The Lantern Vol. 17, No. 1, Fall 1948

• In the Arms of the Sea • The Expressed Should Be Repressed • Puppy Love • Tommy • How to Eat a Ravioli Dinner • The Divine Blessing • On Thunder • There Is No Hell • Old Love Re-met • Autumn Eve • Dr. Cornelius Weygandthttps://digitalcommons.ursinus.edu/lantern/1046/thumbnail.jp

The Lantern Vol. 17, No. 1, Fall 1948

• In the Arms of the Sea • The Expressed Should Be Repressed • Puppy Love • Tommy • How to Eat a Ravioli Dinner • The Divine Blessing • On Thunder • There Is No Hell • Old Love Re-met • Autumn Eve • Dr. Cornelius Weygandthttps://digitalcommons.ursinus.edu/lantern/1046/thumbnail.jp

Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project.

BACKGROUND: United States (U.S.) healthcare is a volume-based inefficient delivery system. Value requires the consideration of quality, which is lacking in most healthcare disciplines. OBJECTIVE: To assess whether patients who met specific evidence-based medicine (EBM)-based criteria preoperatively for lumbar fusion would achieve higher rates of achieving the minimal clinical important difference (MCID) than those who did not meet the EBM indications. METHODS: All elective lumbar fusion cases, March 2018 to August 2019, were prospectively evaluated and categorized based on EBM guidelines for surgical indications. The MCID was defined as a reduction of ≥5 points in Oswestry Disability Index (ODI). Multiple logistic regression identified multivariable-adjusted odds ratio of EBM concordance. RESULTS: A total of 325 lumbar fusion patients were entered with 6-mo follow-up data available for 309 patients (95%). The median preoperative ODI score was 24.4 with median 6-mo improvement of 7.0 points (P \u3c .0001). Based on ODI scores, 79.6% (246/309) improved, 3.8% (12/309) had no change, and 16% (51/309) worsened. A total of 191 patients had ODI improvement reaching the MCID. 93.2% (288/309) cases were EBM concordant, while 6.7% (21/309) were not.In multivariate analysis, EBM concordance (P = .0338), lower preoperative ODI (P \u3c .001), lower ASA (American Society of Anesthesiologists) (P = .0056), and primary surgeries (P = .0004) were significantly associated with improved functional outcome. EBM concordance conferred a 3.04 (95% CI 1.10-8.40) times greater odds of achieving MCID in ODI at 6 mo (P = .0322), adjusting for other factors. CONCLUSION: This analysis provides validation of EBM guideline criteria to establish optimal patient outcomes. The EBM concordant patients had a greater than 3 times improved outcome compared to those not meeting EBM fusion criteria

Does Pre-Operative Opiate Choice Increase Risk of Post-Operative Infection and Subsequent Surgery?

BACKGROUND: Opioids are commonly prescribed for chronic pain prior to spinal surgery and research has shown an increased rate of post-operative adverse events in these patients. OBJECTIVE: This study compared the incidence of two-year subsequent surgical procedures and post-operative adverse events in patients undergoing lumbar fusion with or without 90-day pre-operative opioid use. We hypothesized that patients using preoperative opioids to have a higher incidence of subsequent surgery and adverse outcomes. METHODS: A retrospective cohort study was performed using Optum Pan-Therapeutic Electronic Health Records database including adult patients who had their first lumbar fusion between 2015 and 2018. The daily average preoperative opioid dosage 90 days prior to fusion was determined as morphine equivalent dose (MED) and further categorized into high-dose (MED\u3e100mg/day) and low-dose (1-100mg/day). Clinical outcomes were compared after adjusting for confounders. RESULTS: A total of 23,275 patients were included, with 2,112 (10%) patients using opioids preoperatively. There was a significantly higher incidence of infection compared to non-users (12.3% versus 10.1%; P=0.01). There was no association between subsequent fusion surgery (7.9% versus 7.5%, P=0.52) and subsequent decompression surgery (4.1% versus 3.6%; P=0.3) between opioid users and non-users. Regarding post-operative infection risk, low-dose users showed significantly higher incidence (12.7% versus 10.1%; P CONCLUSION: Consistent with prior publications, opioid use was significantly associated with a higher incidence of two-year post-operative infection compared to non-use. Low-dose opioid users had higher post-operative infection rates than non-users