Bone morphogenetic protein (BMP) can increase the likelihood of solid arthrodesis in spinal surge... more Bone morphogenetic protein (BMP) can increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events. We sought to examine adolescent idiopathic (AIS) and non-idiopathic scoliosis (NIS) for reoperation events with and without the use of BMP using a large statewide database. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 10 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment. A total of 2,658 and 2,431 cases were identified of AIS and NIS, respectively. The use of BMP at the initial visit was performed at a rate of 4.5% for AIS and 21.0% for NIS fusion surgery. For posterior fusion cases longer than eight levels, the reoperation rate for pseudarthrosis was 1.0% in AIS and 18.4% in NIS (p < .001). For NIS fusions greater than eight levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 22% when BMP was not used, a relative risk of 4.0 (p < .001). For AIS, there was no substantial increase in risk when not using BMP for fusion greater than eight levels (p < .001). We found a significant decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP in the case of NIS. In contrast, use of BMP does not benefit the AIS population.
Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Databas... more Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Database. The objective was to determine whether there were differences in reoperation rates among pediatric scoliosis associated with various etiologies compared with idiopathic scoliosis. The incidence of postoperative complications and reoperations is known to vary among patients with diverse scoliosis pathologies. As these are heterogeneous conditions and often with rare occurrence, it is difficult to compare them in a single study. We aimed to assess reoperation events after fusion for several etiologies of pediatric scoliosis. The 2008 to 2011 New York State Inpatient Database was queried using International Classification of Diseases (ICD-9-CM) codes for patients with in-hospital stays including a spine arthrodesis for scoliosis. All approaches, all fusion lengths, and ages 10 to 21 were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk...
Retrospective analysis of relevant in-hospital patient records from the New York State Inpatient ... more Retrospective analysis of relevant in-hospital patient records from the New York State Inpatient Database. We aimed to assess reoperation risk in adolescent idiopathic scoliosis (AIS) by surgeon and hospital operative volume. The need for early reoperation can be devastating for patient and family, is a burden to the physician and adds significant cost. Previous studies have shown improved outcomes associated with higher volume surgeons and hospitals, but reoperation events have not yet been explored. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for adolescent idiopathic scoliosis patients aged 10-21 undergoing spine arthrodesis. Patient identifiers and revisit linkage variables were used to identify reoperation events. Annual surgeon and hospital volumes were stratified into tertiles (low, medium, high) via identifier codes. The relative risk of reoperation after spine arthrodesis was computed based on relevant patient inpatient stays. Over 2008 to 2011, a total of 3,928 primary fusion operations for AIS were identified. The overall rate of reoperation after spine fusion for idiopathic scoliosis was 7.1%. Low volume surgeons performed less than 6 AIS fusions per year, medium volume surgeons performed less than 43, and high volume surgeons performed from 43 to 228. Reoperation after a primary fusion for adolescent idiopathic scoliosis showed reduced frequency among higher volume surgeons (14.1% for low vs. 5.1% for high, p<0.001, see Table for Hospitals). Early reoperation after spine fusion for idiopathic scoliosis is seen more frequently in lower volume institutions and surgeons. Appreciating the resources and limitations at a clinician's institution is important to developing practices to prevent these devastating events. This work also has implications for strategies that aim to direct limited healthcare resources to centers with low complication rates.
Background: Postoperative wound complications after posterior spinal fusion are difficult to mana... more Background: Postoperative wound complications after posterior spinal fusion are difficult to manage. The incidence in the nonidiopathic patient population is significantly higher than the adolescent idiopathic population. A comparison of wound complications after posterior spinal fusion for nonidiopathic scoliosis between the utilization of the orthopaedic surgical team at the time of closure performing a nonstandardized wound closure versus a plastic surgeon with a plastic multilayered closure technique and rotational flap coverage when needed had not previously been evaluated. The purpose of this study was to compare the complication rate between nonstandardized and plastic multilayered closure of the surgical incision in patients undergoing posterior spinal fusion for nonidiopathic scoliosis. Methods: The charts of 76 patients with a primary diagnosis of scoliosis associated with a syndrome or neuromuscular disease and who underwent a posterior spinal fusion were reviewed. Forty-...
The Journal of bone and joint surgery. American volume, Jan 21, 2014
Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to dete... more Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis. This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain output, and total blood losses. The primary outcomes were intraoperative blood loss and postoperative drainage. Secondary outcomes were transfusion requirements and hematocrit changes both intraoperatively an...
The purpose of this study was to investigate the potential of a high‐throughput, easily implement... more The purpose of this study was to investigate the potential of a high‐throughput, easily implemented, cost‐effective, video analysis software–based mobility protocol to quantify spine kinematics. This prospective cohort study of clinical biomechanics implemented 2‐dimensional (2D) image processing at a tertiary‐care academic institution. Ten healthy, able‐bodied volunteers were recruited for 2D videography of gait and functional motion. The reliability of a 2D video analysis software program for gait and range of motion metrics was evaluated over 2 independent experimental sessions, assessing for inter‐trial, inter‐session, and inter‐rater reliability. Healthy volunteers were evaluated for simple forward and side bending, rotation, treadmill stride length, and more complex seated‐to‐standing tasks. Based on established intraclass correlation coefficients, results indicated that reliability was considered good to excellent for simple forward and side bending, rotation, stride length, ...
Spine surgery is usually associated with large blood loss necessitating blood transfusions. Blood... more Spine surgery is usually associated with large blood loss necessitating blood transfusions. Blood loss-associated morbidity can be due to direct risks, such as hypotension and organ damage, or as result of blood transfusions. The antifibrinolytic, tranexamic acid (TXA) is a lysine analogues which inhibits activation of plasminogen and has shown to be beneficial in reducing surgical blood loss. The purpose of the meta-analysis is to consolidate the findings of randomized controlled trials (RCTs) investigating the use of TXA on surgical bleeding in spine surgery. Meta-analysis STUDY SAMPLE: RCTs investigating effectiveness of intravenous TXA in reducing blood loss in spine surgery, compared to a placebo/ no treatment group. MEDLINE, Embase, Cochrane controlled trials register and Google Scholar were used to identify RCTs published before January 2014 that examined the effectiveness of intravenous TXA on reduction of blood loss and blood transfusions, compared to a placebo/ no treatment group in spine surgery. Meta analysis was performed using RevMan 5. Weighted mean difference was used to summarize findings across the trials for continuous outcomes. Dichotomous data were expressed as risk ratio with 95% confidence intervals (CI). A p < 0.05 was considered statistically significant. Eleven RCTs were included for TXA (644 total patients). TXA reduced intraoperative, postoperative and total blood loss by an average of 219 ml ([-322,-116], p<0.05), 119 ml ([-141,-98], p<0.05) and 202 ml ([-299, -105], p<0.05) respectively. TXA led to a reduction in proportion of patients who received a blood transfusion (RR 0.67 ([0.54, 0.83], p…
To achieve optimal results after fusion for adolescent idiopathic scoliosis (AIS), radiographic p... more To achieve optimal results after fusion for adolescent idiopathic scoliosis (AIS), radiographic parameters must be aligned with motion and performance. The effects of fusion on balance are poorly understood. Center of mass (COM) excursion and instantaneous interaction with center of pressure (COP) provides information about patients' balancing ability during gait. This study investigates the interaction between COM and COP (COM-COP) in AIS patients before and one year after spine fusion and determines what radiographic goals predict restoration of harmonious COM-COP. This was a prospective study that investigated sixteen adolescents with AIS curvature >30˚ requiring surgical correction. Clinical outcomes measures, X-rays, and 3D motion-capture gait analysis were collected. Sagittal and coronal COM and COP offsets and inclination angles were calculated from positional data. COM excursion was calculated as peak COM displacement based on mediolateral and vertical deviation from ...
Bone morphogenetic protein (BMP) can increase the likelihood of solid arthrodesis in spinal surge... more Bone morphogenetic protein (BMP) can increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events. We sought to examine adolescent idiopathic (AIS) and non-idiopathic scoliosis (NIS) for reoperation events with and without the use of BMP using a large statewide database. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 10 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment. A total of 2,658 and 2,431 cases were identified of AIS and NIS, respectively. The use of BMP at the initial visit was performed at a rate of 4.5% for AIS and 21.0% for NIS fusion surgery. For posterior fusion cases longer than eight levels, the reoperation rate for pseudarthrosis was 1.0% in AIS and 18.4% in NIS (p < .001). For NIS fusions greater than eight levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 22% when BMP was not used, a relative risk of 4.0 (p < .001). For AIS, there was no substantial increase in risk when not using BMP for fusion greater than eight levels (p < .001). We found a significant decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP in the case of NIS. In contrast, use of BMP does not benefit the AIS population.
Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Databas... more Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Database. The objective was to determine whether there were differences in reoperation rates among pediatric scoliosis associated with various etiologies compared with idiopathic scoliosis. The incidence of postoperative complications and reoperations is known to vary among patients with diverse scoliosis pathologies. As these are heterogeneous conditions and often with rare occurrence, it is difficult to compare them in a single study. We aimed to assess reoperation events after fusion for several etiologies of pediatric scoliosis. The 2008 to 2011 New York State Inpatient Database was queried using International Classification of Diseases (ICD-9-CM) codes for patients with in-hospital stays including a spine arthrodesis for scoliosis. All approaches, all fusion lengths, and ages 10 to 21 were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk...
Retrospective analysis of relevant in-hospital patient records from the New York State Inpatient ... more Retrospective analysis of relevant in-hospital patient records from the New York State Inpatient Database. We aimed to assess reoperation risk in adolescent idiopathic scoliosis (AIS) by surgeon and hospital operative volume. The need for early reoperation can be devastating for patient and family, is a burden to the physician and adds significant cost. Previous studies have shown improved outcomes associated with higher volume surgeons and hospitals, but reoperation events have not yet been explored. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for adolescent idiopathic scoliosis patients aged 10-21 undergoing spine arthrodesis. Patient identifiers and revisit linkage variables were used to identify reoperation events. Annual surgeon and hospital volumes were stratified into tertiles (low, medium, high) via identifier codes. The relative risk of reoperation after spine arthrodesis was computed based on relevant patient inpatient stays. Over 2008 to 2011, a total of 3,928 primary fusion operations for AIS were identified. The overall rate of reoperation after spine fusion for idiopathic scoliosis was 7.1%. Low volume surgeons performed less than 6 AIS fusions per year, medium volume surgeons performed less than 43, and high volume surgeons performed from 43 to 228. Reoperation after a primary fusion for adolescent idiopathic scoliosis showed reduced frequency among higher volume surgeons (14.1% for low vs. 5.1% for high, p<0.001, see Table for Hospitals). Early reoperation after spine fusion for idiopathic scoliosis is seen more frequently in lower volume institutions and surgeons. Appreciating the resources and limitations at a clinician's institution is important to developing practices to prevent these devastating events. This work also has implications for strategies that aim to direct limited healthcare resources to centers with low complication rates.
Background: Postoperative wound complications after posterior spinal fusion are difficult to mana... more Background: Postoperative wound complications after posterior spinal fusion are difficult to manage. The incidence in the nonidiopathic patient population is significantly higher than the adolescent idiopathic population. A comparison of wound complications after posterior spinal fusion for nonidiopathic scoliosis between the utilization of the orthopaedic surgical team at the time of closure performing a nonstandardized wound closure versus a plastic surgeon with a plastic multilayered closure technique and rotational flap coverage when needed had not previously been evaluated. The purpose of this study was to compare the complication rate between nonstandardized and plastic multilayered closure of the surgical incision in patients undergoing posterior spinal fusion for nonidiopathic scoliosis. Methods: The charts of 76 patients with a primary diagnosis of scoliosis associated with a syndrome or neuromuscular disease and who underwent a posterior spinal fusion were reviewed. Forty-...
The Journal of bone and joint surgery. American volume, Jan 21, 2014
Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to dete... more Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis. This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain output, and total blood losses. The primary outcomes were intraoperative blood loss and postoperative drainage. Secondary outcomes were transfusion requirements and hematocrit changes both intraoperatively an...
The purpose of this study was to investigate the potential of a high‐throughput, easily implement... more The purpose of this study was to investigate the potential of a high‐throughput, easily implemented, cost‐effective, video analysis software–based mobility protocol to quantify spine kinematics. This prospective cohort study of clinical biomechanics implemented 2‐dimensional (2D) image processing at a tertiary‐care academic institution. Ten healthy, able‐bodied volunteers were recruited for 2D videography of gait and functional motion. The reliability of a 2D video analysis software program for gait and range of motion metrics was evaluated over 2 independent experimental sessions, assessing for inter‐trial, inter‐session, and inter‐rater reliability. Healthy volunteers were evaluated for simple forward and side bending, rotation, treadmill stride length, and more complex seated‐to‐standing tasks. Based on established intraclass correlation coefficients, results indicated that reliability was considered good to excellent for simple forward and side bending, rotation, stride length, ...
Spine surgery is usually associated with large blood loss necessitating blood transfusions. Blood... more Spine surgery is usually associated with large blood loss necessitating blood transfusions. Blood loss-associated morbidity can be due to direct risks, such as hypotension and organ damage, or as result of blood transfusions. The antifibrinolytic, tranexamic acid (TXA) is a lysine analogues which inhibits activation of plasminogen and has shown to be beneficial in reducing surgical blood loss. The purpose of the meta-analysis is to consolidate the findings of randomized controlled trials (RCTs) investigating the use of TXA on surgical bleeding in spine surgery. Meta-analysis STUDY SAMPLE: RCTs investigating effectiveness of intravenous TXA in reducing blood loss in spine surgery, compared to a placebo/ no treatment group. MEDLINE, Embase, Cochrane controlled trials register and Google Scholar were used to identify RCTs published before January 2014 that examined the effectiveness of intravenous TXA on reduction of blood loss and blood transfusions, compared to a placebo/ no treatment group in spine surgery. Meta analysis was performed using RevMan 5. Weighted mean difference was used to summarize findings across the trials for continuous outcomes. Dichotomous data were expressed as risk ratio with 95% confidence intervals (CI). A p < 0.05 was considered statistically significant. Eleven RCTs were included for TXA (644 total patients). TXA reduced intraoperative, postoperative and total blood loss by an average of 219 ml ([-322,-116], p<0.05), 119 ml ([-141,-98], p<0.05) and 202 ml ([-299, -105], p<0.05) respectively. TXA led to a reduction in proportion of patients who received a blood transfusion (RR 0.67 ([0.54, 0.83], p…
To achieve optimal results after fusion for adolescent idiopathic scoliosis (AIS), radiographic p... more To achieve optimal results after fusion for adolescent idiopathic scoliosis (AIS), radiographic parameters must be aligned with motion and performance. The effects of fusion on balance are poorly understood. Center of mass (COM) excursion and instantaneous interaction with center of pressure (COP) provides information about patients' balancing ability during gait. This study investigates the interaction between COM and COP (COM-COP) in AIS patients before and one year after spine fusion and determines what radiographic goals predict restoration of harmonious COM-COP. This was a prospective study that investigated sixteen adolescents with AIS curvature >30˚ requiring surgical correction. Clinical outcomes measures, X-rays, and 3D motion-capture gait analysis were collected. Sagittal and coronal COM and COP offsets and inclination angles were calculated from positional data. COM excursion was calculated as peak COM displacement based on mediolateral and vertical deviation from ...
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Papers by Thomas Errico