12 research outputs found
No Difference in Two-Year Revisions Between Hybrid Fusion and Two-Level Anterior Discectomy and Fusion: A National Database Study.
No full textSTUDY DESIGN: Retrospective Cohort.
OBJECTIVE: This study utilized a large national database to compare two-year revision rates, in addition to complications and costs, of hybrid surgery (HS) compared to two-level anterior cervical discectomy and fusion (ACDF).
METHODS: This study used the PearlDiver Mariner dataset selecting for patients aged 18 and older who had at least 90-day active longitudinal follow-up who underwent two-level ACDF or two-level Hybrid surgery (single level ACDF and single level CDA). Patients with prior spinal trauma, infection, cancer, or posterior fusion were excluded. Primary outcomes measures were 90-day major and minor medical complications, ED visits, readmissions, as well as two-year revisions. Patients were also assessed for postoperative dysphagia, incidental durotomy, vascular injury, 90-day surgical site, and implant complications. Additionally, hospitalization and postoperative costs were evaluated.
RESULTS: There were 4570 two-level ACDF surgeries and 888 hybrid surgeries. After matching the cohorts, no statistical differences in demographics were found. There were no differences in reoperation rates at all measured time points nor 2-year complications. HS had a lower incidence of major (1.6% vs 3.1%,
CONCLUSION: Hybrid surgery is a safe and effective surgical treatment for cervical disease in appropriately selected patients
Penicillin Allergy in Spine Surgery: Increased Rates of Sepsis, Emergency Room Visits, and Readmission.
No full textOBJECTIVE: To determine if a penicillin allergy is an independent risk factor for poor outcomes after anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF).
METHODS: A retrospective database review was performed using the PearlDiver data set. The study population included all patients younger than 85 years who underwent elective PLF or ACDF with diagnosis of penicillin allergy using International Classification of Diseases codes. Study patients were compared with controls for 90-day complications and 1-year reoperation rates. A multivariate logistic regression was used to determine the independent effect of penicillin allergy on the postoperative outcomes.
RESULTS: PLF cohort multivariate analysis showed that patients with a penicillin allergy had a significantly increased risk of sepsis (2.6% vs. 2.0%; P = 0.020), urinary tract infection (10.8% vs. 8.4%; P \u3c 0.001), emergency room visits (27.3% vs. 20.2%; P \u3c 0.001), and readmissions (9.6% vs. 6.4%; P \u3c 0.001) within 90 days index of surgery. Similarly, the ACDF cohort multivariate analysis showed that a penicillin allergy was associated with an increased risk of sepsis (1.8% vs. 1.1%; P \u3c 0.001), emergency room visits (27.2% vs. 20.7%; P \u3c 0.001), and readmissions (6.8% vs. 5.6%; P = 0.003) within 90 days index of surgery.
CONCLUSIONS: The present study found that a reported penicillin allergy is associated with an increase in sepsis, urinary tract infection, emergency room visit, and readmission postoperatively within 90 days after PLF and ACDF. The findings can help physicians provide patients with more comprehensive preoperative counseling in the setting of patient-reported penicillin allergy
Anterior cervical discectomy and fusion in patients with preexisting dementia: Increased medical complications, costs, and 90-day readmissions.
No full textSTUDY DESIGN: Retrospective-Cohort INTRODUCTION: Dementia is among the most common health concerns for the aging population, characterized by steep cognitive decline and subsequent loss of independence. Limited orthopedic literature examines the influence that dementia has on patients undergoing elective spinal surgeries.
METHODS: Employing the PearlDriver Database, a study population consisting of patients who underwent primary elective ACDF with a prior diagnosis of dementia were selected using Internal Classification Disease-9 (ICD) and ICD-10 codes. Patients with a history of trauma, infection, or malignancy were excluded. Patients with dementia were compared to matched controls via logistical regression accounting for patient demographics, medical comorbidities and levels operated on. Patients were assessed for 90-day outcomes including medical complications, emergency department visits, readmissions, one-year reoperation, hospital length of stay (LOS) and total operative hospitalization costs, and 90-day postoperative cost.
RESULTS: There were 4104 patients in the dementia group and 20,269 patients in the matched control group who underwent primary ACDF. Multivariate analysis showed that patients with dementia undergoing ACDF were associated with increased 90-day major and minor medical complications (p \u3c 0.001). Patients with dementia were also associated with an increased risk of dysphagia (p \u3c 0.001), 90-day ER visits(p \u3c 0.001), 90-day readmissions(p \u3c 0.001), and increased LOS(p \u3c 0.001) following ACDF compared to the control group. Additionally, both total hospitalization costs and 90-day postoperative costs were higher in the dementia cohort(p \u3c 0.001).
CONCLUSION: Preoperative dementia diagnosis in patients undergoing ACDF is associated with increased number of readmissions, hospitalization and 90-day costs, and postoperative medical complications
Penicillin Allergy in Spine Surgery: Increased Rates of Sepsis, Emergency Room Visits, and Readmission
No full textPrevalence of Osteoporosis Treatment and Its Effect on Post-Operative Complications, Revision Surgery and Costs After Multi-Level Spinal Fusion
No full textSTUDY DESIGN: Retrospective cohort study. OBJECTIVE: To study the prevalence of pre-operative osteoporosis treatment, and its effect on risk of ORC, revision surgery and costs in osteoporotic patients undergoing ≥3-level spinal fusion for degenerative pathology. METHODS: Patients and procedures of interest were included using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding. Our outcome measures were ORC at 1-year post-operatively and included instrumentation complications, pathological fracture, and revision surgery. Kaplan-Meier survival curves and Cox proportional hazards analysis was done to study the effect of osteoporosis treatment on risk of ORC. RESULTS: We included a total of 849 patients with documented osteoporosis undergoing ≥3-level spinal fusion. White (85.6%), female (82.7%), and 60-79 years of age (79.9%) was the most common demographic. Of entire cohort, 121(14.3%) were on osteoporosis treatment prior to spinal fusion. Of treated patients, 52/121 (43.0%) had continued prescriptions at 1 year post-operatively. Treated patients and not-treated patients had 1-year ORC incidence of 9.1% and 15.0%, respectively. The average 1-year reimbursement/patient for managing ORC was 21,147 (not-treated). On adjusted cox analysis, pre-operative osteoporosis treatment was associated with a lower risk of ORC (HR: 0.53, 95% CI: 0.28-0.99, p = 0.04). CONCLUSIONS: Pre-operative osteoporosis treatment is associated with lower risk of ORC and revision surgery at 1-year after ≥3-level spinal fusion. There is a low incidence of osteoporosis treatment prior to spinal fusion, and subsequently a low rate of treatment continuation after surgery. These findings highlight the need for heightened awareness, patient education and management of osteoporosis before elective multi-level spinal fusion
Improvement of postural stability and gait velocity after cervical decompression surgery in patients with cervical spondylotic myelopathy.
No full textOBJECTIVE: Cervical spondylotic myelopathy (CSM) is a progressive degenerative condition that can lead to significant neurological deficits, including gait instability. Biomechanical alterations of gait and its various components are poorly understood. The goal of the current study was to determine how spatiotemporal gait parameters, as well as postural and dynamic stability, change after surgery in CSM patients.
METHODS: A total of 47 subjects were included, with 23 test subjects and 24 controls. Baseline measurements were made for both cohorts. In the CSM cohort, repeat measurements were made at 3 and 6 months postoperatively. To record spatiotemporal and dynamic stability parameters, subjects performed walking trials over force plates on a 15-m runway. To assess postural stability, standing balance trials were conducted on a floor-mounted force plate. Three-dimensional motion analysis cameras and gait modeling software were used to quantify and visually represent results. Statistical analysis was completed using repeated-measures ANOVA and paired t-tests. Significance was set at p \u3c 0.05.
RESULTS: CSM patients had significantly increased gait velocity at the 6-month follow-up (mean 0.948 ± 0.248 m/sec/leg length) versus baseline (mean 0.852 ± 0.257 m/sec/leg length) (p = 0.039). The tilted ellipse area was significantly decreased at the 6-month follow-up compared with baseline (mean 979.8 ± 856.7 mm2 vs 598.0 ± 391.1 mm2, p = 0.018). Angular momentum excursion was not significantly different between baseline and the 3- and 6-month follow-ups.
CONCLUSIONS: CSM patients displayed significant improvement in gait velocity and postural stability parameters after decompressive surgery. Dynamic stability parameters did not change significantly during the study period
Neurospine
No full textObjective: The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. Methods: A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008-2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use. Results: A total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. Conclusion: Patients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use
Increasing Cost Efficiency in Adult Spinal Deformity Surgery: Identifying Predictors of Lower Total Costs.
No full textSTUDY DESIGN: Retrospective study of a prospective multicenter database.
OBJECTIVE: The purpose of this study was to identify predictors of lower total surgery costs at 3 years for Adult Spinal Deformity (ASD) patients.
SUMMARY OF BACKGROUND DATA: ASD surgery involves complex deformity correction.
METHODS: Inclusion criteria: surgical ASD (scoliosis≥20°, SVA≥5 cm, PT≥25°, or thoracic kyphosis ≥60°) patients \u3e18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality adjusted life year was assessed. A Conditional Variable Importance Table used non-replacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.
RESULTS: 316/322 ASD patients met inclusion criteria. At 3Y follow up, the potential cost of ASD surgery ranged from 116,312.54. The average costs of surgery at 3 years was found to be 57,606.88 to $116,312.54. Predictors of lower costs included higher baseline SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different baseline deformity profiles, allowing for the optimization of cost efficiency for all patients.Level of Evidence: 3
Increasing Cost Efficiency in Adult Spinal Deformity Surgery: Identifying Predictors of Lower Total Costs.
No full textStudy designRetrospective study of a prospective multicenter database.ObjectiveThe purpose of this study was to identify predictors of lower total surgery costs at 3 years for adult spinal deformity (ASD) patients.Summary of background dataASD surgery involves complex deformity correction.MethodsInclusion criteria: surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients >18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.ResultsThree hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from 116,312.54. The average costs of surgery at 3 years was found to be 57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.Level of Evidence: 3
Global PIQA: Evaluating Physical Commonsense Reasoning Across 100+ Languages and Cultures
No full textTo date, there exist almost no culturally-specific evaluation benchmarks for large language models (LLMs) that cover a large number of languages and cultures. In this paper, we present Global PIQA, a participatory commonsense reasoning benchmark for over 100 languages, constructed by hand by 335 researchers from 65 countries around the world. The 116 language varieties in Global PIQA cover five continents, 14 language families, and 23 writing systems. In the non-parallel split of Global PIQA, over 50% of examples reference local foods, customs, traditions, or other culturally-specific elements. We find that state-of-the-art LLMs perform well on Global PIQA in aggregate, but they exhibit weaker performance in lower-resource languages (up to a 37% accuracy gap, despite random chance at 50%). Open models generally perform worse than proprietary models. Global PIQA highlights that in many languages and cultures, everyday knowledge remains an area for improvement, alongside more widely-discussed capabilities such as complex reasoning and expert knowledge. Beyond its uses for LLM evaluation, we hope that Global PIQA provides a glimpse into the wide diversity of cultures in which human language is embedded.See §A for author list. Global PIQA would not be possible without the efforts of all of the authors. Wealso thank several anonymous contributors who preferred not to be authors on this paper. The research of Yolanda Xavier is supported by Portuguese national funding through the FCT– Portuguese Foundation for Science and Technology, I.P. as part of the project UID/3213/2025– Linguistics Research Centre of NOVA University Lisbon (CLUNL) and by the Doctoral Grant (FCT PhD grant) number 2022.13977.BD from the same funder. Group 0025 is supported by the following grants: CLARIN-PL (POIR.04.02.00-00C002/19, FENG.02.04-IP.040004/24, 2024/WK/01), DARIAH-PL (POIR.04.02.00-00-D006/20, KPOD.01.18-IW.03-0013/23). Annika Simonsen was funded by the European Commission under grant agreement no. 101135671. CEB has been partially funded by the German ministry for education and research (BMBF) through the TRAILS project (grant number 01IW24005). Group 0070 is supported by funding from King Abdullah University of Science and Technology (KAUST)- Center of Excellence for Generative AI, under award number 5940. Group 0079 would like to thank Mr. Sudhir R. Narayana for help with correction and verification of items in their dataset. Sina Ahmadi gratefully acknowledges support from the University of Zurich (UZH) Postdoc Grant (reference number 269093). Group 0133 would like to thank the MbazaNLP community, including students from the University of Rwanda, School of Art and Languages. We would also like to thank Yonatan Bisk for useful insights into the original PIQA dataset
