Alan Job - Academia.edu (original) (raw)

Papers by Alan Job

Clinical Spine Surgery: A Spine Publication

STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to compare 30-day readmission and ... more STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to compare 30-day readmission and postdischarge morbidity for posterior cervical decompression and fusion (PCDF) in patients who were discharged to home versus rehabilitation. SUMMARY OF BACKGROUND DATA An increasing number of patients are being discharged to postacute inpatient care facilities following spine surgery. However, little research has been performed to evaluate the effect of this trend on short-term outcomes. MATERIALS AND METHODS Patients who underwent PCDF from 2011 to 2018 were identified using the National Surgical Quality Improvements Program (NSQIP)-database. Regression was utilized to compare primary outcomes between home and rehabilitation groups and to control for predictors of outcomes. RESULTS We identified 8912 patients. Unadjusted analysis revealed that rehabilitation-discharge patients had greater readmission (10.4% vs. 8.0%, P=0.002) and postdischarge morbidity (7.1% vs. 4.0%, P<0.001) rates. After controlling for patient-related factors, rehabilitation-discharge independently predicted postdischarge morbidity (P<0.001, odds ratio=2.232). Readmission no longer differed between groups (P=0.071, odds ratio=1.311). Rates of discharge to rehabilitation increased from 23.5% in 2011 to 25.3% in 2018, while postdischarge morbidity rates remained stagnant.Patients discharged to rehabilitation were older (66.9 vs. 59.4 y); more likely to be African American (21.4% vs. 13.8%) and have diabetes (27.1% vs. 17.5%), steroid use (6.4% vs. 4.7%, P=0.002), and American Society of Anaesthesiologists (ASA)-class ≥3 (80.2% vs. 57.7%); less likely to be male (53.9% vs. 57.4%, P=0.004) and smokers (20.3% vs. 26.6%); and had greater operative time (198 vs. 170 min) and length of hospital stay (5.9 vs. 3.3 d) (P<0.001). CONCLUSIONS Despite controlling for significant factors, discharge to rehabilitation independently predicted a 2.2 times increased odds of postdischarge morbidity. Rates of discharge to rehabilitation increased overtime without an appreciable decrease in postdischarge morbidity, suggesting that greater resources are being utilized in the postacute care period without an obvious justification. Therefore, home-discharge should be prioritized after hospitalization for PCDF when feasible. These findings are notable in light of reform efforts aimed at reducing costs while improving quality of care.

Journal of Spine Surgery

Background: Despite its widespread use, definitive data demonstrating the efficacy of liposomal b... more Background: Despite its widespread use, definitive data demonstrating the efficacy of liposomal bupivacaine (LB) is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). Therefore, this investigation examined whether ACDF patients who received intra-operative LB (LB cohort) exhibited decreased post-operative opioid use and lengths of hospital stay (LOS) compared to ACDF patients who did not receive intra-operative LB (controls). Methods: Eighty-two patients who underwent primary ACDF by a single surgeon from 2016 to 2019 were identified from an institutional database. Fifty-nine patients received intra-operative LB while twenty-three did not. Patient characteristics, medical comorbidities, complications, post-operative opioid consumption, and LOS data were collected. Results: The LB cohort did not require fewer opioids on post-operative day (POD) 0, POD1, POD2, or throughout the hospital course after normalizing by LOS (total per LOS). The number of cervical vertebrae involved in surgery, but not LB use, predicted opioid consumption on POD0, POD1, and total per LOS. For every vertebral level involved, 242 additional morphine milligram equivalents (MME) were consumed on POD0, 266 additional MME were utilized on POD1, and 130 additional MME were consumed in total per LOS. Conclusions: ACDF patients who received intra-operative LB did not require fewer post-operative opioids or exhibit a decreased LOS compared to controls. Patients whose procedures involved a greater number of cervical vertebrae were associated with greater opioid consumption on POD0, POD1, and total per LOS. ACDF patients, especially those who had a high number of vertebrae involved, may require alternative analgesia to LB.

The Spine Journal, 2021

BACKGROUND CONTEXT Spinal surgery is often complicated by significant blood loss which can lead t... more BACKGROUND CONTEXT Spinal surgery is often complicated by significant blood loss which can lead to increased patient morbidity and mortality. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has shown promise in decreasing blood loss as well as need for postoperative blood transfusion when given during surgery. PURPOSE Recent studies have begun to report on the benefits of TXA when given perioperatively during spinal surgery2. Few studies, however, have looked at the effects of TXA in patients undergoing anterior cervical discectomy and fusion (ACDF). In this study we aimed to evaluate the effectiveness of TXA in reducing intraoperative blood loss in a cohort of ACDF patients. STUDY DESIGN/SETTING Retrospective, single-surgeon study at academic medical center. PATIENT SAMPLE All patients who underwent primary ACDF during this time either with or without the augment of TXA were included. OUTCOME MEASURES The mean differences in intraoperative blood loss as well as the change from pre to post-surgical hemoglobin and hematocrit, measured at presurgical testing 1 week prior to surgery and on postop day 1 were analyzed in TXA-treated patients compared to non-TXA-treated patients. Additionally, the number of patients requiring postoperative drain and average drain output on postoperative day #1 were measured. Mean length of stay in between groups was also analyzed. This study was subject to IRB approval. METHODS Medical records for all patients who underwent primary ACDF with a single surgeon at a tertiary center over a 3-year period from September 2016-October 2019 were evaluated retrospectively. RESULTS A total of 83 patients underwent primary ACDF during the study period. Three additional patients who underwent revision of ACDF were excluded for the purposes of this study. Of the 83 patients who underwent primary ACDF, 14 received TXA perioperatively while 69 did not receive TXA. Preoperative diagnoses included spinal stenosis, disc herniation, and spondylolisthesis. Distribution of diagnoses was equal among study groups. Patient demographics and comorbidities including age, BMI, cardiovascular disease, respiratory disease, diabetes and smoking status were evaluated and there were no significant differences between groups. Patients who received TXA had significantly lower mean operative blood loss than the non-TXA patients (41.1mL vs 77.4mL p CONCLUSIONS TXA has been reported as a useful perioperative tool to decrease bleeding associated with spinal surgery. We found in our patients who underwent ACDF that intraoperative use of IV TXA led to a significant decrease in intraoperative blood loss, however, there was no difference in the change in pre and postoperative hemoglobin and hematocrit between ACDF patients who received TXA and those who did not. There was also no difference in mean postoperative length-of-stay between the TXA and non-TXA groups. Additionally, while not significant, there was a trend towards TXA patients being less likely to require a drain postoperatively (p=.062) and those requiring a drain having less output in the early postoperative period (p=.056). While use of TXA perioperatively for ACDF was shown in this study to decrease operative blood loss, this change was not reflected in surgical hemoglobin change or overall length of stay. Further analysis of the benefits of TXA on bleeding in ACDF patients is warranted. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

International Journal of Spine Surgery, 2021

Background: Radiculopathy and myelopathy resulting from degenerative disc disease are currently t... more Background: Radiculopathy and myelopathy resulting from degenerative disc disease are currently treated with anterior cervical discectomy and fusion (ACDF), but there is a high incidence of adjacent segment disease after treatment. Methods: With recent advances in cervical disc arthroplasty (CDA), we performed a review of published articles, examining the latest clinical data on the efficacy, safety, and complications of the current cervical disc devices on the market. We focused on the long-term follow up data of single-level, multi-level, and hybrid CDA as compared to ACDF, paying close attention to the newest cervical disc devices. A search was performed utilizing PubMed, Google Scholar, and Clinical Key to identify articles on 1-level, 2-level, and hybrid approaches to CDA. The articles were reviewed by two authors for relevance and power with higher emphasis placed on FDA IDE trials. Results: The results conclude that CDA has an equivalent or improved clinical outcome when compared with ACDF with improved patient reported neck disability indexes and VAS neck pain scale. CDA also has lower rates of dysphagia, adjacent segment disease, and lower rates of reoperation when compared to ACDF. The data suggest there is no increased rate of reoperation in patients treated with multilevel CDA when compared to ACDF. In addition, the data from the limited clinical trials suggest that hybrid CDA and ACDF is safe and decreases risk of ASD. Conclusion: CDA has been shown to be effective and safe with low complication rates. However, the data are of low quality, and more hybrid studies must be performed in the future to confirm these findings. Clinical Relevance: The reduction in overall postsurgical complications including ASD and in the need for additional surgery in the CDA group. Level of Evidence: 3.

The Spine Journal, 2021

BACKGROUND CONTEXT Liposomal bupivacaine (LB) is local anesthetic perioperatively infiltrated int... more BACKGROUND CONTEXT Liposomal bupivacaine (LB) is local anesthetic perioperatively infiltrated into the surgical site to promote postoperative analgesia. Despite its widespread use, definitive data demonstrating its efficacy is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). PURPOSE To examine whether ACDF patients who received preoperative LB (LB group) exhibited decreased postoperative opioid use and length of hospital stay (LOS) compared to ACDF patients who did not receive preoperative LB (controls). STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Eighty-two patients who underwent primary ACDF (n = 82). OUTCOME MEASURES Surgical complications, postoperative opioid use, and LOS. METHODS Eighty-two patients who underwent primary ACDF by a single surgeon from 2016-2019 were retrospectively identified from an institutional database. Patient demographics, medical comorbidities, surgical complications, postoperative opioid use a...

The Spine Journal, 2021

BACKGROUND CONTEXT Patients undergoing lumbar spinal surgery often report significant postoperati... more BACKGROUND CONTEXT Patients undergoing lumbar spinal surgery often report significant postoperative pain, necessitating increased postoperative analgesia and prolonging hospital stay. Liposomal bupivacaine (LB) is a novel local anesthetic encapsulated in a lipid bilayer, resulting in sustained-release analgesia, that is believed to decrease postoperative pain. While the efficacy of perioperative LB infiltration has been demonstrated in various orthopedic procedures, there has been little evidence for its use in patients undergoing lumbar spinal surgery. PURPOSE The aim of this paper was to evaluate the efficacy of liposomal bupivacaine for lowering postoperative opiate usage and length of hospital stay in the management of anterior and posterior lumbar decompression and fusion. STUDY DESIGN/SETTING A retrospective study consisting of 107 patients who underwent lumbar spinal surgery performed by a single surgeon (R.V.) from 2016 to 2019. PATIENT SAMPLE A total of 107 patients included in analysis were those who underwent anterior or posterior decompression and fusion for lumbar spondylolisthesis and stenosis. OUTCOME MEASURES Postoperative opiate use in morphine equivalents (mEq) and hospital length of stay (LOS). METHODS Demographic information, postoperative opiate use and length of hospital stay were obtained through in-depth review of electronic medical records (EMR). Data were analyzed using independent t-tests and multiple linear regression. RESULTS There were 51 (47.6%) patients who received LB, while 56 patients did not receive any perioperative local anesthetic. Patients who received LB did not have significantly lower postoperative opiate usage on postoperative day (POD) 0, POD1, POD2, or total per LOS (p=0.861, 0.602, 0.721, 0.974 respectively). Multivariate analysis showed age significantly predicted postoperative opiate usage on POD 0 (p=0.044) and total per LOS (p=0.035), while LB did not. Patients that received LB had a longer LOS with a mean of 5.45 days compared to 4.7 days for patients that did not receive LB, although significance was not reached (p=0.235). CONCLUSIONS Local anesthetics are often employed by surgeons to improve postoperative pain control. LB did not significantly decrease postoperative opiate use or shorten LOS. At this time LB was not shown to be clinically effective in patients undergoing anterior or posterior discectomy and fusion, though further evaluation is required. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Clinical Spine Surgery: A Spine Publication, 2021

STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to ... more STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to compare 30-day postdischarge morbidity for 3-or-more level (multilevel) posterior lumbar fusion in patients who were discharged to home versus rehabilitation. SUMMARY OF BACKGROUND DATA Spine surgery has been increasingly performed in the elderly population, with many of these patients being discharged to rehabilitation and skilled nursing facilities. However, research evaluating the safety of nonhome discharge following spine surgery is limited. MATERIALS AND METHODS Patients who underwent multilevel posterior lumbar fusion from 2005 to 2018 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Regression was utilized to compare primary outcomes between discharge disposition and to evaluate for predictors thereof. RESULTS We identified 5276 patients. Unadjusted analysis revealed that patients who were discharged to rehabilitation had greater postdischarge morbidity (5.6% vs. 2.6%). After adjusting for baseline differences, discharge to rehabilitation no longer predicted postdischarge morbidity [odds ratio (OR)=1.409, confidence interval: 0.918-2.161, P=0.117]. Multivariate analysis also revealed that age (P=0.026, OR=1.023), disseminated cancer (P=0.037, OR=6.699), and readmission (P<0.001, OR=28.889) independently predicted postdischarge morbidity. CONCLUSIONS Thirty days morbidity was statistically similar between patients who were discharged to home and rehabilitation. With appropriate patient selection, discharge to rehabilitation can potentially minimize 30-day postdischarge morbidity for more medically frail patients undergoing multilevel posterior lumbar fusion. These results are particularly important given an aging population, with a great portion of elderly patients who may benefit from postacute care facility discharge following spine surgery.

Global Spine Journal, 2020

Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performe... more Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings. Methods: Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof. Results: We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no ...

The Spine Journal, 2020

in 14.1% below L4, with a trend toward less occurrence in the S2AI group (OR 0.47, p=0.06). Revis... more in 14.1% below L4, with a trend toward less occurrence in the S2AI group (OR 0.47, p=0.06). Revision surgery was required in 22.7% of our cohort, with no difference between groups (p=0.449). Patients with failure of the pelvic fixation had less improvement in their HRQL at 2years (

The Spine Journal, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Supplemental Material, Supplementary_File for Comparative Analysis of 30-Day Readmission, Reopera... more Supplemental Material, Supplementary_File for Comparative Analysis of 30-Day Readmission, Reoperation, and Morbidity Between Lumbar Disc Arthroplasty Performed in the Inpatient and Outpatient Settings Utilizing the ACS-NSQIP Dataset by Austen David Katz, Dean Cosmo Perfetti, Alan Job, Max Willinger, Jeffrey Goldstein, Daniel Kiridly, Peter Olivares, Alexander Satin and David Essig in Global Spine Journal

Clinical Spine Surgery: A Spine Publication

STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to compare 30-day readmission and ... more STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to compare 30-day readmission and postdischarge morbidity for posterior cervical decompression and fusion (PCDF) in patients who were discharged to home versus rehabilitation. SUMMARY OF BACKGROUND DATA An increasing number of patients are being discharged to postacute inpatient care facilities following spine surgery. However, little research has been performed to evaluate the effect of this trend on short-term outcomes. MATERIALS AND METHODS Patients who underwent PCDF from 2011 to 2018 were identified using the National Surgical Quality Improvements Program (NSQIP)-database. Regression was utilized to compare primary outcomes between home and rehabilitation groups and to control for predictors of outcomes. RESULTS We identified 8912 patients. Unadjusted analysis revealed that rehabilitation-discharge patients had greater readmission (10.4% vs. 8.0%, P=0.002) and postdischarge morbidity (7.1% vs. 4.0%, P<0.001) rates. After controlling for patient-related factors, rehabilitation-discharge independently predicted postdischarge morbidity (P<0.001, odds ratio=2.232). Readmission no longer differed between groups (P=0.071, odds ratio=1.311). Rates of discharge to rehabilitation increased from 23.5% in 2011 to 25.3% in 2018, while postdischarge morbidity rates remained stagnant.Patients discharged to rehabilitation were older (66.9 vs. 59.4 y); more likely to be African American (21.4% vs. 13.8%) and have diabetes (27.1% vs. 17.5%), steroid use (6.4% vs. 4.7%, P=0.002), and American Society of Anaesthesiologists (ASA)-class ≥3 (80.2% vs. 57.7%); less likely to be male (53.9% vs. 57.4%, P=0.004) and smokers (20.3% vs. 26.6%); and had greater operative time (198 vs. 170 min) and length of hospital stay (5.9 vs. 3.3 d) (P<0.001). CONCLUSIONS Despite controlling for significant factors, discharge to rehabilitation independently predicted a 2.2 times increased odds of postdischarge morbidity. Rates of discharge to rehabilitation increased overtime without an appreciable decrease in postdischarge morbidity, suggesting that greater resources are being utilized in the postacute care period without an obvious justification. Therefore, home-discharge should be prioritized after hospitalization for PCDF when feasible. These findings are notable in light of reform efforts aimed at reducing costs while improving quality of care.

Journal of Spine Surgery

Background: Despite its widespread use, definitive data demonstrating the efficacy of liposomal b... more Background: Despite its widespread use, definitive data demonstrating the efficacy of liposomal bupivacaine (LB) is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). Therefore, this investigation examined whether ACDF patients who received intra-operative LB (LB cohort) exhibited decreased post-operative opioid use and lengths of hospital stay (LOS) compared to ACDF patients who did not receive intra-operative LB (controls). Methods: Eighty-two patients who underwent primary ACDF by a single surgeon from 2016 to 2019 were identified from an institutional database. Fifty-nine patients received intra-operative LB while twenty-three did not. Patient characteristics, medical comorbidities, complications, post-operative opioid consumption, and LOS data were collected. Results: The LB cohort did not require fewer opioids on post-operative day (POD) 0, POD1, POD2, or throughout the hospital course after normalizing by LOS (total per LOS). The number of cervical vertebrae involved in surgery, but not LB use, predicted opioid consumption on POD0, POD1, and total per LOS. For every vertebral level involved, 242 additional morphine milligram equivalents (MME) were consumed on POD0, 266 additional MME were utilized on POD1, and 130 additional MME were consumed in total per LOS. Conclusions: ACDF patients who received intra-operative LB did not require fewer post-operative opioids or exhibit a decreased LOS compared to controls. Patients whose procedures involved a greater number of cervical vertebrae were associated with greater opioid consumption on POD0, POD1, and total per LOS. ACDF patients, especially those who had a high number of vertebrae involved, may require alternative analgesia to LB.

The Spine Journal, 2021

BACKGROUND CONTEXT Spinal surgery is often complicated by significant blood loss which can lead t... more BACKGROUND CONTEXT Spinal surgery is often complicated by significant blood loss which can lead to increased patient morbidity and mortality. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has shown promise in decreasing blood loss as well as need for postoperative blood transfusion when given during surgery. PURPOSE Recent studies have begun to report on the benefits of TXA when given perioperatively during spinal surgery2. Few studies, however, have looked at the effects of TXA in patients undergoing anterior cervical discectomy and fusion (ACDF). In this study we aimed to evaluate the effectiveness of TXA in reducing intraoperative blood loss in a cohort of ACDF patients. STUDY DESIGN/SETTING Retrospective, single-surgeon study at academic medical center. PATIENT SAMPLE All patients who underwent primary ACDF during this time either with or without the augment of TXA were included. OUTCOME MEASURES The mean differences in intraoperative blood loss as well as the change from pre to post-surgical hemoglobin and hematocrit, measured at presurgical testing 1 week prior to surgery and on postop day 1 were analyzed in TXA-treated patients compared to non-TXA-treated patients. Additionally, the number of patients requiring postoperative drain and average drain output on postoperative day #1 were measured. Mean length of stay in between groups was also analyzed. This study was subject to IRB approval. METHODS Medical records for all patients who underwent primary ACDF with a single surgeon at a tertiary center over a 3-year period from September 2016-October 2019 were evaluated retrospectively. RESULTS A total of 83 patients underwent primary ACDF during the study period. Three additional patients who underwent revision of ACDF were excluded for the purposes of this study. Of the 83 patients who underwent primary ACDF, 14 received TXA perioperatively while 69 did not receive TXA. Preoperative diagnoses included spinal stenosis, disc herniation, and spondylolisthesis. Distribution of diagnoses was equal among study groups. Patient demographics and comorbidities including age, BMI, cardiovascular disease, respiratory disease, diabetes and smoking status were evaluated and there were no significant differences between groups. Patients who received TXA had significantly lower mean operative blood loss than the non-TXA patients (41.1mL vs 77.4mL p CONCLUSIONS TXA has been reported as a useful perioperative tool to decrease bleeding associated with spinal surgery. We found in our patients who underwent ACDF that intraoperative use of IV TXA led to a significant decrease in intraoperative blood loss, however, there was no difference in the change in pre and postoperative hemoglobin and hematocrit between ACDF patients who received TXA and those who did not. There was also no difference in mean postoperative length-of-stay between the TXA and non-TXA groups. Additionally, while not significant, there was a trend towards TXA patients being less likely to require a drain postoperatively (p=.062) and those requiring a drain having less output in the early postoperative period (p=.056). While use of TXA perioperatively for ACDF was shown in this study to decrease operative blood loss, this change was not reflected in surgical hemoglobin change or overall length of stay. Further analysis of the benefits of TXA on bleeding in ACDF patients is warranted. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

International Journal of Spine Surgery, 2021

Background: Radiculopathy and myelopathy resulting from degenerative disc disease are currently t... more Background: Radiculopathy and myelopathy resulting from degenerative disc disease are currently treated with anterior cervical discectomy and fusion (ACDF), but there is a high incidence of adjacent segment disease after treatment. Methods: With recent advances in cervical disc arthroplasty (CDA), we performed a review of published articles, examining the latest clinical data on the efficacy, safety, and complications of the current cervical disc devices on the market. We focused on the long-term follow up data of single-level, multi-level, and hybrid CDA as compared to ACDF, paying close attention to the newest cervical disc devices. A search was performed utilizing PubMed, Google Scholar, and Clinical Key to identify articles on 1-level, 2-level, and hybrid approaches to CDA. The articles were reviewed by two authors for relevance and power with higher emphasis placed on FDA IDE trials. Results: The results conclude that CDA has an equivalent or improved clinical outcome when compared with ACDF with improved patient reported neck disability indexes and VAS neck pain scale. CDA also has lower rates of dysphagia, adjacent segment disease, and lower rates of reoperation when compared to ACDF. The data suggest there is no increased rate of reoperation in patients treated with multilevel CDA when compared to ACDF. In addition, the data from the limited clinical trials suggest that hybrid CDA and ACDF is safe and decreases risk of ASD. Conclusion: CDA has been shown to be effective and safe with low complication rates. However, the data are of low quality, and more hybrid studies must be performed in the future to confirm these findings. Clinical Relevance: The reduction in overall postsurgical complications including ASD and in the need for additional surgery in the CDA group. Level of Evidence: 3.

The Spine Journal, 2021

BACKGROUND CONTEXT Liposomal bupivacaine (LB) is local anesthetic perioperatively infiltrated int... more BACKGROUND CONTEXT Liposomal bupivacaine (LB) is local anesthetic perioperatively infiltrated into the surgical site to promote postoperative analgesia. Despite its widespread use, definitive data demonstrating its efficacy is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). PURPOSE To examine whether ACDF patients who received preoperative LB (LB group) exhibited decreased postoperative opioid use and length of hospital stay (LOS) compared to ACDF patients who did not receive preoperative LB (controls). STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Eighty-two patients who underwent primary ACDF (n = 82). OUTCOME MEASURES Surgical complications, postoperative opioid use, and LOS. METHODS Eighty-two patients who underwent primary ACDF by a single surgeon from 2016-2019 were retrospectively identified from an institutional database. Patient demographics, medical comorbidities, surgical complications, postoperative opioid use a...

The Spine Journal, 2021

BACKGROUND CONTEXT Patients undergoing lumbar spinal surgery often report significant postoperati... more BACKGROUND CONTEXT Patients undergoing lumbar spinal surgery often report significant postoperative pain, necessitating increased postoperative analgesia and prolonging hospital stay. Liposomal bupivacaine (LB) is a novel local anesthetic encapsulated in a lipid bilayer, resulting in sustained-release analgesia, that is believed to decrease postoperative pain. While the efficacy of perioperative LB infiltration has been demonstrated in various orthopedic procedures, there has been little evidence for its use in patients undergoing lumbar spinal surgery. PURPOSE The aim of this paper was to evaluate the efficacy of liposomal bupivacaine for lowering postoperative opiate usage and length of hospital stay in the management of anterior and posterior lumbar decompression and fusion. STUDY DESIGN/SETTING A retrospective study consisting of 107 patients who underwent lumbar spinal surgery performed by a single surgeon (R.V.) from 2016 to 2019. PATIENT SAMPLE A total of 107 patients included in analysis were those who underwent anterior or posterior decompression and fusion for lumbar spondylolisthesis and stenosis. OUTCOME MEASURES Postoperative opiate use in morphine equivalents (mEq) and hospital length of stay (LOS). METHODS Demographic information, postoperative opiate use and length of hospital stay were obtained through in-depth review of electronic medical records (EMR). Data were analyzed using independent t-tests and multiple linear regression. RESULTS There were 51 (47.6%) patients who received LB, while 56 patients did not receive any perioperative local anesthetic. Patients who received LB did not have significantly lower postoperative opiate usage on postoperative day (POD) 0, POD1, POD2, or total per LOS (p=0.861, 0.602, 0.721, 0.974 respectively). Multivariate analysis showed age significantly predicted postoperative opiate usage on POD 0 (p=0.044) and total per LOS (p=0.035), while LB did not. Patients that received LB had a longer LOS with a mean of 5.45 days compared to 4.7 days for patients that did not receive LB, although significance was not reached (p=0.235). CONCLUSIONS Local anesthetics are often employed by surgeons to improve postoperative pain control. LB did not significantly decrease postoperative opiate use or shorten LOS. At this time LB was not shown to be clinically effective in patients undergoing anterior or posterior discectomy and fusion, though further evaluation is required. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Clinical Spine Surgery: A Spine Publication, 2021

STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to ... more STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to compare 30-day postdischarge morbidity for 3-or-more level (multilevel) posterior lumbar fusion in patients who were discharged to home versus rehabilitation. SUMMARY OF BACKGROUND DATA Spine surgery has been increasingly performed in the elderly population, with many of these patients being discharged to rehabilitation and skilled nursing facilities. However, research evaluating the safety of nonhome discharge following spine surgery is limited. MATERIALS AND METHODS Patients who underwent multilevel posterior lumbar fusion from 2005 to 2018 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Regression was utilized to compare primary outcomes between discharge disposition and to evaluate for predictors thereof. RESULTS We identified 5276 patients. Unadjusted analysis revealed that patients who were discharged to rehabilitation had greater postdischarge morbidity (5.6% vs. 2.6%). After adjusting for baseline differences, discharge to rehabilitation no longer predicted postdischarge morbidity [odds ratio (OR)=1.409, confidence interval: 0.918-2.161, P=0.117]. Multivariate analysis also revealed that age (P=0.026, OR=1.023), disseminated cancer (P=0.037, OR=6.699), and readmission (P<0.001, OR=28.889) independently predicted postdischarge morbidity. CONCLUSIONS Thirty days morbidity was statistically similar between patients who were discharged to home and rehabilitation. With appropriate patient selection, discharge to rehabilitation can potentially minimize 30-day postdischarge morbidity for more medically frail patients undergoing multilevel posterior lumbar fusion. These results are particularly important given an aging population, with a great portion of elderly patients who may benefit from postacute care facility discharge following spine surgery.

Global Spine Journal, 2020

Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performe... more Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings. Methods: Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof. Results: We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no ...

The Spine Journal, 2020

in 14.1% below L4, with a trend toward less occurrence in the S2AI group (OR 0.47, p=0.06). Revis... more in 14.1% below L4, with a trend toward less occurrence in the S2AI group (OR 0.47, p=0.06). Revision surgery was required in 22.7% of our cohort, with no difference between groups (p=0.449). Patients with failure of the pelvic fixation had less improvement in their HRQL at 2years (

The Spine Journal, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Supplemental Material, Supplementary_File for Comparative Analysis of 30-Day Readmission, Reopera... more Supplemental Material, Supplementary_File for Comparative Analysis of 30-Day Readmission, Reoperation, and Morbidity Between Lumbar Disc Arthroplasty Performed in the Inpatient and Outpatient Settings Utilizing the ACS-NSQIP Dataset by Austen David Katz, Dean Cosmo Perfetti, Alan Job, Max Willinger, Jeffrey Goldstein, Daniel Kiridly, Peter Olivares, Alexander Satin and David Essig in Global Spine Journal