Impact of Age on 30-day Postoperative Complications Following Spine Surgery

Introduction Age has been shown to increase risk of postoperative complications. The current study is the largest known study of postoperative complications after spine surgery by age cohort, using the National Surgical Quality Improvement Program (NSQIP) database. Methods A retrospective analysis NSQIP data of 46,509 patients undergoing spine surgery from 2005 to 2014 was performed using specific Current Procedural Terminology (CPT) codes. 30-day postoperative data was collected, analyzed, and broken into age cohorts \u3c30, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-89, to determine differences in complications by age group. Results 46,509 patients were analyzed. Age was a significant predictor of deep surgical site infection, reoperation rate, pneumonia, pulmonary embolism, unplanned intubation, urinary tract infection, requiring postoperative transfusion, postoperative myocardial infarction, cardiac arrest requiring resuscitation, and DVT. Older patients also had longer overall hospital stays and higher rates of hospital readmission. There was no difference in the rate of superficial SSI based on age groups and the highest rate of wound disruption was found in the \u3c30 age group. Discussion Age is a significant predictor of most 30-day postoperative complications after spine surgery. Higher rates of complications in older age cohorts, as well as increased length of stay and higher readmission rates, suggest the need for individualized counseling and decision-making around spine surgery in the elderly

Low Serum Albumin Levels are Associated with Increased 30-Day Cardiopulmonary Complications, Reoperation, and Readmission Rates Following Total Shoulder Arthroplasty

Copyright © The Iowa Orthopaedic Journal 2019. Background: Hypoalbuminemia has been associated with several medical complications following surgery in a variety of orthopedic procedures. Hypoalbuminemia has previously been shown to have an increased risk for transfusions, hospital stay longer than three days, and mortality following total shoulder arthroplasty (TSA). This study seeks to further assess the relationship between low serum albumin and morbidity to allow surgeons to both preoperatively optimize patients and assess the risk of surgery prior to TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program® database was queried to identify 14,494 TSA patients, 6,129 (42.23%) who met inclusion criteria. Patients who had shoulder hemiarthroplasty, revision TSA, or incomplete serum albumin data were excluded. Demographic factors, preoperative comorbidities, and acute complication rates were assessed between hypoalbuminemic (n=485; 7.91%) and a propensity-matched control cohort (n=485), controlling for differences in patient demographics and comorbidities. Multivariate propensity-adjusted logistic regression analyses were used to assess hypoalbuminemia as an independent risk factor for specific postoperative complications. Results: Hypoalbuminemic patients undergoing TSA demonstrated significantly higher rates of pulmonary complications (p=0.006), unplanned intubation (p=0.014), DVT/PE (p=0.014), cardiac complications (p=0.033), infectious complications (p=0.025), blood transfusions (p\u3c0.001), reoperation (p=0.007), extended length of stay (\u3e 4 days) (p=0.036), unplanned readmission (p=0.001), and mortality (p=0.025) in the 30-day postoperative period when compared to the propensity-matched control cohort. On multivariate regression analyses, hypoalbuminemia independently increased the risk for pulmonary complications (OR 9.678, p=0.031), blood transfusions (OR 2.539, p\u3c0.001), reoperation (OR 5.461, p=0.032), and readmission (OR 2.607, p=0.007). Conclusions: Hypoalbuminemic patients undergoing TSA had increased rates of overall cardiac and pulmonary complications, unplanned intubations, DVT/PE\u27s, overall infectious complications, increased incidence of blood transfusions, reoperation, extended LOS (\u3e 4 days), readmission, and death. Multivariate analyses demonstrated that low albumin was independently associated with increased risk for pulmonary complications, blood transfusions, reoperation, and readmission. Preoperative albumin levels in patients undergoing TSA may help with preoperative risk stratification and optimization.Level of evidence: III

The Effect of Turf Toe Injuries on Player Performance in the National Football League

Copyright © The Iowa Orthopaedic Journal 2019. Background: Turf toe results from hyperdorsiflexion of the first metatarsophalangeal joint, injuring the plantar capsuloligamentous complex. We hypothesized that National Football League (NFL) player performance following turf toe injury would decrease in comparison to controls at the same position. Methods: Demographics, return to play, and season performance data on players sustaining turf toe injuries in the NFL from 2010-2015 were collected. An Offensive Power Rating (OPR=[total yards/10]+[total touchdowns x6]) or Defensive Power Rating (DPR=total tackles+[total sacks x2]+[total interceptions x2]) was calculated for each player. Control data were collected for NFL players in 2013 with no history of turf toe injury. Statistical analysis was performed using Wilcoxon Rank Sum tests. Results: Twenty-four injured players and 436 controls were included. Nineteen players returned to play within the regular season of injury (mean 36.7 ± 28.9 days). Seventeen players were removed from team injury reports for turf toe within the regular season (mean 42.6 ± 26.2 days). Three players required season-ending surgery. Comparison of 1-year post- versus pre-injury revealed an insignificant median OPR difference (-18.9 IQR -43.4 to 10.3 vs. control -12.2 IQR -46.2 to 47.7, p = 0.328) and median DPR difference (-1.0 IQR -26.0 to 17.0 vs. control 2.0 IQR -15.0 to 18.0, p = NA). Comparison of 2-year data revealed no significant median OPR difference (-32.6 IQR -122.2 to 1.0 vs. control -20.7 IQR -72.6 to 44.7, p = 0.327) and median DPR difference (-5.0 IQR -19.0 to 6.0 vs. control -4.5 IQR -22.0 to 12.5, p= NA). Conclusions: Turf toe results in significant loss of playing time. Despite the long recovery period, NFL players have similar performance following injury compared to controls. The effect of turf toe injuries on performance is variable.Level of evidence: IV