Upload
jeffrey-a-rihn
View
214
Download
2
Embed Size (px)
Citation preview
96S Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
Saturday, October 9, 20107:25–8:25 AM
General Session: Best Papers
207. Does Obesity Affect Outcomes in the Lumbar Spine Patient?
Jeffrey A. Rihn, MD1, Kristen Radcliff, MD1, Alan S. Hilibrand, MD1,
Wenyan Zhao, MS2, Emily Blood, MS2, Alexander R. Vaccaro, MD, PhD1,
Todd J. Albert, MD1, James N. Weinstein, MS, DO2; 1Thomas Jefferson
University Hospital, The Rothman Institute, Philadelphia, PA, USA;2The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH, USA
BACKGROUND CONTEXT: The affect of obesity on the treatment
outcomes for lumbar degenerative disorders remains unknown.
PURPOSE: The purpose of this study is to determine if obesity affects
treatment outcomes for lumbar intervertebral disc herniation (IDH), steno-
sis (SpS) and degenerative spondylolisthesis (DS).
STUDY DESIGN/SETTING: As-treated analysis on the combined
randomized and observational cohorts from the Spine Patient Outcomes
Research Trail (SPORT).
PATIENT SAMPLE: Patients enrolled in SPORT for IDH, SpS, or DS
treatment.
OUTCOME MEASURES: ODI, SF-36 bodily pain (BP) and physical
function (PF) scores and secondary outcome measures.
METHODS: A comparison was made between patients with a body mass
ndex (BMI) less than 30 (n5552 IDH, 373 SpS, 376 DS) and those with
a BMI greater than or equal to 30 (n5245 IDH, 261 SpS, 225 DS). Obesity
was defined as a BMI greater than or equal to 30. Baseline patient character-
istics, intraoperative data, and complications were documented. Primary and
secondary outcomes were measured at baseline and regular follow-up time
intervals up to 4 years. The difference in improvement from operative and
nonoperative treatment (treatment effect) was determined at each follow-
up interval.
RESULTS: At 4-years follow-up, operative and nonoperative treatment
provided improvement in all primary outcome measures over baseline in
patients with BMI of less than 30 and greater than or equal to 30. For IDH
and SpS patients, there were no differences in the surgical complication or re-
operation rates between groups. DS patients with BMI greater than or equal to
30 had a higher postoperative infection rate (5% vs. 1%, p50.05) and twice
the reoperation rate at 4-years follow-up (20% vs. 11%, p50.01) than those
with BMI less than 30. At 4-years, operative treatment of SpS and DS was
equally effective in both BMI groups in terms of the primary outcome mea-
sures, with the exception that obese DS patients had worse SF36 PF scores
compared to nonobese patients (27.1 vs. 22.6, p50.017). IDH patients with
a BMI greater than or equal to 30 did worse with operative treatment than
those with BMI less than 30 in all primary outcome measures. With nonoper-
ative treatment, SpS patients with BMI greater than or equal to 30 did worse in
regards to all three primary outcome measures, and IDH and DS patients with
BMI greater than or equal to 30 had similar SF-36 outcomes but worse ODI
outcomes. Treatment effects for all lumbar conditions were significant within
each BMI group for all primary outcome measures, in favor of surgery. There
were no significant differences in the treatment effect for any primary or sec-
ondary outcome measures at 4 years between those with BMI less than 30 and
greater than or equal to 30, with the exception of the treatment effects for ODI
in the SpS patients (-7.4 vs. -13.9, p50.037) and SF-36 PF in the DS patients
(14.0 vs. 25.6, p50.004).
CONCLUSIONS: Obesity does not affect the clinical outcome of
operative treatment for SpS. There are higher rates of infection and reop-
eration and a lower SF-36 PF score in obese patients following surgery for
DS. Surgery for IDH is not as effective in obese patients. Nonoperative
treatment may not be as effective in obese patients with IDH, SpS, or DS.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include
any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.255
All referenced figures and tables will be available at the Annual Mee
208. Morbidity and Mortality Associated with the Operative
Treatment of Disorders of the Pediatric Spine: A Report
from the SRS M&M Committee
Kai-Ming Fu, MD, PhD1, Justin Smith, MD, PhD1, David Hamilton, MD1,
Joseph H. Perra, MD2, David W. Polly, MD3, Christopher P. Ames, MD4,
Sigurd H. Berven, MD4, Steven D. Glassman, MD5,
D. Raymond Knapp, MD6, Christopher I. Shaffrey, MD1
Scoliosis Research Society Morbidity and Mortality Committee7;1University of Virginia, Charlottesville, VA, USA; 2Twin Cities
Spine Center, Minneapolis, MN, USA; 3University of Minnesota,
Minneapolis, MN, USA; 4University of California-San Francisco,
San Francisco, CA, USA; 5Kenton D Leatherman Spine Center,
Louisville, KY, USA; 6Orlando Health, Orlando, FL, USA; 7SRS,
Milwaukee, WI, USA
BACKGROUND CONTEXT: Currently few studies regarding complica-
tions and mortality associated with operative treatment of pediatric spinal
disorders are available to guide the surgeon.
PURPOSE: This study provides more detailed complication and mortality
data with an analysis of 23,918 pediatric cases reported in the multicenter
multi-surgeon Scoliosis Research Society (SRS) Morbidity and Mortality
(M&M) database.
STUDY DESIGN/SETTING: Retrospective review of prospectively
collected complications database.
PATIENT SAMPLE: 23,918 operative pediatric spine cases reported
from 2004–2007.
OUTCOME MEASURES: Complications and mortality as reported in
the perioperative period.
METHODS: The SRS M&M database was queried for the years 2004–
2007. Inclusion criterion was age!18. Cases were categorized by opera-
tion type and disease process. Multiple details on the surgical approach,
use of neurophysiological monitoring and type of instrumentation were
recorded. Major perioperative complications and deaths were evaluated.
Statistical analysis was performed with chi square testing with a P- value
of!0.05 considered significant.
RESULTS: 23,918 patients were included. The mean age was 13 with
a standard deviation of 3.6 years. Diseases reported were predominantly
deformity including scoliosis (19642), kyphosis (1455), spondylolisthesis
(748) and trauma (478). The overall complication rate was 8.5%. Major
complications are listed in table 1. Complications and mortality by dis-
ease process are listed in table 2. Complications by operation type are
listed in table 3. The major complications were due to infection or respi-
ratory concerns. Patients undergoing revision (2034) and osteotomy
(2787) operations were more likely to suffer a complication and new neu-
rological deficit. 31 deaths were reported for an overall rate of 0.13%.
Respiratory complications were the most common etiology of mortality
(13). 84% (26) of deaths occurred in children undergoing scoliosis
correction.
CONCLUSIONS: Spinal surgery in children is associated with a range of
complications depending on type of operation, but a low mortality rate.
Patients undergoing more aggressive corrective procedures for deformity
are more likely to suffer complications.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include
any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.256
209. Postoperative Improvement in Health Related Quality of Life:
A National Comparison of Surgical Treatment for Focal (1–2 Level)
Lumbar Spinal Stenosis Compared to Total Joint Replacement for
Osteoarthritis
Y. Raja Rampersaud, MD, FRCSC1, Eugene Wai, MD, FRCSC2,
Edward Abraham, MD, FRCSC3, David Alexander, MD, FRCSC4,
ting and will be included with the post-meeting online content.