaths or neurological deficits observed. PEG sealant appears to be a safe adjunct to standard dural closure in pediatric cranial surgery patients to augment dural closure.

Can Statistics Alone Add Clinical Meaning to Non-Specific Billing Databases?

Revision surgery after an operation for the treatment of lumbar stenosis is an undesired outcome. In an attempt to further understand the incidence of revision surgery after the initial treatment of lumbar spinal stenosis, the authors of the current paper used the Medicare Provider Analysis and Review (MedPAR) billing database from 1999 to 2008. As with any retrospective study relying on billing data to make appropriate clinical conclusions, one must recognize and understand the limitations of the potentially flawed and biased source data that have no easily verifiable inputs or controls. In this case, the authors just accepted the data as presented. The MedPAR database contains information about all Medicare hospital claims submitted for reimbursement. Importantly, the database only contains broad, categorically based, facility ICD-9-CM billing codes selected by billing personnel after the fact rather than the surgeon-selected Healthcare Common Procedure Coding System (HCPCS) Level-I Current Procedure Terminology (CPT) code, which also does not always accurately reflect what was done. These data only reflect what is needed for hospitals to collect payments, and they include no other scientific or clinical facts or discussion of indications or techniques. The multicenter study from 1997 that was cited by the authors to support their analysis regarding the accuracy of coding indicated that seventeen of sixty-one patients who had undergone previous lumbar surgery actually had the appropriate code for the diagnosis1. The abstract states, “Although there were both false-negative and false-positive codes at each institution, most errors were related to the low sensitivity of coding for previous spinal operations: only seventeen (28 per cent) of sixty-one such diagnoses were coded correctly.”1 Newer studies evaluating the accuracy of ICD-9-CM-based databases have shown a similarly …

Surgical Management of Advanced Osteoarthritis of the Temporomandibular Joint With Metal Fossa-Eminence Hemijoint Replacement: 10-Year Retrospective Study

To evaluate the surgical outcomes and clinical experience of the treatment of degenerative osteoarthritis of the temporomandibular joint with metal fossa-eminence hemijoint replacement. A retrospective chart review showed 99 patients (94 females and 5 males) who underwent treatment of degenerative joint disease with hemijoint replacement surgery, including data on 141 operated joints (57 unilateral, and 42 bilateral). A visual analog scale (VAS) patient-response questionnaire with directives was mailed to the 99 patients. The questionnaire investigated the patient's experience before and after the treatment procedure in 5 areas: 1) pain intensity, 2) pain experience, 3) chewing ability, 4) mouth opening, and 5) joint noise. In addition, patients were requested to score on a VAS of 1 to 10 their overall satisfaction with the treatment outcome. Treatment outcomes were also compared between patients who received an autogenous abdominal fat graft placement before wound closure, and those who did not receive this adjunctive treatment. Forty-two of 99 patients responded to the questionnaires, with an average follow-up time of 5.1 years. In these 42 patients, pain experience was reduced by 68.6% (4.5 +/- 1.3 [mean +/- SD], presurgery, vs 1.4 +/- 1.7, current, on a 6-point scale). In addition, pain intensity was reduced by 58.7% (7.5 +/- 2.2, presurgery, vs 3.1 +/- 3.0, current, on a 10-point scale). Thirty-three of 42 patients (78.6%) stated in the questionnaire that they were highly satisfied with the results of surgical treatment (average, 9.0 +/- 1.2 on a 0-to-10-point VAS scale). Fifty-one patients (71 joints) did not receive an adjunctive abdominal fat graft, whereas 48 patients (70 joints) received this adjunctive treatment. In the nonfat group, 17 (21.5%) joints required revision surgery, and in the fat group, 4 joints (6.5%) required revision surgery. Temporomandibular hemiarthroplasty with metal fossa-eminence prosthesis provides predictable and satisfactory results in patients operated upon for advanced osteoarthritis. The incidence of revision surgery was found to be reduced with the application of fat graft adjunctive treatment.