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Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion
STUDY DESIGN: Retrospective large database study. OBJECTIVE: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. METHODS: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485078/ https://www.ncbi.nlm.nih.gov/pubmed/32905718 http://dx.doi.org/10.1177/2192568219880823 |
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author | Lu, Young Lin, Charles C. Stepanyan, Hayk Alvarez, Andrew P. Bhatia, Nitin N. Kiester, P. Douglas Rosen, Charles D. Lee, Yu-Po |
author_facet | Lu, Young Lin, Charles C. Stepanyan, Hayk Alvarez, Andrew P. Bhatia, Nitin N. Kiester, P. Douglas Rosen, Charles D. Lee, Yu-Po |
author_sort | Lu, Young |
collection | PubMed |
description | STUDY DESIGN: Retrospective large database study. OBJECTIVE: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. METHODS: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-CM codes between the years of 2009 and 2011 using the Nationwide Inpatient Sample database. Main outcome measures were in-hospital neurologic, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, wound-related complications, and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients with and without cirrhosis undergoing spinal fusion. RESULTS: A total of 1 214 694 patients underwent elective spinal fusions from 2009 to 2011. Oh these, 6739 were cirrhotic. Cirrhosis was a significant independent predictor for respiratory (odds ratio [OR] = 1.43, confidence interval [CI] 1.29-1.58; P < .001), gastrointestinal (OR = 1.72, CI 1.48-2.00; P < .001), urinary and renal (OR = 1.90, CI 1.70-2.12; P < 0.001), wound (OR = 1.36, CI 1.17-1.58; P < 0.001), and overall inpatient postoperative complications (OR = 1.43, CI 1.33-1.53; P < .001). Cirrhosis was also independently associated with significantly greater inpatient mortality (OR = 2.32, CI 1.72-3.14; P < .001). Cirrhotic patients also had significantly longer lengths of stay (5.35 vs 3.35 days; P < .001) and inpatient costs ($36 738 vs $29 068; P < .001). CONCLUSIONS: Cirrhosis is associated with increased risk of perioperative complications, mortality and greater resource utilization. Cirrhotic patients undergoing spinal fusion surgeries should be counseled on these increased risks. Current strategies for perioperative management of cirrhotic patients undergoing spinal fusion surgery need improvement. |
format | Online Article Text |
id | pubmed-7485078 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-74850782020-09-17 Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion Lu, Young Lin, Charles C. Stepanyan, Hayk Alvarez, Andrew P. Bhatia, Nitin N. Kiester, P. Douglas Rosen, Charles D. Lee, Yu-Po Global Spine J Original Articles STUDY DESIGN: Retrospective large database study. OBJECTIVE: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. METHODS: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-CM codes between the years of 2009 and 2011 using the Nationwide Inpatient Sample database. Main outcome measures were in-hospital neurologic, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, wound-related complications, and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients with and without cirrhosis undergoing spinal fusion. RESULTS: A total of 1 214 694 patients underwent elective spinal fusions from 2009 to 2011. Oh these, 6739 were cirrhotic. Cirrhosis was a significant independent predictor for respiratory (odds ratio [OR] = 1.43, confidence interval [CI] 1.29-1.58; P < .001), gastrointestinal (OR = 1.72, CI 1.48-2.00; P < .001), urinary and renal (OR = 1.90, CI 1.70-2.12; P < 0.001), wound (OR = 1.36, CI 1.17-1.58; P < 0.001), and overall inpatient postoperative complications (OR = 1.43, CI 1.33-1.53; P < .001). Cirrhosis was also independently associated with significantly greater inpatient mortality (OR = 2.32, CI 1.72-3.14; P < .001). Cirrhotic patients also had significantly longer lengths of stay (5.35 vs 3.35 days; P < .001) and inpatient costs ($36 738 vs $29 068; P < .001). CONCLUSIONS: Cirrhosis is associated with increased risk of perioperative complications, mortality and greater resource utilization. Cirrhotic patients undergoing spinal fusion surgeries should be counseled on these increased risks. Current strategies for perioperative management of cirrhotic patients undergoing spinal fusion surgery need improvement. SAGE Publications 2019-10-10 2020-10 /pmc/articles/PMC7485078/ /pubmed/32905718 http://dx.doi.org/10.1177/2192568219880823 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Articles Lu, Young Lin, Charles C. Stepanyan, Hayk Alvarez, Andrew P. Bhatia, Nitin N. Kiester, P. Douglas Rosen, Charles D. Lee, Yu-Po Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion |
title | Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion |
title_full | Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion |
title_fullStr | Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion |
title_full_unstemmed | Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion |
title_short | Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion |
title_sort | impact of cirrhosis on morbidity and mortality after spinal fusion |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485078/ https://www.ncbi.nlm.nih.gov/pubmed/32905718 http://dx.doi.org/10.1177/2192568219880823 |
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