16 research outputs found
Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series
<p>Abstract</p> <p>Background</p> <p>Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P).</p> <p>Methods</p> <p>All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF) were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care.</p> <p>Results</p> <p>64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14), older age (1), and patient preference (2). At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia.</p> <p>Conclusion</p> <p>In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.</p
P177 - Revision Rate in Robotic-Guided vs Fluoro-Guided Minimally Invasive Spinal Fusion Surgery: Report from MIS ReFRESH Prospective Comparative Study
P176 - Complication Rate in Robotic-Guided vs Fluoro-Guided Minimally Invasive Spinal Fusion Surgery: Report from MIS Refresh Prospective Comparative Study
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140. Complications and revision rates in minimally invasive Mazor robotic-guided vs fluoroscopic-guided spinal fusions: the MIS ReFRESH prospective comparative study
As robotic-guidance and minimally invasive approaches become more prevalent in spine surgery, there is a growing interest in high-level scientific evidence of their clinical value. MIS ReFRESH is the first prospective, multicenter study designed to compare robotic-guidance and fluoroscopic techniques for differences in surgical complications, revision surgery rates and exposure to intraoperative radiation. The MIS ReFRESH study assessed adults undergoing minimally invasive (MIS) lumbar fusions of 1-3 levels.
To prospectively assess the impact of Mazor robotic-guidance compared to fluoro-guidance on the rates of surgical complications, revision surgery and intraoperative radiation exposure in MIS short lumbar fusions.
Prospective, multicenter, controlled, partially randomized study.
Adult patients with degenerative lumbar conditions undergoing minimally invasive fusion of 1-3 levels.
Comparison of incidence of surgical complications, revision surgeries and intraoperative fluoroscopy time. Analysis of variables through Cox logistic regression model and a Kaplan Meyer Survival Curve of surgical complications.
Data were prospectively collected from adult patients indicated for lumbar fusion surgery, including demographics, comorbidities, surgical complications, revision surgeries and use of intraoperative fluoroscopy (in seconds). A single site randomized patients between arms, while other sites enrolled exclusively to one arm. Primary endpoints were analyzed at 1-year follow-up.
A total of 9 sites enrolled 485 patients: 374 in the robot-guided arm (RG), and 111 in the fluoro-guided arm (FG). One site randomized patients, 16 to RG and 11 to FG. 93.2% of patients had >1 year follow-up and were included in the analysis of primary endpoints. There were no differences between the groups with regards to gender, Charlson Comorbidity Index (CCI), Diabetes, Cancer or HIV status. RG patients were significantly heavier, younger and included more smokers. Mean age of RG patients was 59.0 years vs 62.5 for FG (p=0.009) and BMI was 31.2 vs 28.1, respectively (p<0.001). Percentage of smokers was almost double in the RG group (15.2% vs 7.2%, p=.029). Surgical time was similar between groups (skin-to-skin time/#screws) at 24.9 min RG and 22.9 FG (p=0.55). RG cases were significantly more complex as 38.2% were 2-3 levels vs 20.7% in FH (p<0.001). One-level fusions were 61.8% RG vs 79.3% FH (p<0.001). Use of fluoroscopy for the instrumentation phase of the surgery was 16.7 sec in RG vs 77.1 sec FH, resulting in a 60 sec average reduction in fluoro per case in RG. Fluoroscopy time per screw was 3.6 seconds RG vs 17.8 seconds FH leading to an 80% average reduction of fluoro time / screw in RG (p<0.001). Average follow-up was 2.1 years in RG and 2.9 years in FG. Within the first year of follow-up there were 38 (10.2%) surgical complications in RG vs 39 (35.1%) in FG, and 5 (1.3%) revisions in RG vs 4 (3.6%) in FG. When evaluated in a Cox logistic regression model that includes age, gender, BMI, CCI and # screws, the Hazard Ratio (HR) for a complication was 5.2 times higher in FG compared to RG (95% Confidence Interval (CI): 0.118-0.307, p<0.001). Hazard ratio for a revision surgery was 8.8 times higher in FG compared to RG cases (95% CI 0.032-0.399, p<0.001).
In a prospective, multicenter, comparative study of MIS lumbar fusions, surgeries performed with Mazor robotic guidance were found to have a 5.2 times lower risk of developing a surgical complication and 8.8 times lower risk for revision surgery compared to fluoro-guidance during the first year of follow-up. Normalized surgical times/instrumentation were similar between the two groups and RG reduced fluoro time per screw by 80%, or approximately a minute per case.
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