Etka Kurucan - Academia.edu (original) (raw)
Papers by Etka Kurucan
Journal of spine surgery, Sep 1, 2018
Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skele... more Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skeleton. Structural changes render the spine susceptible to fractures, which can be treated operatively or nonoperatively. The preferred surgical approach is not well established. The objective of this study is to evaluate trends in the surgical treatment of AS patients with cervical and thoracolumbar spine fractures. Methods: Using the nationwide inpatient sample (NIS) database, we identified 961 (4,683 weighted) AS patients from 2003 to 2014 who had fusion surgery for vertebral fractures. Our primary outcome was the national trend in use of posterior (PSF), anterior posterior (APSF), and anterior fusion (ASF) surgeries. In addition, we examined patient demographics, complications, institutional characteristics, and hospitalization lengths and costs. Results: The number of fusions performed in AS patients with fractures increased significantly (P<0.01). The proportion of cervical fractures receiving fusions stayed consistent, whereas that of thoracolumbar fractures increased significantly (P<0.01). Patients undergoing APSF had higher hospitalization lengths in cervical and thoracolumbar fractures (P<0.01). There was significant association between pulmonary complications and cervical fusions (P<0.01). Conclusions: Surgical treatment has been growing in popularity for thoracolumbar fractures but staying consistent for cervical fractures in AS patients. Surgical approach has shifted for cervical fractures with APSF transitioning from most to least popular approach from 2003 to 2014. For thoracolumbar fractures, PSF has remained the preferred approach. APSF had significantly higher pulmonary complication rates with cervical fractures. This finding can help surgeons in treating fractures in AS patients with underlying pulmonary disease.
The Journal of Hand Surgery, Nov 1, 2020
Purpose Treatment for upper extremity amputations includes revision amputation or attempted repla... more Purpose Treatment for upper extremity amputations includes revision amputation or attempted replantation. The rate of digital replantation has been declining in the United States. Prior studies discovered the presence of socioeconomic disparities associated with these injuries. The goals of this study were to investigate yearly trends of traumatic upper extremity amputations and evaluate the presence of disparities with access to care in these injuries. Methods The 2008 to 2014 New York Statewide Planning and Research Cooperative System (SPARCS) inpatient and outpatient databases were utilized to identify patients who had traumatic upper extremity amputations. We queried the database for patient characteristics, resource utilization characteristics, insurance status, major in-hospital complications, and mortality. Patients at low-, medium-, and high-volume institutions were compared. We performed multivariable logistic regressions for the binary variable replantation (yes/no) controlling for age, sex, race, insurance status, amputation level, admission hour, and comorbidities. Results A total of 2,492 patients met our inclusion criteria: 92.1% sustained digital amputations and 7.9% sustained arm amputations. The annual rate of inpatient finger amputations decreased significantly (1.9 per 100,000 people in 2008 vs 1.4 per 100,000 people in 2014) during the study period while that of outpatient finger amputations increased significantly (12.0 per 100,000 people in 2008 vs 15.5 per 100,000 people in 2014). Multivariable analysis demonstrated incrementally lower odds for replantation with increasing age and increased odds for replantation in patients with private insurance (odds ratio, 1.64; 95% confidence interval, 1.08e2.50). The number of replantation surgeries at medium-volume institutions decreased by 45% while remaining steady in low-and high-volume institutions. Conclusions Our findings corroborate the findings of other studies that underscore the existence of disparities with respect to insurance status in these injuries. Replantations occur more frequently at high-volume hospitals and are more common in younger patients with private insurance. This finding suggests that patients with traumatic amputations may benefit from treatment at high-volume institutions. Further research to help improve access to such institutions is warranted.
The Spine Journal, Oct 1, 2018
Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the... more Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with noncervical spine involvement. Purpose: To compare patient characteristics, comorbidities and complications in patients with and without RA undergoing primary non-cervical spine fusions.
Spine deformity, Nov 1, 2018
Study Design: Analysis of a national database. Objective: To analyze trends in spinal fusion surg... more Study Design: Analysis of a national database. Objective: To analyze trends in spinal fusion surgery for neurofibromatosis type I (NF-1) patients and to compare the surgical approaches. Summary of Background Data: The preferred surgical approach for fusion treatment of spinal deformity in NF is not well established. Methods: We identified 548 patients with a diagnosis of NF-1 who had received spinal fusion surgery between 2003 and 2014. We compared posterior spinal fusion (PSF), anterior-posterior spinal fusion (APSF), and anterior spinal fusion with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05. Results: The number of spinal fusions for NF-1 significantly increased (p 5 .02) over the study period. The rate of PSF surgeries increased 2.9-fold, whereas the rate of APSF surgeries decreased 2.2-fold. There was also a significant association between the location of the fusion and surgical approach (p!.01), with 66% of ASF cases being cervical spine cases. Compared with patients undergoing PSF and ASF, patients undergoing APSF were significantly younger (p!.01) and had significantly higher hospitalization lengths and costs (p!.01).
Surgical Neurology International
Background: We compared the characteristics, comorbidities, and complications in spinal deformity... more Background: We compared the characteristics, comorbidities, and complications in spinal deformity patients with and without multiple sclerosis (MS) undergoing primary lumbar spine fusion. Methods: We used the Nationwide Inpatient Sample (NIS) from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes to create experimental MS (842 patients) and non-MS control (165,726 patients) cohorts undergoing primary lumbar spine fusion. Characteristics, comorbidities, and complications in spinal deformity patients with and without MS were evaluated using univariate and bivariate analysis. Results: MS spinal deformity patients undergoing primary lumbar spine fusion were younger, more likely to be female and more likely to undergo surgery at urban teaching hospitals. They also exhibited higher rates of depression and lower rates of diabetes without chronic complications, hypertension, and renal failure. However, no significant ...
The Journal of Hand Surgery, 2020
Purpose Treatment for upper extremity amputations includes revision amputation or attempted repla... more Purpose Treatment for upper extremity amputations includes revision amputation or attempted replantation. The rate of digital replantation has been declining in the United States. Prior studies discovered the presence of socioeconomic disparities associated with these injuries. The goals of this study were to investigate yearly trends of traumatic upper extremity amputations and evaluate the presence of disparities with access to care in these injuries. Methods The 2008 to 2014 New York Statewide Planning and Research Cooperative System (SPARCS) inpatient and outpatient databases were utilized to identify patients who had traumatic upper extremity amputations. We queried the database for patient characteristics, resource utilization characteristics, insurance status, major in-hospital complications, and mortality. Patients at low-, medium-, and high-volume institutions were compared. We performed multivariable logistic regressions for the binary variable replantation (yes/no) controlling for age, sex, race, insurance status, amputation level, admission hour, and comorbidities. Results A total of 2,492 patients met our inclusion criteria: 92.1% sustained digital amputations and 7.9% sustained arm amputations. The annual rate of inpatient finger amputations decreased significantly (1.9 per 100,000 people in 2008 vs 1.4 per 100,000 people in 2014) during the study period while that of outpatient finger amputations increased significantly (12.0 per 100,000 people in 2008 vs 15.5 per 100,000 people in 2014). Multivariable analysis demonstrated incrementally lower odds for replantation with increasing age and increased odds for replantation in patients with private insurance (odds ratio, 1.64; 95% confidence interval, 1.08e2.50). The number of replantation surgeries at medium-volume institutions decreased by 45% while remaining steady in low-and high-volume institutions. Conclusions Our findings corroborate the findings of other studies that underscore the existence of disparities with respect to insurance status in these injuries. Replantations occur more frequently at high-volume hospitals and are more common in younger patients with private insurance. This finding suggests that patients with traumatic amputations may benefit from treatment at high-volume institutions. Further research to help improve access to such institutions is warranted.
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.
Journal of Spine Surgery, 2018
Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skele... more Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skeleton. Structural changes render the spine susceptible to fractures, which can be treated operatively or nonoperatively. The preferred surgical approach is not well established. The objective of this study is to evaluate trends in the surgical treatment of AS patients with cervical and thoracolumbar spine fractures. Methods: Using the nationwide inpatient sample (NIS) database, we identified 961 (4,683 weighted) AS patients from 2003 to 2014 who had fusion surgery for vertebral fractures. Our primary outcome was the national trend in use of posterior (PSF), anterior posterior (APSF), and anterior fusion (ASF) surgeries. In addition, we examined patient demographics, complications, institutional characteristics, and hospitalization lengths and costs. Results: The number of fusions performed in AS patients with fractures increased significantly (P<0.01). The proportion of cervical fractures receiving fusions stayed consistent, whereas that of thoracolumbar fractures increased significantly (P<0.01). Patients undergoing APSF had higher hospitalization lengths in cervical and thoracolumbar fractures (P<0.01). There was significant association between pulmonary complications and cervical fusions (P<0.01). Conclusions: Surgical treatment has been growing in popularity for thoracolumbar fractures but staying consistent for cervical fractures in AS patients. Surgical approach has shifted for cervical fractures with APSF transitioning from most to least popular approach from 2003 to 2014. For thoracolumbar fractures, PSF has remained the preferred approach. APSF had significantly higher pulmonary complication rates with cervical fractures. This finding can help surgeons in treating fractures in AS patients with underlying pulmonary disease.
Spine deformity
Analysis of a national database. To analyze trends in spinal fusion surgery for neurofibromatosis... more Analysis of a national database. To analyze trends in spinal fusion surgery for neurofibromatosis type I (NF-1) patients and to compare the surgical approaches. The preferred surgical approach for fusion treatment of spinal deformity in NF is not well established. We identified 548 patients with a diagnosis of NF-1 who had received spinal fusion surgery between 2003 and 2014. We compared posterior spinal fusion (PSF), anterior-posterior spinal fusion (APSF), and anterior spinal fusion with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05. The number of spinal fusions for NF-1 significantly increased (p = .02) over the study period. The rate of PSF surgeries increased 2.9-fold, whereas the rate of APSF surgeries decreased 2.2-fold. There was also a significant association between the location of the fusion and surgical approach (p<.01), with 66% of AS...
The Spine Journal, 2018
Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the... more Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with noncervical spine involvement. Purpose: To compare patient characteristics, comorbidities and complications in patients with and without RA undergoing primary non-cervical spine fusions.
Orthopedic Reviews
Background Recently social media use within healthcare has increased significantly. Today, it is ... more Background Recently social media use within healthcare has increased significantly. Today, it is common for patients to browse the Internet, including physicians’ social media pages, to learn about their medical conditions and search for providers. The purpose of this study is to analyze the use of social media among hand surgeons, and to compare this use between academic and private surgeons. Methods Using the American Society for Surgery of the Hand’s (ASSH) online directory, all active members practicing within the ten most populated U.S. cities were identified. Social media presence was determined by an Internet search of platforms. Members were stratified by practice model (academic vs. private). Chi-square and t-tests were used to compare categorical and continuous variables, and a multivariable logistic regression was performed for the binary variable practice model. Results Two hundred and fifty-six hand surgeons were identified with 150 (59%) in academic and 106 (41%) in pr...
HAND, 2020
Background: There is a paucity of research examining the impact of social deprivation on the leve... more Background: There is a paucity of research examining the impact of social deprivation on the level of symptom severity at presentation, including in common hand conditions like carpal tunnel syndrome. We aimed to determine whether patient deprivation is associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores. Methods: Patients presenting to an academic hand clinic from December 2016 to December 2018 for a new patient visit for carpal tunnel syndrome completed PROMIS UE, PF, PI, and Depression Computer Adaptive Tests. Bivariate analyses were done to compare patient variables between the least and most deprived thirds, as measured by Area Deprivation Index (ADI), at the state (New York) and national levels. Multivariable linear regression was used to determine whether there was an association between social deprivation and PROMIS UE, PF, PI, and Depression scores...
The Journal of Hand Surgery, 2021
Clinical Spine Surgery, 2020
The objective of this study was to compared surgical site infection (SSI) rates between patients ... more The objective of this study was to compared surgical site infection (SSI) rates between patients under lumbar discectomy with an operative microscope versus surgical loupes. Summary of Background Data: Lumbar decompressions for herniated disks or lumbar stenosis are common spine procedures. Some studies have raised the concern that drape contamination of the operative microscope may be an additional risk for SSIs. We hypothesize that the use of the operative microscope for lumbar decompression procedures does not increase infection rates. Methods: A retrospective cohort analysis was performed on patients undergoing lumbar spinal decompressions via microscopic assistance (MA) or loupe assistance (LA) by 2 orthopedic spine surgeons at a tertiary academic medical center. Patients treated from November, 2012 to October, 2016 were enrolled. Variables including age, sex, race, body mass index, smoking status, length of surgery, intraoperative complications, estimated blood loss, and postoperative SSIs within 30 days were collected. Results: A total of 225 patients were included in the study. Sixtythree patients underwent LA lumbar decompression, and 162 underwent MA lumbar decompression. There were 72 female individuals/90 male individuals in the MA group and 31 female individuals/33 male individuals in the LA group. The MA was significantly older 45.2 versus 40.4 in LA, P-value of 0.02 and had a significantly higher body mass index (30.64 vs. 27.79, P < 0.002). SSI rates were not significantly different, MA 3.7% (6/162) and LA 7.9% (5/63), P-value of 0.14. The MA group had a significantly longer operative time (92 vs. 50 min, P < 0.001). Dural tears rates were 3.1% in MA and 1.6% in LA, P-value of 0.3 and were associated with longer operative time in the MA group, 162.2 versus 90.2 minutes, P-value of <0.0001. Multivariate regression analysis did not identify any significant differences between the 2 groups. Conclusions: The use of the operative microscope had similar infection rates as LA microdiscectomies. In academic institutions, the operative microscope may allow more opportunities for residents or fellows to partake/assist in the procedure as compared with LA procedures.
The Spine Journal, 2019
Because the NIS database is publicly available, our study was exempt from institutional review bo... more Because the NIS database is publicly available, our study was exempt from institutional review board approval.
Spine, 2019
Study Design. A retrospective database analysis. Objective. The aim of this study was to analyze ... more Study Design. A retrospective database analysis. Objective. The aim of this study was to analyze US trends in surgical approaches for ossification of the posterior longitudinal ligament (OPLL); and to compare US patient and hospital characteristics, length of stay, total charges, and 30-day complications by surgical approach in OPLL management. Summary of Background Data. A robust literature on surgical management of OPLL in East Asian countries, where OPLL has a higher prevalence, exists. However, there is a paucity of literature evaluating the surgical management of OPLL in non-Asian countries. Methods. Using the Nationwide Inpatient Sample (NIS), we identified surgically treated OPLL patients from 2003 to 2014. Data on patient characteristics, surgical approaches, complications, hospital characteristics, length of stay, and hospital charges were extracted and analyzed. Analysis of variance (ANOVA) and Chi-squared tests were used to assess variation across categorical variables. Linear regression was used to evaluate the trend of surgical management for OPLL over the study timeframe. Results. Five thousand two hundred twelve patients fit our inclusion criteria. The overall complication rate was 21.5%, but the highest complication rate was for patients undergoing a combined anterior-posterior decompression/fusion (44.7%). Patients undergoing a combined anterior-posterior decompression/fusion had a longer length of stay and higher total charges (P < 0.01). Overall, surgical OPLL cases significantly increased from 2003 to 2014 (336-920; P < 0.01). Conclusion. To our knowledge, this is the largest study examining the surgical treatment of OPLL in a non-Asian country. OPLL surgical cases increased over the study timeframe and the overall surgical complication rate was 21.5%. The percentage of Asians or Pacific Islanders with OPLL undergoing surgical intervention was 10.8%, which is higher than the prevalence in the US population (4.9%). This suggests a potential genetic component to OPLL. Future work is warranted to determine how best to decrease the high complication rate.
Journal of Bone and Joint Surgery
Journal of spine surgery, Sep 1, 2018
Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skele... more Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skeleton. Structural changes render the spine susceptible to fractures, which can be treated operatively or nonoperatively. The preferred surgical approach is not well established. The objective of this study is to evaluate trends in the surgical treatment of AS patients with cervical and thoracolumbar spine fractures. Methods: Using the nationwide inpatient sample (NIS) database, we identified 961 (4,683 weighted) AS patients from 2003 to 2014 who had fusion surgery for vertebral fractures. Our primary outcome was the national trend in use of posterior (PSF), anterior posterior (APSF), and anterior fusion (ASF) surgeries. In addition, we examined patient demographics, complications, institutional characteristics, and hospitalization lengths and costs. Results: The number of fusions performed in AS patients with fractures increased significantly (P<0.01). The proportion of cervical fractures receiving fusions stayed consistent, whereas that of thoracolumbar fractures increased significantly (P<0.01). Patients undergoing APSF had higher hospitalization lengths in cervical and thoracolumbar fractures (P<0.01). There was significant association between pulmonary complications and cervical fusions (P<0.01). Conclusions: Surgical treatment has been growing in popularity for thoracolumbar fractures but staying consistent for cervical fractures in AS patients. Surgical approach has shifted for cervical fractures with APSF transitioning from most to least popular approach from 2003 to 2014. For thoracolumbar fractures, PSF has remained the preferred approach. APSF had significantly higher pulmonary complication rates with cervical fractures. This finding can help surgeons in treating fractures in AS patients with underlying pulmonary disease.
The Journal of Hand Surgery, Nov 1, 2020
Purpose Treatment for upper extremity amputations includes revision amputation or attempted repla... more Purpose Treatment for upper extremity amputations includes revision amputation or attempted replantation. The rate of digital replantation has been declining in the United States. Prior studies discovered the presence of socioeconomic disparities associated with these injuries. The goals of this study were to investigate yearly trends of traumatic upper extremity amputations and evaluate the presence of disparities with access to care in these injuries. Methods The 2008 to 2014 New York Statewide Planning and Research Cooperative System (SPARCS) inpatient and outpatient databases were utilized to identify patients who had traumatic upper extremity amputations. We queried the database for patient characteristics, resource utilization characteristics, insurance status, major in-hospital complications, and mortality. Patients at low-, medium-, and high-volume institutions were compared. We performed multivariable logistic regressions for the binary variable replantation (yes/no) controlling for age, sex, race, insurance status, amputation level, admission hour, and comorbidities. Results A total of 2,492 patients met our inclusion criteria: 92.1% sustained digital amputations and 7.9% sustained arm amputations. The annual rate of inpatient finger amputations decreased significantly (1.9 per 100,000 people in 2008 vs 1.4 per 100,000 people in 2014) during the study period while that of outpatient finger amputations increased significantly (12.0 per 100,000 people in 2008 vs 15.5 per 100,000 people in 2014). Multivariable analysis demonstrated incrementally lower odds for replantation with increasing age and increased odds for replantation in patients with private insurance (odds ratio, 1.64; 95% confidence interval, 1.08e2.50). The number of replantation surgeries at medium-volume institutions decreased by 45% while remaining steady in low-and high-volume institutions. Conclusions Our findings corroborate the findings of other studies that underscore the existence of disparities with respect to insurance status in these injuries. Replantations occur more frequently at high-volume hospitals and are more common in younger patients with private insurance. This finding suggests that patients with traumatic amputations may benefit from treatment at high-volume institutions. Further research to help improve access to such institutions is warranted.
The Spine Journal, Oct 1, 2018
Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the... more Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with noncervical spine involvement. Purpose: To compare patient characteristics, comorbidities and complications in patients with and without RA undergoing primary non-cervical spine fusions.
Spine deformity, Nov 1, 2018
Study Design: Analysis of a national database. Objective: To analyze trends in spinal fusion surg... more Study Design: Analysis of a national database. Objective: To analyze trends in spinal fusion surgery for neurofibromatosis type I (NF-1) patients and to compare the surgical approaches. Summary of Background Data: The preferred surgical approach for fusion treatment of spinal deformity in NF is not well established. Methods: We identified 548 patients with a diagnosis of NF-1 who had received spinal fusion surgery between 2003 and 2014. We compared posterior spinal fusion (PSF), anterior-posterior spinal fusion (APSF), and anterior spinal fusion with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05. Results: The number of spinal fusions for NF-1 significantly increased (p 5 .02) over the study period. The rate of PSF surgeries increased 2.9-fold, whereas the rate of APSF surgeries decreased 2.2-fold. There was also a significant association between the location of the fusion and surgical approach (p!.01), with 66% of ASF cases being cervical spine cases. Compared with patients undergoing PSF and ASF, patients undergoing APSF were significantly younger (p!.01) and had significantly higher hospitalization lengths and costs (p!.01).
Surgical Neurology International
Background: We compared the characteristics, comorbidities, and complications in spinal deformity... more Background: We compared the characteristics, comorbidities, and complications in spinal deformity patients with and without multiple sclerosis (MS) undergoing primary lumbar spine fusion. Methods: We used the Nationwide Inpatient Sample (NIS) from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes to create experimental MS (842 patients) and non-MS control (165,726 patients) cohorts undergoing primary lumbar spine fusion. Characteristics, comorbidities, and complications in spinal deformity patients with and without MS were evaluated using univariate and bivariate analysis. Results: MS spinal deformity patients undergoing primary lumbar spine fusion were younger, more likely to be female and more likely to undergo surgery at urban teaching hospitals. They also exhibited higher rates of depression and lower rates of diabetes without chronic complications, hypertension, and renal failure. However, no significant ...
The Journal of Hand Surgery, 2020
Purpose Treatment for upper extremity amputations includes revision amputation or attempted repla... more Purpose Treatment for upper extremity amputations includes revision amputation or attempted replantation. The rate of digital replantation has been declining in the United States. Prior studies discovered the presence of socioeconomic disparities associated with these injuries. The goals of this study were to investigate yearly trends of traumatic upper extremity amputations and evaluate the presence of disparities with access to care in these injuries. Methods The 2008 to 2014 New York Statewide Planning and Research Cooperative System (SPARCS) inpatient and outpatient databases were utilized to identify patients who had traumatic upper extremity amputations. We queried the database for patient characteristics, resource utilization characteristics, insurance status, major in-hospital complications, and mortality. Patients at low-, medium-, and high-volume institutions were compared. We performed multivariable logistic regressions for the binary variable replantation (yes/no) controlling for age, sex, race, insurance status, amputation level, admission hour, and comorbidities. Results A total of 2,492 patients met our inclusion criteria: 92.1% sustained digital amputations and 7.9% sustained arm amputations. The annual rate of inpatient finger amputations decreased significantly (1.9 per 100,000 people in 2008 vs 1.4 per 100,000 people in 2014) during the study period while that of outpatient finger amputations increased significantly (12.0 per 100,000 people in 2008 vs 15.5 per 100,000 people in 2014). Multivariable analysis demonstrated incrementally lower odds for replantation with increasing age and increased odds for replantation in patients with private insurance (odds ratio, 1.64; 95% confidence interval, 1.08e2.50). The number of replantation surgeries at medium-volume institutions decreased by 45% while remaining steady in low-and high-volume institutions. Conclusions Our findings corroborate the findings of other studies that underscore the existence of disparities with respect to insurance status in these injuries. Replantations occur more frequently at high-volume hospitals and are more common in younger patients with private insurance. This finding suggests that patients with traumatic amputations may benefit from treatment at high-volume institutions. Further research to help improve access to such institutions is warranted.
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.
Journal of Spine Surgery, 2018
Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skele... more Background: Ankylosing spondylitis (AS) is a rheumatologic condition that affects the axial skeleton. Structural changes render the spine susceptible to fractures, which can be treated operatively or nonoperatively. The preferred surgical approach is not well established. The objective of this study is to evaluate trends in the surgical treatment of AS patients with cervical and thoracolumbar spine fractures. Methods: Using the nationwide inpatient sample (NIS) database, we identified 961 (4,683 weighted) AS patients from 2003 to 2014 who had fusion surgery for vertebral fractures. Our primary outcome was the national trend in use of posterior (PSF), anterior posterior (APSF), and anterior fusion (ASF) surgeries. In addition, we examined patient demographics, complications, institutional characteristics, and hospitalization lengths and costs. Results: The number of fusions performed in AS patients with fractures increased significantly (P<0.01). The proportion of cervical fractures receiving fusions stayed consistent, whereas that of thoracolumbar fractures increased significantly (P<0.01). Patients undergoing APSF had higher hospitalization lengths in cervical and thoracolumbar fractures (P<0.01). There was significant association between pulmonary complications and cervical fusions (P<0.01). Conclusions: Surgical treatment has been growing in popularity for thoracolumbar fractures but staying consistent for cervical fractures in AS patients. Surgical approach has shifted for cervical fractures with APSF transitioning from most to least popular approach from 2003 to 2014. For thoracolumbar fractures, PSF has remained the preferred approach. APSF had significantly higher pulmonary complication rates with cervical fractures. This finding can help surgeons in treating fractures in AS patients with underlying pulmonary disease.
Spine deformity
Analysis of a national database. To analyze trends in spinal fusion surgery for neurofibromatosis... more Analysis of a national database. To analyze trends in spinal fusion surgery for neurofibromatosis type I (NF-1) patients and to compare the surgical approaches. The preferred surgical approach for fusion treatment of spinal deformity in NF is not well established. We identified 548 patients with a diagnosis of NF-1 who had received spinal fusion surgery between 2003 and 2014. We compared posterior spinal fusion (PSF), anterior-posterior spinal fusion (APSF), and anterior spinal fusion with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05. The number of spinal fusions for NF-1 significantly increased (p = .02) over the study period. The rate of PSF surgeries increased 2.9-fold, whereas the rate of APSF surgeries decreased 2.2-fold. There was also a significant association between the location of the fusion and surgical approach (p<.01), with 66% of AS...
The Spine Journal, 2018
Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the... more Background Context: Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with noncervical spine involvement. Purpose: To compare patient characteristics, comorbidities and complications in patients with and without RA undergoing primary non-cervical spine fusions.
Orthopedic Reviews
Background Recently social media use within healthcare has increased significantly. Today, it is ... more Background Recently social media use within healthcare has increased significantly. Today, it is common for patients to browse the Internet, including physicians’ social media pages, to learn about their medical conditions and search for providers. The purpose of this study is to analyze the use of social media among hand surgeons, and to compare this use between academic and private surgeons. Methods Using the American Society for Surgery of the Hand’s (ASSH) online directory, all active members practicing within the ten most populated U.S. cities were identified. Social media presence was determined by an Internet search of platforms. Members were stratified by practice model (academic vs. private). Chi-square and t-tests were used to compare categorical and continuous variables, and a multivariable logistic regression was performed for the binary variable practice model. Results Two hundred and fifty-six hand surgeons were identified with 150 (59%) in academic and 106 (41%) in pr...
HAND, 2020
Background: There is a paucity of research examining the impact of social deprivation on the leve... more Background: There is a paucity of research examining the impact of social deprivation on the level of symptom severity at presentation, including in common hand conditions like carpal tunnel syndrome. We aimed to determine whether patient deprivation is associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores. Methods: Patients presenting to an academic hand clinic from December 2016 to December 2018 for a new patient visit for carpal tunnel syndrome completed PROMIS UE, PF, PI, and Depression Computer Adaptive Tests. Bivariate analyses were done to compare patient variables between the least and most deprived thirds, as measured by Area Deprivation Index (ADI), at the state (New York) and national levels. Multivariable linear regression was used to determine whether there was an association between social deprivation and PROMIS UE, PF, PI, and Depression scores...
The Journal of Hand Surgery, 2021
Clinical Spine Surgery, 2020
The objective of this study was to compared surgical site infection (SSI) rates between patients ... more The objective of this study was to compared surgical site infection (SSI) rates between patients under lumbar discectomy with an operative microscope versus surgical loupes. Summary of Background Data: Lumbar decompressions for herniated disks or lumbar stenosis are common spine procedures. Some studies have raised the concern that drape contamination of the operative microscope may be an additional risk for SSIs. We hypothesize that the use of the operative microscope for lumbar decompression procedures does not increase infection rates. Methods: A retrospective cohort analysis was performed on patients undergoing lumbar spinal decompressions via microscopic assistance (MA) or loupe assistance (LA) by 2 orthopedic spine surgeons at a tertiary academic medical center. Patients treated from November, 2012 to October, 2016 were enrolled. Variables including age, sex, race, body mass index, smoking status, length of surgery, intraoperative complications, estimated blood loss, and postoperative SSIs within 30 days were collected. Results: A total of 225 patients were included in the study. Sixtythree patients underwent LA lumbar decompression, and 162 underwent MA lumbar decompression. There were 72 female individuals/90 male individuals in the MA group and 31 female individuals/33 male individuals in the LA group. The MA was significantly older 45.2 versus 40.4 in LA, P-value of 0.02 and had a significantly higher body mass index (30.64 vs. 27.79, P < 0.002). SSI rates were not significantly different, MA 3.7% (6/162) and LA 7.9% (5/63), P-value of 0.14. The MA group had a significantly longer operative time (92 vs. 50 min, P < 0.001). Dural tears rates were 3.1% in MA and 1.6% in LA, P-value of 0.3 and were associated with longer operative time in the MA group, 162.2 versus 90.2 minutes, P-value of <0.0001. Multivariate regression analysis did not identify any significant differences between the 2 groups. Conclusions: The use of the operative microscope had similar infection rates as LA microdiscectomies. In academic institutions, the operative microscope may allow more opportunities for residents or fellows to partake/assist in the procedure as compared with LA procedures.
The Spine Journal, 2019
Because the NIS database is publicly available, our study was exempt from institutional review bo... more Because the NIS database is publicly available, our study was exempt from institutional review board approval.
Spine, 2019
Study Design. A retrospective database analysis. Objective. The aim of this study was to analyze ... more Study Design. A retrospective database analysis. Objective. The aim of this study was to analyze US trends in surgical approaches for ossification of the posterior longitudinal ligament (OPLL); and to compare US patient and hospital characteristics, length of stay, total charges, and 30-day complications by surgical approach in OPLL management. Summary of Background Data. A robust literature on surgical management of OPLL in East Asian countries, where OPLL has a higher prevalence, exists. However, there is a paucity of literature evaluating the surgical management of OPLL in non-Asian countries. Methods. Using the Nationwide Inpatient Sample (NIS), we identified surgically treated OPLL patients from 2003 to 2014. Data on patient characteristics, surgical approaches, complications, hospital characteristics, length of stay, and hospital charges were extracted and analyzed. Analysis of variance (ANOVA) and Chi-squared tests were used to assess variation across categorical variables. Linear regression was used to evaluate the trend of surgical management for OPLL over the study timeframe. Results. Five thousand two hundred twelve patients fit our inclusion criteria. The overall complication rate was 21.5%, but the highest complication rate was for patients undergoing a combined anterior-posterior decompression/fusion (44.7%). Patients undergoing a combined anterior-posterior decompression/fusion had a longer length of stay and higher total charges (P < 0.01). Overall, surgical OPLL cases significantly increased from 2003 to 2014 (336-920; P < 0.01). Conclusion. To our knowledge, this is the largest study examining the surgical treatment of OPLL in a non-Asian country. OPLL surgical cases increased over the study timeframe and the overall surgical complication rate was 21.5%. The percentage of Asians or Pacific Islanders with OPLL undergoing surgical intervention was 10.8%, which is higher than the prevalence in the US population (4.9%). This suggests a potential genetic component to OPLL. Future work is warranted to determine how best to decrease the high complication rate.
Journal of Bone and Joint Surgery