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Staged Circumferential Lumbar Fusions have Less Intraoperative Complications and Shorter Operative Time with No Difference in 30-, 90-, and 1-year Complications: A Propensity-Matched Cohort Analysis of 190 Patients – Lumbar Spinal Stenosis

The article focuses on comparing the perioperative complications and outcomes of staged versus single-anesthetic circumferential lumbar fusions (cLFs) in the treatment of lumbar degenerative disease. The study included 123 patients undergoing single-anesthetic cLFs and 154 patients undergoing staged cLFs. Propensity-matching techniques were used to compare the two groups based on various factors. The results showed that staged cLFs had shorter total surgery time but longer total PACU time compared to single-anesthetic cLFs. Intraoperative complications were also lower in the staged group. However, there were no significant differences in in-hospital, 30-day, 90-day, and 1-year complications between the two approaches. The study concluded that staged cLFs can reduce total surgical time and intraoperative complications without increasing overall complications

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Published article

CONCLUSION: There is a decrease in total surgical time and intraoperative complications during staged compared to single-anesthetic cLF with no difference in in-hospital, 30-day, 90-day, and 1-year complications between approaches.

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Spine J. 2023 Sep 8:S1529-9430(23)03366-1. doi: 10.1016/j.spinee.2023.08.014. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Circumferential lumbar fusions (cLFs) are becoming more common with increasing and more minimally invasive anterior access techniques. Staging allows reassessment of indirect decompression and alignment prior to the posterior approach, and optimization of OR time management. Safety of staging has been well documented,

Spine J. 2023 Sep 8:S1529-9430(23)03366-1. doi: 10.1016/j.spinee.2023.08.014. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Circumferential lumbar fusions (cLFs) are becoming more common with increasing and more minimally invasive anterior access techniques. Staging allows reassessment of indirect decompression and alignment prior to the posterior approach, and optimization of OR time management. Safety of staging has been well documented in deformity surgery but has yet to be delineated in less extensive, degenerative cLFs.

PURPOSE: The purpose of this study is to compare perioperative complications and outcomes between staged vs. single-anesthetic circumferential fusions in the lumbar spine.

STUDY DESIGN: Propensity-matched comparative observational cohort PATIENT SAMPLE: Patients who underwent cLFs for lumbar degenerative disease OUTCOME MEASURES: In-hospital, 30-day, 90-day, and 1-year complications METHODS: From 123 patients undergoing single-anesthetic and 154 patients undergoing staged cLF, 95 patients in each group were propensity-matched based on age, sex, BMI, ASA score, smoking, revision, and number of levels. We compared perioperative, 30-day, 90-day, and 1-year complications between the two cohorts.

RESULTS: Mean days between stages was 1.58. Single-anesthetic cLF had longer total surgery time (304 vs 240 min, p<0.001) but shorter total PACU total time (133 vs 196 min, p<0.001). However, there was no difference in total anesthesia time (368 vs 374min, p=0.661) and total EBL (357 vs 320cc, p=0.313). Intra-operative complications were 9 incidental durotomies in the single-anesthetic and 1 iliac vein injury in the staged group (9% vs 1%, p=0.018). There was no difference of in-hospital (38 vs 31, p=0.291), 30-day (16 vs 23, p=0.281), 90-day (10 vs 15, p=0.391), 1-year complications (9 vs 12, p=0.644), and overall cumulative 1-year complications (54 vs 56, p=0.883) between the two cohorts.

CONCLUSION: There is a decrease in total surgical time and intraoperative complications during staged compared to single-anesthetic cLF with no difference in in-hospital, 30-day, 90-day, and 1-year complications between approaches.

PMID:37690479 | DOI:10.1016/j.spinee.2023.08.014

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Staged Circumferential Lumbar Fusions have Less Intraoperative Complications and Shorter Operative Time with No Difference in 30-, 90-, and 1-year Complications: A Propensity-Matched Cohort Analysis of 190 Patients

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Spine J. 2023 Sep 8:S1529-9430(23)03366-1. doi: 10.1016/j.spinee.2023.08.014. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Circumferential lumbar fusions (cLFs) are becoming more common with increasing and more minimally invasive anterior access techniques. Staging allows reassessment of indirect decompression and alignment prior to the posterior approach, and optimization of OR time management. Safety of staging has been well documented

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