Rate Of Subsequent Surgery Research Articles

The natural history of canine occult Grade II medial patellar luxation: an observational study.

To determine the risk of lameness and the rate of subsequent medial patellar luxation surgery in dogs that present with occult Grade II medial patellar luxation. Retrospective owner survey and review of clinical records of adult dogs diagnosed with Grade II medial patellar luxation that were initially asymptomatic and managed non-surgically that had a minimum of 4-year follow-up. Clinical notes and owner questionnaires identified dogs that subsequently developed lameness and required surgery on the previously asymptomatic stifle. Thirty-eight dogs were included with an average follow-up of 51 months. Seventeen dogs re-presented for unscheduled contralateral medial patellar luxation surgery at an average of 15 months after initial presentation. A further two dogs had chronic contralateral limb lameness after an average of 33 months after initial surgery and may have been potential surgical candidates. Fifty percent of adult dogs presenting with occult Grade II medial patellar luxation subsequently developed chronic lameness or required surgery.

Open and Closed Reduction for Developmental Dysplasia of the Hip in New York State: Incidence of Hip Reduction and Rates of Subsequent Surgery.

Background:There are limited data on the incidence and outcomes of open and closed hip reduction in patients with developmental dysplasia of the hip (DDH). The aims of this study were to determine the incidence of open and closed reduction of the hip using population-level data and to assess the rates of subsequent surgery.Methods:Children aged 3 years and younger with DDH who underwent open or closed reduction of the hip between 1997 and 2013 were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patient age, sex, race, and insurance status as well as concurrent procedures were extracted. Admissions through 2014 were searched for subsequent surgeries, providing a minimum 1-year post-reduction surveillance for all patients. Age-specific incidence rates were calculated using New York State annual population data. The rates of concurrent and subsequent surgeries were calculated. A sensitivity analysis was performed to provide a range for the rates of subsequent surgery. Univariate analyses consisted of chi-square or Fisher exact tests for categorical variables.Results:In total, 897 patients (637 who underwent closed reduction and 260 who underwent open reduction) were identified. The age-specific incidence per 100,000 population was 12.5 for closed reduction and 2.6 for open reduction for <1-year-olds, 2.2 for both closed and open reductions for 1-year-olds, 0.4 for closed reduction and 1.0 for open reduction for 2-year-olds, and <0.3 for closed reduction and 0.5 for open reduction for 3-year-olds. Overall, closed reductions were performed more frequently over the study period (p < 0.01). The estimated rate of subsequent ipsilateral surgery was 12.4% (range, 9.4% to 33.1%) after index closed reduction and was 14.2% (range, 8.5% to 40.1%) after index open reduction.Conclusions:We found that the incidence of closed or open hip reduction for DDH was small and that there was an increase in the number of closed reductions performed over time. The rates of subsequent surgery remained relatively high for patients after index closed or open hip reduction.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Incidence and risk factors of reoperation in patients with adjacent segment disease: A meta-analysis.

Study Design:This was a systematic review of the literature and meta-analysis.Objective:The objective of this study was to evaluate the current literature regarding the risk factors contributing to reoperation due to adjacent segment disease (ASD).Summary of Background Data:ASD is a broad term referring to a variety of complications which might require reoperation. Revision spine surgery is known to be associated with poor clinical outcomes and high rate of complications. Unplanned reoperation has been suggested as a quality marker for the hospitals.Materials and Methods:An electronic search was conducted using PubMed. A total of 2467 articles were reviewed. Of these, 55 studies met our inclusion criteria and included an aggregate of 1940 patients. Data were collected pertaining to risk factors including age, sex, fusion length, lumbar lordosis, body mass index, pelvic incidence, sacral slope, pelvis tilt, initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment. Analysis of the data was performed using Comprehensive Meta-Analysis software (Biostat, Inc.).Results:The overall pooled incidence rate of reoperation due to ASD from all included studies was 0.08 (confidence interval: 0.065–0.098). Meta-regression analysis demonstrated no significant interaction between age and reoperation rate (P = 0.48). A comparison of the event rates between males and females demonstrated no significant difference between male and female reoperation rates (P = 0.58). There was a significantly higher rate of ASD in patients with longer fusion constructs (P = 0.0001).Conclusions:We found that 8% of patients in our included studies required reoperation due to ASD. Our analysis also revealed that longer fusion constructs correlated with a higher rate of subsequent revision surgery. Therefore, the surgeon should limit the number of fusion levels if possible to reduce the risk of future reoperation due to ASD.Level of evidence:IV

384 Likelihood of Subsequent Penile Surgery for Patients with Peyronie's Disease Previously Treated with Collagenase Clostridium Histolyticum or Penile Surgery

Since the introduction of collagenase clostridium histolyticum (collagenase), it has rapidly become one of the most commonly utilized therapies for treating patients with Peyronie's disease (PD), although surgery remains an effective treatment option for some patients. One of the key arguments for surgery has been that it is able to fully correct the condition without a need for additional treatments. However, to date, no studies have specifically evaluated the rate of subsequent penile surgery among men with PD who received treatment with collagenase or penile surgery. To compare the percentage of men who underwent one or more penile surgeries after being treated with Methods: A retrospective analysis was performed for patients who received either collagenase or penile surgery for PD using the IQVIA Real-World Data Adjudicated Claims Database consisting of >150 million individuals across the US. The index event was first-line treatment with either collagenase or surgery (ie, penile plication, incision/excision and grafting [I&G], or a penile prosthesis [PP]) between January 1, 2014 and June 30, 2017. Continuous enrollment of ≥6 months before and 12 months after the index date was required. Subsequent surgeries during the 12 or 24 months following initial treatment were identified. Comparative outcomes were reported between cohorts and among different surgery subtypes.

Incidence of Corrective Procedures After Nonoperatively Managed Distal Radius Fractures in the Elderly.

Introduction:Although the majority distal radius fractures in the elderly are initially managed nonoperatively, the true incidence of subsequent corrective surgery is unknown. The purpose of this study was to determine the incidence and predictors of corrective surgery after conservative management.Methods:ICD-9 and Current Procedural Terminology codes were queried from the Medicare 5% sample to select patients aged 65 years and older undergoing nonsurgical treatment of distal radius fractures with a minimum 5-year follow-up. Rates of subsequent ipsilateral wrist surgery were correlated against patient age, sex, geographic region, and initial closed reduction.Results:Five thousand eighty patients with a mean age of 78.3 years were included. Fifty-five patients (1.1%) had undergone subsequent wrist surgery at a median time of 182 days after injury. The youngest cohort (65 to 69 years) had a significantly higher operation rate (1.9%, P = 0.007) than the oldest cohort (80+ years) (0.5%, P = 0.004). There was no notable difference in corrective procedures between sex, geographic region, and initial closed reduction.Discussion:Once surgical intervention is deemed unnecessary per standard guidelines, the data support successful nonsurgical management in a large majority of patients but highlight a small subset of younger patients who remain at increased risk of requiring additional surgery.

Clinical Effectiveness of Percutaneous Epidural Neuroplasty According to the Type of Single-Level Lumbar Disc Herniation : A 12-Month Follow-Up Study.

ObjectiveTo determine whether the outcomes of percutaneous epidural neuroplasty (PEN) are influenced by the type of lumbar disc herniation (LDH) and evaluate the effectiveness of PEN in patients with single-level LDH. MethodsThis study included 430 consecutive patients with single-level LDH who underwent PEN. Before treatment, the LDH type was categorized as bulging, protrusion, extrusion, and sequestration, while Pfirrmann grades were assigned according to imaging findings. Visual analog scale (VAS) scores for back and leg pain and success rates (Odom’s criteria) were assessed at 1, 3, 6, and 12 months after treatment. ResultsThe mean preoperative VAS scores for back and leg pain were 6.90 and 4.23, respectively; these decreased after PEN as follows : 2.25 and 1.45, respectively, at 1 month; 2.61 and 1.68, respectively, at 3 months; 2.28 and 1.48, respectively, at 6 months; and 2.88 and 1.48, respectively, at 12 months (p<0.001). The decrease in VAS scores for leg pain was significantly greater in the extrusion and sequestration groups than in the other two groups (p<0.05); there were no other significant differences among groups. More than 70% patients exhibited good or excellent 12-month outcomes according to Odom’s criteria. Subsequent surgery was required for 59 patients (13.7%), with a significantly higher rate in the extrusion (25.0%) and sequestration (30.0%) groups than in the bulging (7.3%) and protrusion (13.8%) groups (p<0.05). Nevertheless, subsequent surgery was not required for >70% patients with extrusion or sequestration. Patients with Pfirrmann grades 1–3 (14.0–21.5%) showed a significantly higher rate of subsequent surgery than those with Pfirrmann grade 0 (4.9%; p<0.05). ConclusionOur findings suggest that PEN is an effective treatment for back and leg pain caused by single-level LDH, with the outcomes remaining unaffected by the LDH type.

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes.

Background:Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought.Purpose:To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016.Study Design:Case series; Level of evidence, 4.Methods:The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft).Results:A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time (R2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft (P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique (P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs.Conclusion:Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Objectives: Ulnar collateral ligament (UCL) reconstruction of the elbow is a commonly performed surgery on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. The purpose of this study is to provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Methods: The Major League Baseball (MLB) Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS while surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play rates, return to play times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (Docking vs. Modified Jobe) and graft sources (palmaris longus autograft vs. hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1,424 days (47 months) after their primary surgery. There was a trend toward increasing numbers of revision surgeries over time (R2=0.441; p=0.104). The most commonly used tunnel configuration was the Modified Jobe technique (n=41, 59.4%) and the most common graft utilized was hamstring autograft (n=34, 49.3%). 76.6% of pitchers were able to return to play (RTP) and 55.3% were able to return to the same level of play. Mean time to RTP in players with a palmaris longus autograft was 436 days versus 540 days for hamstring autograft (p=0.108) and the mean time to RTP in players was 423 days for the Docking technique versus 519 days for the Modified Jobe technique (p=0.296). Similar rates of subsequent injuries and surgeries were noted between the two revision techniques and two most commonly used graft constructs. Conclusion: This report detailing revision UCL reconstruction amongst professional baseball pitchers showed a trend towards increasing numbers of revisions being performed, a finding consistent with other recent studies. The overall return to play percentage was higher than previously reported (76.6%); however, significantly fewer (55.3%) players returned to the same level of play. This work also demonstrated decreased return to play times (n=484 days, SD: 117.3) compared to other investigations. The Modified Jobe was the most commonly used surgical technique and the two most commonly used graft constructs were hamstring autograft and palmaris longus autograft. Although this analysis did not reveal any statistically significant comparative differences between surgical techniques or graft constructs, future studies involving head-to-head comparisons of these surgical variables, specific to revision UCL reconstruction, may be helpful in improving player outcomes and career performance.

Clinical and imaging characteristics of patients with extreme low back pain or sciatica referred for spinal injection.

To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50years of age, while spinal stenosis was the most common in patients ≥ 50years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6months (P = 0.004). Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.

Preoperative Factors Associated With Subsequent Distal Clavicle Resection After Rotator Cuff Repair.

Background:Acromioclavicular osteoarthritis and rotator cuff tears are commonly coincident.Purpose:To determine the rate of subsequent distal clavicle excision (DCE) when rotator cuff repair (RCR) is performed without DCE and the risk factors for subsequent DCE after RCR.Study Design:Case-control study; Level of evidence, 3.Methods:The operative logs of 2 surgeons from 2007 to 2016 were retrospectively reviewed for all patients who underwent RCR with or without DCE. Preoperative demographic data, symptoms, physical examination, and standardized outcomes (visual analog scale for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) were noted. Acromioclavicular (AC) arthritis was classified on preoperative radiographs. The rate of subsequent surgery on the AC joint was determined via chart review, and univariate and multivariate analyses were conducted to determine risk factors for revision.Results:In total, 894 patients underwent isolated RCR, and 46 underwent concomitant RCR and DCE. On retrospective chart review, of those who underwent isolated RCR, the revision rate for any reason was 7.5% (67 patients), and the rate of subsequent AC surgery was 1.1% (10 patients). Preoperatively, 88% of the total cohort was considered to have a radiographically normal AC joint. On multivariate analysis of patients who underwent isolated RCR, the risk factors for subsequent AC surgery included preoperative tenderness to palpation at the AC joint (10% vs 63%, P < .001), female sex (35% vs 80%, P < .001), and surgery on the dominant side (60% vs 100%, P = .002). On multivariate analysis, these 3 factors explained 50% of the variance in revision AC surgery. When these 3 factors were present in combination, there was a 40% rate of revision AC surgery.Conclusion:This records review found that 10 of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection. Risk factors for subsequent DCE included tenderness to palpation at the AC joint, female sex, and surgery on the dominant side, with subsequent DCE performed in 40% of cases with a combination of these 3 factors. Because the duration of follow-up was short and the number of reoperations small, some caution is recommended in interpreting these results, as the analyses may be underpowered.

Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

Background: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring surgical reconstruction. Despite acceptable published return-to-play outcomes, multiple techniques and graft types have been described. Purpose: This study compares UCL reconstruction (UCLR) outcomes based on tunnel configuration and graft type. Study Design: Cohort study; Level of evidence, 3. Methods: After approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCLR between 2010 and 2014 were identified and included. The following patient characteristics were analyzed: age, pitching role (starter vs reliever), level of play (MLB vs Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique, graft type, and concomitant procedures. Primary outcome measures consisted of the ability to return to play at any level (RTP), ability to return to the same level of play (RSL), time to return, subsequent elbow injuries, and need for subsequent or revision elbow surgery. The effects of patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The RTP rate was 79.9%, and the RSL rate was 71.2%. Grafts used to reconstruct the UCL included the palmaris longus autograft (n = 361, 63.7%), the gracilis autograft (n = 135, 23.8%), and other grafts (n = 70, 12.5%). Surgical techniques utilized were the docking technique (n = 171, 30.2%), the modified Jobe technique (n = 290, 51.2%), and other techniques (n = 105, 18.6%). There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the docking versus modified Jobe technique (80.1% vs 82.4%, respectively; P = .537) and for the 2 primary graft types (83.1% for palmaris longus vs 80.7% for gracilis; P = .596). The rate of subsequent elbow surgery was 10.5% for the docking technique versus 14.8% for the modified Jobe technique (P = .203), and the rate of revision UCLR was 2.9% versus 6.2% for the docking versus modified Jobe technique, respectively (P = .128). Significant trends toward an increasing use of the palmaris longus autograft (P = .023) and the docking technique (P = .006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP (P < .001) and RSL (P < .001), but they required a longer time to return (mean difference, 35 days; P = .039) and had a higher likelihood of subsequent elbow (odds ratio [OR], 3.58 [95% CI, 2.06-6.23]; P < .001) and forearm injuries (OR, 5.70 [95% CI, 1.99-16.30]; P = .004) but not subsequent elbow surgery. No specific variables correlated with the rates of subsequent elbow surgery or revision UCLR in the multivariate analysis. The use of concomitant ulnar nerve transposition did not affect outcomes. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by UCLR technique or graft type. There was a high rate (46.3%) of subsequent throwing elbow injuries. MLB pitchers were more likely to RTP and RSL, but they had a higher frequency of subsequent elbow and forearm injuries than MiLB pitchers. Both the docking technique and the palmaris longus autograft are increasing in popularity among surgeons treating professional baseball players.

Patients treated with surgical irrigation and debridement for infection after ACL reconstruction have a high rate of subsequent knee surgery

ObjectivesThe purpose of this cross-sectional study was to describe the rates of additional surgery and patient-reported outcomes in patients who underwent surgical irrigation and debridement (I&D) for infection following anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that additional surgery is associated with worse patient-reported outcomes.MethodsPatients diagnosed with a postoperative infection following ACLR (defined as one requiring surgical treatment with either a deep or superficial I&D) were identified from a prospective cohort. Both primary and revision ACLRs were included, as well as any graft type (autografts and allografts). Patient-reported outcomes (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS] and Marx activity level) and subsequent surgeries were collected at 2-year and 6 year follow-up from the initial ACLR surgery. Baseline demographics and 2-year and 6-year outcomes (from initial ACLR) were compared between patients who did or did not undergo additional surgery subsequent to I&D using Wilcoxon rank-sum tests for continuous variables and Fisher’s exact tests for categorical variables.ResultsTwenty-one of 3210 ACLR patients (0.7%) had a postoperative infection requiring surgical I&D. This group consisted of 12 men and 9 women, mean (SD) age of 25.8 (11.3) years, 18 primary and 3 revision ACLRs and 16 autografts and 5 allografts. The mean time from ACLR to the surgical I&D was 39 days. In these patients, IKDC scores improved from 44±17 prior to initial ACLR to 83±16 at 6-year follow-up (p<0.001). While all KOOS scores improved from baseline to final follow-up, activity level decreased from 11±6 to 7±5 points (p<0.001). Follow-up related to subsequent surgery was obtained on 20 of 21 patients (95%). Forty per cent of the infection group (n=8 of 20) underwent additional surgery following their I&D, with three patients (15%) undergoing revision ACLR and one patient (5%) undergoing total knee arthroplasty. Patients who underwent additional surgery had lower Marx activity at 2 years compared with patients who had no subsequent surgeries (4±3vs 9±5 points, p=0.018).ConclusionPatients who undergo I&D for an infection following ACLR have a high rate of additional surgery but still attain reasonable clinical outcomes 6 years after ACLR.Level of evidenceIV

Transcatheter pulmonary valvuloplasty in neonates with pulmonary atresia and intact ventricular septum

Transcatheter pulmonary valvuloplasty in neonates with pulmonary atresia and intact ventricular septum (PA-IVS) or duct-dependent pulmonary valve stenosis (DD-PVS) has become a reasonable alternative to surgical right ventricle decompression. To investigate mid-term outcomes following pulmonary valvuloplasty. Sixty-five neonates with PA-IVS (n=29) or DD-PVS (n=36) (median age 4 days; mean weight 3.0kg) undergoing pulmonary valvuloplasty were reviewed retrospectively. Procedural data and clinical outcomes were assessed. Pulmonary valvuloplasty was successful in 59 patients (90.8%). Preterm birth, larger tricuspid valve annulus diameter and PA-IVS correlated with procedural failure. Eleven patients (18.6%) required a Blalock-Taussig shunt during early follow-up, despite valvuloplasty. These neonates had smaller tricuspid and pulmonary valve annulus Z-scores (-1.9 vs. -0.8 [p=0.04] and -2.5 vs. -0.9 [P=0.005], respectively) and a higher incidence of "bipartite" right ventricle (P=0.02). Mean follow-up was 5.4±3.3 years. Mortality after successful valvuloplasty was 8.5% (n=5). Among the 54 survivors, biventricular repair was achieved in 52 patients (96.3%), including nine with a previous Blalock-Taussig shunt. The cumulative rate of subsequent surgery (excluding Blalock-Taussig shunt) was 13.7% (95% confidence interval 6.8-26.7%) and 16.4% (95% confidence interval 8.5-30.4%) at 2 and 4 years, respectively. Secondary surgery was significantly more frequent in PA-IVS compared with DD-PVS, and in neonates with a Blalock-Taussig shunt (P=0.003 and 0.01, respectively). Selected neonates with DD-PVS or PA-IVS managed by transcatheter pulmonary valvuloplasty had a good mid-term outcome. In neonates with a borderline small right ventricle, a hybrid strategy with a supplementary source of pulmonary blood flow can be efficient to achieve biventricular repair.

Increasing Numbers of Preoperative Shoulder Injections Are Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery

Increasing Numbers of Preoperative Shoulder Injections Are Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery

Increasing Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery

To identify any dose-dependent association between the use of subacromial corticosteroid injections within a year before rotator cuff repair (RCR) and subsequent need for revision rotator cuff surgery. Two large administrative databases were queried for patients undergoing arthroscopic RCR. A minimum of 1year of preoperative database exposure and 2years of postoperative database follow-up were required for inclusion. Patients were stratified into groups that received 0 (control), 1, 2, or 3 or more ipsilateral corticosteroid shoulder injections within the year prior to RCR. The outcome of interest was ipsilateral revision arthroscopic or open RCR or arthroscopic debridement for a diagnosis of rotator cuff tear within 2years of the index surgery. Revision rates were compared between groups using a multivariate logistic regression analysis controlling for demographic and comorbidity confounders. A total of 110,567 patients from the Medicare database and 12,892 patients from the private insurance database were included. There was no association between a single injection within the year prior to RCR and revision surgery in either cohort. The use of 2 or more injections was associated with a significant increase in the risk of requiring revision surgery in both the Medicare (odds ratio [OR], 2.76-3.26; P < .0001) and private insurance (OR, 2.53-2.87; P < .0001) populations. A single shoulder injection within a year prior to arthroscopic RCR was not associated with any increased risk of revision surgery; however, the administration of 2 or more injections was associated with a substantially increased risk of subsequent revision rotator cuff surgery (OR, 2.53-3.26). Although causality cannot be established on the basis of this database review, caution is recommended when considering more than 1 shoulder corticosteroid injection in patients with potentially repairable rotator cuff tears. Level III, retrospective cohort study.

Decompressive laminectomy without fusion for lumbar facet joint cysts

Lumbar synovial facet joint cysts cause nerve root compression and radiculopathy. Excision of these cysts is often performed for patients with significant symptoms. There is uncertainty regarding the need for performing a concomitant arthrodesis to prevent spinal instability. This study was performed to assess the rate of postoperative spinal instability with patients undergoing laminectomy without fusion for treatment of lumbar facet joint cysts. Patients who had received a decompressive laminectomy for excision of lumbar spinal cyst(s) without fusion from 2000 to 2015 were reviewed. Their progress was monitored over a 15 year period (2000–2015). SF-12 health surveys were completed at each clinic appointment. Patients were also contacted via phone and mail to assess their postoperative quality of life and to determine whether any further spinal surgery was performed. Forty-six patients were studied with an average follow up of 43 months (1 month–13 years). Two patients had subsequent spinal surgery, neither of which was a fusion. The mean preoperative SF-12 scores were 28 for physical function and 44 for mental function, while the final postoperative follow up score was 33 for physical function and 50 for mental function. Lumbar spinal facet joint cyst excision can be performed by laminectomy without fusion. The rate of subsequent fusion surgery is low.

Rates and Risk Factors for Future Stress Urinary Incontinence Surgery after Pelvic Organ Prolapse Repair in a Large Population-based Cohort in California

ObjectivesTo determine the rate and risk factors for future stress urinary incontinence (SUI) surgery in a large population-based cohort of previously continent women following pelvic organ prolapse (POP) repair without concomitant SUI treatment. MethodsData from the Office of Statewide Health Planning and Development were used to identify all women who underwent anterior, apical, or combined anteroapical POP repair without concomitant SUI procedures in the state of California between 2005 and 2011 with at least 1-year follow-up. Patient and surgical characteristics were explored for associations with subsequent SUI procedures. ResultsOf 41,689 women undergoing anterior or apical POP surgery, 1,504 (3.6%) underwent subsequent SUI surgery with a mean follow-up time of 4.1 years. Age (odds ratio [OR] 1.01), obesity (OR 1.98), use of mesh at the time of POP repair (OR 2.04), diabetes mellitus (OR 1.19), white race, and combined anteroapical repair (OR 1.30) were associated with increased odds of future SUI surgery. ConclusionThe rate of subsequent surgery for de novo SUI following POP repair on a population level is low. Patient and surgical characteristics may alter a woman's individual risk and should be considered in surgical planning.

Thursday, September 27, 2018 3:35 PM–5:05 PM section on motion technology abstract presentations: 131. Analysis of reoperations after cervical total disc replacement in a consecutive series of 504 patients

BACKGROUND CONTEXT One important factor in evaluating the safety of an implant is the rate of subsequent surgery and the reasons for surgery, particularly those that are related to possible problems with the implant. PURPOSE The purpose of this study was to determine the re-operation rate for a series of cervical TDR patients. STUDY DESIGN/SETTING The study was conducted at a multi-site spine specialty clinic. Surgery records were reviewed to identify cervical TDR patients and those who underwent subsequent surgery. PATIENT SAMPLE Cervical TDR cases involving ProDisc-C (Centinel Spine) were identified, beginning with the first case performed in 2003 at a multisite spine specialty center. Only patients who were at least 2 years postoperative were included, producing a consecutive of 504 patients. The number of levels operated was: one level in 463 patients, two levels in 39 patients and three levels in two patients. There were 112 hybrids in the series (TDR at one level and fusion at an adjacent segment). OUTCOME MEASURES The primary outcome measure was the occurrence of a re-operation. METHODS Data collected included general demographics, level(s) operated, and blood loss. A surgery log through 12-31-17 was reviewed to identify re-operations occurring in the TDR patients. For each re-operation, the reason, duration from index surgery, and procedure were recorded. The mean duration form the index surgery to the search of the surgery log for re-operations was 69.4 months, range 24 to 169 months. RESULTS Re-operation occurred in 28 patients (5.5%). These included: three TDR removals and ACF performed (one for migration, one subsidence, and one spondylosis), one TDR repositioning, 20 adjacent segment degeneration (five of which were hybrid procedures or fusion prior to TDR), one wound infection, one hematoma and two received stimulators for pain control. There were no re-operations for device failure. The mean duration between the index surgery and re-operation at an adjacent segment was 44.8 months. CONCLUSIONS The re-operation rate was relatively low at 5.5%, none of which were performed for device failure. These results support the safety of this device.

Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery

Objectives:Subacromial steroid injections are frequently used in the initial conservative management of rotator cuff (RC) tears, however, the long-term effect of this treatment in patients who eventually undergo rotator cuff repair (RCR) is not well defined in the literature. The objective of this study is to identify any dose-dependent association between injections prior to rotator cuff repair (RCR) and subsequent revision surgery.Methods:Two large databases were queried for patients undergoing arthroscopic RCR. Patients with one year of pre-operative database exposure and a minimum of two years post-operative follow-up were included. In each database, three study groups were formed, stratified by the number of ipsilateral injections given within the year prior to RCR: one, two and three or more injections. A control group without any prior injection was identified and matched to the single injection group in each database. The outcome of interest was ipsilateral revision arthroscopic or open rotator cuff repair, or arthroscopic debridement for a diagnosis of rotator cuff tear within 2 years of the index surgery. Revision surgery rates were compared between groups using a multivariate logistic regression analysis controlling for demographic and comorbidity confounders. This allowed for identification of the independent association between the number of injections and the need for subsequent revision surgery.Results:108,516 patients from the Medicare database and 11,360 patients from the private database were included (Table 1A-B). There was no association between a single injection within the year prior to RCR and revision surgery in either database. In the Medicare database, two or more injections was associated with a substantial increase in the risk of requiring revision surgery (OR 2.40-2.62, P < 0.0001). A similar association was noted in the private insurance database for patients with two or more injections (OR 2.09-2.42, P < 0.0001) (Table 1A-B).Conclusion:A single shoulder injection within a year prior to arthroscopic RCR is not associated with any increased risk of revision surgery. Two or more injections within a year prior to RCR appears to be associated with a substantially increased risk of revision surgery. While causality cannot be established on the basis of this database review, caution is recommended when considering more than one shoulder injection in patients with potentially repairable RC tears.Table 1A.Risk of Revision Rotator Cuff Surgery Stratified by Number of Preoperative Injections (Medicare Patients)Ipsilateral Revision Surgery Study Group Total N N of Revisions % Revisions Adjusted O.R. [95% Cl] P Value Control103,5143,6913.6%--1 Injection2,7381033.8%1.09[0.96 - 1.25]0.1942 Injections1,137968.4%2.40 [2.08 - 2.76]< 0.00013+ Injections1,127998.8%2.62 [2.29 - 3.01]< 0.0001Table 1B.Risk of Revision Rotator Cuff Surgery Stratified by Number of Preoperative Injections (Humana Patients)Ipsilateral Revision Surgery Study Group Total N N of Revisions % Revisions Adjusted O.R. [95% Cl] P Value Control7,4622152.9%--1 Injection2,25067 3.0%0.95 [0.78 - 1.16]0.3332 Injections890536.0%2.09[1.69 - 2.58]< 0.00013+ Injections758577.5%2.42 [1.96 - 2.99]< 0.0001

The Frequency of Re-Surgery After Cervical Disc Nucleoplasty

In percutaneous cervical nucleoplasty (PCN) a portion of the nucleus tissue is ablated using the Coblation technique. Re-surgery is an important factor for the clinical outcome. However, the rate of subsequent surgery after PCN is still unknown. The aim of this study was to investigate the frequency of an additional open surgery after PCN in a retrospective of more than 10 years. Retrospective observational study. Consecutive patients with PCN between 2005 and 2007 were included. Patient's satisfaction was evaluated using McNab's outcome criteria. The necessity of an additional open surgery at the cervical spine, the period between PCN and the fusion, and the treated levels were analyzed. One hundred thirty-three patients were included. The follow-up time was longer than 5 years in 31.6% of patients and longer than 10 years in 6.0% of patients. The short-term success rate was 70.7%; however, subsequent surgery was performed in 19.5% of patients. Overall, 57.7 % of reoperations were performed during the first year after PCN. In patients with a good result after PCN, subsequent surgery was less frequent, and the interval between PCN and additional surgery was larger (P < 0.01). This is the first study reporting the frequency of re-surgery after PCN. Overall, 70.7% patient satisfaction was observed after 1 month. This result is worsened because of a re-surgery rate of 19.5%. The data from this study suggest that PCN is a poor replacement for conventional open surgery. Degeneration of the disc is progressive despite or because of PCN.