tively collected data using the American College of Surgeons National. Surgical Quality Improvement Program (ACS NSQIP) database from. 2005 to 2012.
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S cervical fusion (PCF) due to the frequent diagnosis of spinal stenosis associated with this procedure and the substantial metabolic demand of the spinal cord. No previous studies have evaluated the effect of preoperative anemia on outcomes in PCF. PURPOSE: To investigate the impact of preoperative anemia on outcomes in PCF. STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012. PATIENT SAMPLE: 473 patients. OUTCOME MEASURES: Mortality, complications, length of stay (LOS), readmission, return to operating room (OR). METHODS: Adult patients (O18 years) who underwent PCF (CPT code 22600) between 2005 and 2012 were identified in the NSQIP database and categorized into two groups: anemic (male Hct!39%, female Hct!36%) versus nonanemic. Univariate analysis was performed on patient demographics, preoperative comorbidities and operative variables and postoperative outcomes. Only complications with p!0.05 associated with preoperative anemia in univariate analysis were evaluated in step-wise multivariate logistic regression to determine whether preoperative anemia was an adjusted predictor of postoperative complications and outcomes. Statistical significance was maintained at p!0.05. RESULTS: A total of 473 patients met inclusion criteria, 106 (22.4%) of which were anemic. At baseline, anemic patients were more likely to be American Society of Anesthesiologists (ASA) Class $3 (p!0.0001), diabetic (p50.0001) and have a dependent functional status prior to surgery (p!0.0001). In regard to preoperative comorbidities, anemic patients were more likely to have a bleeding disorder (p50.006), previous stroke (p50.013) and neuromuscular injury (p50.03). In terms of preoperative laboratory values, anemic patients had lower baseline albumin (3.4960.6 vs 4.260.4, p!0.0001) and hematocrit (34.463.7 vs 42.163.1, p! 0.0001). No differences between the two groups existed in terms of operative time (p50.39) and fusion levels (p50.97). Anemic patients had a greater chance of any complication (p!0.0001), death (p50.008), pulmonary complication (p!0.0001) and perioperative blood transfusion (p50.0006). Anemic patients were more likely to have unplanned return to OR (p50.012), unplanned readmission (p50.022) and LOS O5 days (p!0.0001). In multivariate regression, preoperative anemia was found to be an independent predictor of any complication (OR 3.14, p50.0008), pulmonary complication (odds ratio 9.75, p50.0009), perioperative blood transfusion (odds ratio 3.06, p50.0021), unplanned return to OR (odds ratio 2.87, p50.009) and LOS O5 days (odds ratio 2.86, p!0.0001). CONCLUSIONS: Preoperative anemia in adult patients undergoing elective PCF was independently associated with an increased risk of any complication, pulmonary complication, perioperative blood transfusion, unplanned return to OR and LOS O5 days. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.342
P106. Cervical Disc Arthroplasty for Degenerative Disc Disease: Two-Year Follow-Up from an International Prospective, Multicenter, Observational Study Saleh S. Baeesa, MD; Jeddah, Saudi Arabia BACKGROUND CONTEXT: The traditional treatment for degenerative cervical disc disease (DCDD) is neural decompression and fusion. An alternative treatment is cervical disc arthroplasty (CDA) which brings the same benefits of DCDD in addition to maintaining segmental motion, keeping the kinematics of the spine and protecting adjacent levels. PURPOSE: Our study aims to describe routine surgical practice and patient reported outcomes (PROs) when treating DCDD with CDA in a multicenter 2-year prospective observational study (NTC00875810).
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STUDY DESIGN/SETTING: Multicenter 2-year prospective observational study. PATIENT SAMPLE: A total of 194 patients were enrolled (190 patients implanted) from 15 sites across 7 countries. OUTCOME MEASURES: EQ-5D, EQ-VAS and Neck Disability Index (NDI) PROs, intervertebral disc space and adverse events (AEs). METHODS: One hundred and ninety patients were implanted with Prestige LP, patient demographics and intra-operative data were collected; PROs, intervertebral disc space and AEs were assessed preoperatively and at 3, 6, 12 and 24 months (mo) follow-ups. RESULTS: Sixty seven percent of the patients were female, mean age 44.0 years, mean BMI 25.6. Compliance to follow-up was: 92% (175/ 190) at 3 mo, 42% (80/190) at 6 mo, 59% (112/190) at 12 mo and 78% (148/190) at 24 mo. Disc herniation was the most frequent primary indication for cervical arthroplasty (80.5%). Thirty-seven percent of patients already experienced pain for more than 1 year prior to baseline assessment. Mean procedure duration was 87.1 min and mean blood loss was 43.8 ml. The majority (71.0%) of the artificial cervical discs were implanted at level C5-C6 while 16.3% of patients received implants at 2 levels. There was a significant improvement from baseline to 3, 6, 12 and 24 months followups in all 3 PROs: EQ-5D index (baseline 0.59 to 0.78, 0.77, 0.8, 0.76 FUs, p!0.001), EQ-VAS (baseline 51.8 to 73.0, 72.0, 74.3, 71.5 followups, p!0.001) and NDI (baseline 24.1 to 13.2, 12.6, 12.3, 13.4 FUs, p! 0.001). After implantation, the mean disc height at the affected level increased by 0.19mm from baseline (0.22mm) to the 3 mo follow-up (0.41 mm) remaining constant thereafter (0.42, 0.40, 0.39). Mean disc height of levels above and below the implant remained comparable among baseline and all follow-ups. A total number of 63 AEs were recorded in 44 patients, of which 8 were serious AEs and 2 were serious adverse device effects. CONCLUSIONS: Our study shows a significant improvement in patientreported outcomes in the first three months after CDA, which is maintained throughout the 24 months follow-up. FDA DEVICE/DRUG STATUS: Artificial cervical disc (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.343
P107. Anterior versus Posterior Approaches for Surgical Odontoid Stabilization in Patients over 50 Years: 30-Day Morbidity and Mortality Joseph T. Patterson, MD1, David Sing, BS2, Bobby Tay, MD1, Alexander A. Theologis, MD2; 1University of California San Francisco, San Francisco, CA, US; 2University of California San Francisco, San Francisco General Hospital Orthopaedic Trauma Institute, San Francisco, CA, US BACKGROUND CONTEXT: Surgical stabilization of odontoid fractures compared to nonoperative management in patients older than 50 years is associated with higher union rates, fewer complications and lower mortality. However, differences in morbidity and mortality between anterior and posterior approaches to odontoid stabilization are not well defined. PURPOSE: To compare the 30-day morbidity and mortality of anterior and posterior approaches for odontoid fractures in patients over 50 years of age. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected 30-day surgical outcomes database. PATIENT SAMPLE: 243 patients over 50 years of age in the ACSNSQIP database who underwent nonemergent surgical odontoid stabilization for odontoid fracture or nonunion by an anterior or posterior approach. OUTCOME MEASURES: Any adverse event, serious adverse event, mortality, discharge destination and unplanned readmission within 30 days of surgery. METHODS: Patients with International Classification of Diseases 9th Revision codes for odontoid fracture (805.02) or odontoid nonunion (733.81, 733.82) were included. Surgical approach was classified by Common
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
