Total Medical Complications Research Articles

The association of inflammatory bowel disease with postoperative complications, re-admissions and emergency department visits following primary total hip arthroplasty.

Inflammatory bowel disease (IBD) is a systemic inflammatory disorder of the gut. Few studies have evaluated whether patients with a history of IBD have worse outcomes following primary total hip arthroplasty (THA). Therefore, the purpose of this study was to evaluate whether IBD is associated with increased: (1) medical complications; (2) readmissions; and (3) emergency department (ED) visits. Using a nationwide claims database, patients with IBD undergoing primary THA were identified and matched to a comparison group according to age, sex and the Charlson Comorbidity Index. Outcomes assessed included the development of 90-day medical complications, 90-day re-admissions and 90-day ED visit rates. A p-value <0.0001 was considered statistically significant. Patients with IBD had a greater incidence and odds ratio of total medical complications (31.90% vs. 11.47%; OR 2.89; p < 0.0001) compared with matched controls. IBD patients had significantly higher incidence and odds ratio of developing acute kidney injury (5.46 vs. 1.46%; OR 3.92; p < 0.0001), cerebrovascular accident (1.32 vs. 0.35%; OR 3.79; p < 0.0001), pneumonia (4.02 vs. 1.30%; OR 3.19; p < 0.0001), respiratory failure (1.21 vs. 0.41%; OR 2.94; p < 0.0001), deep vein thrombosis (0.89% vs. 0.30%; OR 2.93; p < 0.0001), and other adverse events. IBD patients also had higher incidence and odds ratio of 90-day re-admissions (4.20% vs. 3.23%; OR 1.31; p < 0.0001) and ED visits (6.56% vs. 3.99%; OR 1.69; p < 0.0001). This study found that patients with IBD are at increased risk of 90-day medical complications, re-admissions, and ED visits. Due to its systemic nature, surgeons operating on these patients should be aware of the disease's extra-intestinal manifestations, and the potential postoperative risks in IBD patients. Providers should use this investigation when educating patients on potential risks of elective THA.

Preoperative Depression Screening in Patients with Distal Radius Fractures: An Evaluation of Its Modifiability on Outcomes for Patients with Depressive Disorder

Abstract Background It is unclear whether nonpharmacologic intervention for depressive disorder (DD) in the preoperative period can prevent postoperative complications in hand surgery patients. Questions/Purpose The aims were to evaluate whether psychotherapy visits/depression screenings within 90 days of open reduction and internal fixation (ORIF) for distal radius fractures (DRFs) were associated with lower rates of (1) medical complications and (2) health care utilization (emergency department [ED] visits and readmissions). Methods A retrospective analysis of an administrative claims database from 2010 to 2021 was performed. DD patients who underwent ORIF for DRF were 1:5 propensity score matched by comorbidities, including those who did (n = 8,993) and did not (n = 44,503) attend a psychotherapy visit/depression screening 90 days before surgery. Multivariate logistic regression models were constructed to compare the odds ratio (OR) of medical complications, ED visits, and readmissions within 90 days. The p-values less than 0.001 were significant. Results DD patients who did not attend a preoperative psychotherapy visit/depression screening experienced fivefold higher odds of total medical complications (25.66 vs. 5.27%; OR: 5.25, p &lt; 0.0001), including surgical site infections (1.23 vs. 0.14%; OR: 8.71, p &lt; 0.0001), deep wound infections (0.98 vs. 0.17%; OR: 6.00, p &lt; 0.0001), and transfusions (1.64 vs. 0.22%; OR: 7.61, p &lt; 0.0001). Those who did not attend a psychotherapy visit/depression screening experienced higher odds of ED utilizations (9.71 vs. 2.71%; OR: 3.87, p &lt; 0.0001), however, no difference in readmissions (3.40 vs. 3.54%; OR: 0.96, p = 0.569). Conclusion Depression screening may be a helpful preoperative intervention to optimize patients with DD undergoing hand surgery to minimize postoperative complications and health care utilization. Level of Evidence Level III.

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1- to 2-Level Lumbar Fusion.

Retrospective Case-Control Study. The objectives were to determine whether patients from poor social determinants of health, undergoing primary 1- to 2-level lumbar fusion, demonstrate differences in (1) medical complications, (2) emergency department (ED) utilizations, (3) readmission rates, and (4) costs of care. Measures of socioeconomic disadvantage may enable improved targeting and prevention of potentially increased health care utilization. The Area Deprivation Index (ADI) is a validated index of 17 census-based markers of material deprivation and poverty. A retrospective query of the 2010-2020 PearlDiver database was performed for primary 1- to 2-level lumbar fusions for degenerative lumbar pathology. High ADI (scale: 0-100) is associated with a greater disadvantage. Patients with high ADI (90%+) were 1:1 propensity score matched to controls (ADI: 0-89%) by age, sex, and Elixhauser Comorbidity Index. This yielded 34,442 patients, evenly matched between cohorts. Primary outcomes were to compare 90-day complications, ED utilizations, readmissions, and costs of care. Multivariable logistic regression models computed the odds ratios (OR) of ADI on complications, ED utilizations, and readmissions. P -values <0.05 were significant. Patients with a high ADI incurred higher rates and odds of developing respiratory failures (1.17% vs. 0.87%; OR: 1.35, P =0.005). Acute kidney injuries (2.61% vs. 2.29%; OR: 1.14, P =0.056), deep venous thromboses (0.19% vs. 0.17%; OR: 1.14, P =0.611), cerebrovascular accidents (1.29% vs. 1.31%; OR: 0.99, P =0.886), and total medical complications (23.35% vs. 22.93%; OR: 1.02, P =0.441) were similar between groups. High ADI patients experienced higher rates and odds of ED visits within 90 days (9.67% vs. 8.91%; OR: 1.10, P =0.014) and overall 90-day expenditures ($54,459 vs. $47,044; P <0.001). Socioeconomically disadvantaged patients have increased rates and odds of respiratory failure within 90 days. ED utilization within 90 days of surgery was higher in socioeconomically disadvantaged patients. Social determinants of health could be used to inform health care policy and improve postdischarge care. Level III.

Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer.

Background: Frailty is characterized by reduced physiologic reserve, and for patients with colon cancer, frailty is associated with increased morbidity after resection. One commonly cited reason for performing an end colostomy vs a primary anastomosis in left-sided colon cancer is the belief that frail patients do not have the physiologic reserve to withstand the morbidity associated with an anastomotic leak. We explored the impact of frailty on the type of operation performed in patients with left-sided colon cancer. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for patients with colon cancer who underwent a left-sided colectomy from 2016 to 2018. Patients were categorized using the modified 5-item frailty index. Multivariate regression was used to identify independent predictors of complications and type of operation performed. Results: Of 17,461 patients, 20.7% were considered frail. Frail patients received an end colostomy more often than nonfrail patients (11.3% vs 9.6%, P=0.01). On multivariate analysis, frailty was a significant predictor for total medical complications (odds ratio [OR] 1.45, 95% CI 1.29-1.63) and readmission (OR 1.53, 95% CI 1.32-1.77) but was not independently associated with organ space surgical site infections or reoperation. Frailty was independently associated with receiving an end colostomy vs a primary anastomosis (OR 1.23, 95% CI 1.06-1.44), but an end colostomy did not decrease the risk of reoperation or organ space surgical site infections. Conclusion: Frail patients with left-sided colon cancer are more likely to receive an end colostomy, but an end colostomy does not lower the risk of reoperation or organ space surgical site infections. Based on these results, frailty alone should not prompt the decision to perform an end colostomy, but further studies are needed to guide surgical decision-making in this understudied population.

GASTRIC BALLOON COMPLICATIONS 930 PATIENTS 2014-2020

Deniz Uyak: NO financial relationship with a commercial interest Abstract Origin (Authors) Prof. Dr. Deniz Uyak/ Medical One Hamburg/ Germany In a Clinical-Study we monitored 930 overweight-patients with Intragastric-Balloon (Medsil-Balloon: 536 cases/ 6 Month duration and Spatz3-Balloon: 394 cases/ one year duration) treatment in 7 years / 2014 to 2020). BMI of the patients was over 27. The average age was 46 years (81 % female patients/ 19 % male patients). We considered the number of total medical complications such as bleeding and perforation of the esophagus/ stomach, intestinal obstruction, dehydration, electrolyte-loss, renal-insufficiency, intolerance to balloon treatment and pregnancy.

Chronic Obstructive Pulmonary Disease Associated with Prolonged Opiate Use, Increased Short-Term Complications, and the Need for Revision Surgery following Total Knee Arthroplasty.

Chronic obstructive pulmonary disease (COPD) is a condition which causes a substantial burden to patients, physicians, and the health care system at large. Medical comorbidities are commonly associated with adverse health outcomes in the postoperative period. Here, we present a large database review of patients undergoing total knee arthroplasty (TKA) to determine the effect of COPD on patient outcomes. The PearlDiver database was queried for all patients who underwent TKA between 2007 and the first quarter of 2017. Medical complications, surgical complications, 30-day readmission rates, revision rates, and opioid utilization were assessed at various intervals following TKA among patients with and without COPD. Multivariable regression was used to calculate adjusted odds ratios controlling for age, sex, and medical comorbidities. A total of 46,769 TKA patients with COPD and 120,177 TKA patients without COPD were studied. TKA patients with COPD experienced increased risk of 30-day readmission (40.8% vs. 32.2%, p < 0.0001), 30-day total medical complications (10.2% vs. 7.0%, p < 0.0001), prosthesis explanation at 6 months (0.4% vs. 0.2, p = 0.0130), 1 year (0.6% vs. 0.3%, p = 0.0005), and 2 years (0.8% vs. 0.5%, p = 0.0003), as well as an increased rate of revision (p < 0.0046) compared to TKA patients without COPD. Opioid utilization of TKA patients with COPD was greater significantly than that of TKA patients without COPD at 3, 6, and 12 months. Patients with COPD have an increased risk for medical and surgical complications, readmission, and prolonged opioid use following TKA.

1. Early mobilization vs prolonged (>24hrs) bedrest for incidental durotomy

<h3>BACKGROUND CONTEXT</h3> Incidence of unintended durotomy in thoracic and lumbar decompression procedures ranges from 3%-13%. An arbitrary length of flat bed rest is often prescribed as a tool to reduce cerebrospinal fluid (CSF) pressure on a compromised dural closure. Two popular thoughts are that flat bed rest >24 hours increases medical complications, but flat bed rest > 24 hours protects against CSF leaks/wound complications by reducing the hydrostatic pressure on dural repair. <h3>PURPOSE</h3> To assess whether flat bed rest >24 hours after an incidental durotomy is a risk factor for medical complications and results in longer hospital stay. We hypothesize that <24 hours of bed rest results in fewer medical complications and does not increase the rate of CSF leak/wound complications. <h3>STUDY DESIGN/SETTING</h3> Retrospective case cohort study. <h3>PATIENT SAMPLE</h3> Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures were reviewed from 2010-2020. <h3>OUTCOME MEASURES</h3> The duration of bed rest, length of hospital stay and complications (pulmonary, gastrointestinal, urinary and wound) were recorded. <h3>METHODS</h3> Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures at Virginia Commonwealth University in Richmond, Virginia were reviewed from 2010-2020. This is an IRB approved study. The duration of bed rest, length of hospital stay and complications (pulmonary, gastrointestinal, urinary and wound) were recorded. The rates of complications were compared with regard to the duration of flat bed rest (no bed rest or less than 24hrs vs greater than 24hrs). <h3>RESULTS</h3> A total of 420 primarily repaired incidental durotomies were identified. Of these, 254 patients had bed rest ≤ 24 hours and 107 patients were at bed rest > 24 hours. The average length of stay for patients in bed rest ≤ 24 hours was 4.47 ± 3.64 days vs 7.24 ± 4.23 days for bed rest > 24 hours group (p = < 0.0001). Total medical complications and wound complications (8.66% vs 15.89%, P = 0.043) were increased in the prolonged bed rest group. There was a statistically significant increase in rate of ileus, urinary retention, urinary tract infections, pulmonary issues, and altered mental status in the group with prolonged bedrest after an incidental durotomy. There was no statistically significant difference in the need for revision surgery (7.87% vs 8.41%, P = 0.86). The relative risk of a complication in the group with immediate mobilization was 50% less than the group with prolonged bed rest (RR = 0.5, 95% CI: 0.39-0.62, p = < 0.0001). <h3>CONCLUSIONS</h3> In this retrospective study, flat bed rest greater than 24hrs following incidental durotomy was associated with increased length of stay, increased rate of medical and wound complications. The rate of revision surgery was not higher in the durotomy patients who underwent immediate mobilization. Flat bed rest after an incidental durotomy may not be necessary and may result in higher costs and complications. This data can be helpful in planning enhanced recovery after surgery (ERAS) protocols. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P88. Medical complications and risk factors after long level spinal fusion for adult degeneration scoliosis

BACKGROUND CONTEXT Adult degenerative scoliosis (ADS) treated with long level internal fixation surgery is known for its high incidence of complications. PURPOSE The propose of this study was to determine current medical complication rates and the predictors of each individual medical complication in surgical ASD patients. STUDY DESIGN/SETTING A retrospective review comparative database was used to evaluate long level internal fixation surgery for adult degenerative scoliosis (ADS) patients. PATIENT SAMPLE One hundred and fifty-three ADS patients who underwent long level spinal fusion were included. The total medical complication incidence was 26.1%, which included infection (13.1%), neurological (12.4%), cardiopulmonary (10.5%), gastrointestinal (5.2%), and renal (1.3%) complications. OUTCOME MEASURES The radiological measurements included Cobb angle, PI-LL, lumbar lordosis (LL), spondylolisthesis, C7 sagittal vertical axis (C7SVA), the proximal junctional kyphosis (PJK), and pseudarthrosis. Clinical outcomes were collected preoperatively and last follow-up after surgery. Clinical outcomes include metrics of the Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), and Lumbar Stiffness Disability Index (LSDI). METHODS The patient- and surgical-related risk factors for each individual medical complication were identified by using univariate testing. Patients were separated into groups of with and without medical complication, into groups of with and without infection, into groups with and without neurological complications, and into groups with and without cardiopulmonary complications, retrospectively. Potential risk factors were identified using univariate testing. Multivariate Logistic regression was used to evaluate independent predictors of medical complications. RESULTS Patient-related independent risk factors for development of medical complications included diabetes (OR 2.87, P=.038), smoking (OR 4.44, P=.001); for infection were diabetes (OR 4.74, P=.006) and smoking (OR 3.17, P=.033); for neurological complications were BMI (OR 1.16, P=.010) and diabetes (OR 4.12, P=.014); for cardiopulmonary complications were hypertension (OR 4.35, P=.039), smoking (OR 4.23, P=.035) and cardiac comorbidity (OR 6.14, P=.015). Fusion level (OR 2.79 P=.000), length of hospital stay (OR 1.88 P=.016) and symptom duration (OR 2.57, P=.001). Surgical-related independent risk factors for development of medical complications were fusion level (OR 3.57, P=.000), operative time (OR 0.99, P=.041), osteotomy (OR 9.33, P=.004), blood transfusion (OR 4.37, P=.043) and LOS (OR 1.68, P=.001); for infection were fusion level (OR 2.55, P=.006), blood transfusion (OR 23.06, P=.001) and LOS (OR 1.36, P=.010); for neurological complication were fusion level (OR 2.54, P=.009), osteotomy (OR 9.35, P=.012) and blood transfusion (OR 6.90, P=.033); for cardiopulmonary complication were fusion level (OR 2.17, P=.001). CONCLUSIONS Diabetes and smoking were the most common patient-related independent risk factors increase the development of each individual medical complication. On the other hand, factors fusion levels and blood transfusion were the most common surgical-related independent risk factors increase the development of each individual medical complication. Prevention of these risk factors can reduce the incidence of complications in Chinese patients with ADS surgery.

Incidence and risk factors for multiple medical complications in adult degenerative scoliosis long-level fusion

Adult degenerative scoliosis (ADS) surgery is known for its high incidence of complications. The propose of this study was to determine current complication rates and the predictors of medical complications in surgical ASD patients. A retrospective study of 153 ADS patients who underwent long level spinal fusion with 2-year follow-up between 2012 and 2017. The patient- and surgical-related risk factors for each individual medical complication were identified by using univariate testing. All patients were divided into groups with and without medical complication, infection, neurological complications, and cardiopulmonary complications, respectively. Potential risk factors were identified using univariate testing. Multivariate Logistic regression was used to evaluate independent predictors of medical complications. The total medical complication incidence was 26.1%. Patient-related independent risk factors for the development of medical complications included diabetes, smoking; for infection were diabetes and smoking; for neurological complications were BMI and diabetes; for cardiopulmonary complications were hypertension, smoking and cardiac comorbidity. Surgical-related independent risk factors for the development of medical complications were fusion level, operative time, osteotomy, blood transfusion and LOS; for infection were fusion level, blood transfusion, and LOS; for neurological complication were fusion level, osteotomy and blood transfusion; for cardiopulmonary complication were fusion level. Diabetes and smoking were the most common patient-related independent risk factors increase the development of each individual medical complication. On the other hand, fusion levels and blood transfusion were the most common surgical-related independent risk factors increase the development of each individual medical complication. Prevention of these risk factors can reduce the incidence of complications in Chinese patients with ADS surgery.

Complications of Flat Bed Rest After Incidental Durotomy

Retrospective case series. To determine whether bed rest is a risk factor for specific medical complications. Flat bed rest after incidental durotomy is commonly used to reduce the risk of CSF leakage and associated complications. Retrospective case series of consecutive patients after lumbar laminectomy were identified. Medical records were reviewed for duration of bed rest and complications (pulmonary, wound, neurological, gastrointestinal, and urinary) in the chart notes, repair methods, subfascial drain placement, consultant notes, imaging reports, and discharge summaries. Patients were compared with duration of bed rest >24 hours versus duration of bed rest ≤24 hours. The incidence of complications was compared between groups using the Fisher exact test. There were a total of 42 patients with incidental durotomy. There were 18 patients in the bed rest ≤24 hours group and 24 patients in the bed rest >24 hours group. Comparing the bed rest ≤24 hours to bed rest >24 hours patients, there was no statistically significant difference in the incidence of postdurotomy-related neurological complications, wound complications, and need for revision surgery. There was a statistically significant decrease in the incidence of total medical complications in the ≤24-hour group (0% vs. 50%, P=0.0003). There was an increased incidence of medical complications in the bed rest group >24 hours. Flat bed rest after modern dural repair method may not be a necessity in all cases and may be associated with a higher incidence of medical complications.

Predictors of Pain 1 Year Post-Spinal Cord Injury

Objective: To determine the predictive validity of demographic and medical characteristics to the subsequent development of pain 1 year post-spinal cord injury (SCI).Design: Prospective longitudinal design using data from 18 Model Spinal Cord Injury Systems of Care.Participants: Adults 18 years or older with traumatic-onset SCI (n = 540) evaluated at 1 year postinjury.Outcome Measures: A single item from the Short Form-12 that assessed pain interference in day-to-day activities using a 5-point Likert scale.Predictor Variables: Demographic and medical characteristics, individual and total medical complications during rehabilitation, and insurance provider.Results:Univariate analyses showed age, education, marital status, primary occupation at the time of injury, American Spinal Injury Association motor score, and sponsor of care to be related to pain interference 1 year post-SCI. Polychotomous logistic regression indicated that age and occupational status at the time of injury were the only significant unique predictors of pain interference. The youngest (aged 18-29 years) and oldest (aged 60 years and older) age groups reported the least amount of pain interference,whereas individuals unemployed at the time of injury were significantly more likely to report pain interference. None of the other predictor variables was significant.Conclusion: Age and occupational status appear to be important predictors of pain interference 1 year post-SCI. Future directions of study and limitations are discussed.