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Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery

BACKGROUND: Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. METHODS: Retrospective cohort...

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Autores principales: Sinha, Saurabh, Caplan, Ian, Schuster, James, Piazza, Matthew, Glauser, Gregory, Sharma, Nikhil, Welch, William Charles, Osiemo, Benjamin, Mcclintock, Scott, Ozturk, Ali Kemal, Malhotra, Neil Rainer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335149/
https://www.ncbi.nlm.nih.gov/pubmed/32656128
http://dx.doi.org/10.4103/ajns.AJNS_35_20
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author Sinha, Saurabh
Caplan, Ian
Schuster, James
Piazza, Matthew
Glauser, Gregory
Sharma, Nikhil
Welch, William Charles
Osiemo, Benjamin
Mcclintock, Scott
Ozturk, Ali Kemal
Malhotra, Neil Rainer
author_facet Sinha, Saurabh
Caplan, Ian
Schuster, James
Piazza, Matthew
Glauser, Gregory
Sharma, Nikhil
Welch, William Charles
Osiemo, Benjamin
Mcclintock, Scott
Ozturk, Ali Kemal
Malhotra, Neil Rainer
author_sort Sinha, Saurabh
collection PubMed
description BACKGROUND: Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. METHODS: Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing at a three-hospital urban academic medical center (2013–2017) were undertaken (n = 906). Patient demographics and comorbidities were analyzed. Test of independence, Mann–Whitney–Wilcoxon test, and logistic regression were used to assess differences in length of stay (LOS), discharge disposition/need for postacute care, quality-adjusted life year (QALY), surgical site infection (SSI), hospital cost, total cost, readmission within 30 days, and emergency room (ER) visits within 30 days. RESULTS: Among the study population, 863 patients were braced and 43 were not braced. No difference was seen between the two groups in short-term outcomes from surgery including LOS (P = 0.836), discharge disposition (P = 0.226), readmission (P = 1.000), ER visits (P = 0.281), SSI (P = 1.000), and QALY gain (P = 0.319). However, the braced group incurred a significantly higher direct hospital cost (median increase of 41.43%, P < 0.001) compared to the unbraced cohort (bracing cost excluded). There was no difference in graft type (P = 0.145) or comorbidities (P = 0.20–1.00) such as obesity (P = 1.000), smoking (P = 1.000), chronic obstructive pulmonary disease (P = 1.000), hypertension (P = 0.805), coronary artery disease (P = 1.000), congestive heart failure (P = 1.000), and total number of comorbidities (P = 0.228). CONCLUSION: Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes but will reduce cost.
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spelling pubmed-73351492020-07-09 Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery Sinha, Saurabh Caplan, Ian Schuster, James Piazza, Matthew Glauser, Gregory Sharma, Nikhil Welch, William Charles Osiemo, Benjamin Mcclintock, Scott Ozturk, Ali Kemal Malhotra, Neil Rainer Asian J Neurosurg Original Article BACKGROUND: Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. METHODS: Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing at a three-hospital urban academic medical center (2013–2017) were undertaken (n = 906). Patient demographics and comorbidities were analyzed. Test of independence, Mann–Whitney–Wilcoxon test, and logistic regression were used to assess differences in length of stay (LOS), discharge disposition/need for postacute care, quality-adjusted life year (QALY), surgical site infection (SSI), hospital cost, total cost, readmission within 30 days, and emergency room (ER) visits within 30 days. RESULTS: Among the study population, 863 patients were braced and 43 were not braced. No difference was seen between the two groups in short-term outcomes from surgery including LOS (P = 0.836), discharge disposition (P = 0.226), readmission (P = 1.000), ER visits (P = 0.281), SSI (P = 1.000), and QALY gain (P = 0.319). However, the braced group incurred a significantly higher direct hospital cost (median increase of 41.43%, P < 0.001) compared to the unbraced cohort (bracing cost excluded). There was no difference in graft type (P = 0.145) or comorbidities (P = 0.20–1.00) such as obesity (P = 1.000), smoking (P = 1.000), chronic obstructive pulmonary disease (P = 1.000), hypertension (P = 0.805), coronary artery disease (P = 1.000), congestive heart failure (P = 1.000), and total number of comorbidities (P = 0.228). CONCLUSION: Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes but will reduce cost. Wolters Kluwer - Medknow 2020-05-29 /pmc/articles/PMC7335149/ /pubmed/32656128 http://dx.doi.org/10.4103/ajns.AJNS_35_20 Text en Copyright: © 2020 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sinha, Saurabh
Caplan, Ian
Schuster, James
Piazza, Matthew
Glauser, Gregory
Sharma, Nikhil
Welch, William Charles
Osiemo, Benjamin
Mcclintock, Scott
Ozturk, Ali Kemal
Malhotra, Neil Rainer
Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery
title Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery
title_full Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery
title_fullStr Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery
title_full_unstemmed Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery
title_short Evaluation of Lumbar Spine Bracing as a Postoperative Adjunct to Single-level Posterior Lumbar Spine Surgery
title_sort evaluation of lumbar spine bracing as a postoperative adjunct to single-level posterior lumbar spine surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335149/
https://www.ncbi.nlm.nih.gov/pubmed/32656128
http://dx.doi.org/10.4103/ajns.AJNS_35_20
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