57. Staged vs same-day circumferential thoracolumbar spine surgery

BACKGROUND CONTEXT Complexity and potential risk to the patient in the perioperative period have led to circumferential spine fusion surgery often being performed in a staged fashion, whether in the same admission or split admission. There is no established protocol or clear evidence that this is beneficial to the patient. Previous studies of this topic have tended to favor same-day surgery to staged surgery with decreased blood loss, length of stay and cost. Multiple factors can potentially contribute to morbidity for these patients, including multiple insults activating inflammatory response and repeated exposures to anesthetics. PURPOSE To determine if there is a difference in complication profile between staged vs same-day circumferential, multi-approach thoracolumbar spine surgery. STUDY DESIGN/SETTING A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021 in an academic center. PATIENT SAMPLE All patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion OUTCOME MEASURES Primary outcome: complication rate at 90 days. Secondary outcomes: complication profile - readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection. Surgical characteristics - length of stay, operative time, estimated blood loss, transfusion rates. Demographic characteristics -ages, sex, BMI, diabetes, smoking habits. METHODS A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021. Patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion. Statistical comparison of demographic data (ages, sex, BMI, diabetes, smoking habits), complication rates (readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection) and surgical characteristics (operative time, length of stay, estimated blood loss, transfusion rates) was made between the two groups. RESULTS A total of 1039 patients (918 same-day vs 121 staged) underwent circumferential thoracolumbar spine surgery from 2012 to 2021. The groups differed slightly in demographics with the staged group being slightly older (56.7 yrs same-day vs 59.6 yrs staged, p < 0.05) and had a higher incidence of smoking (6.6% same-day vs 22.3% staged, p < 0.001). The average time between stages was 2.5 days (SD 2.15). The total operative time was significantly longer in the staged group (354 min same-day vs 523 min staged, p < 0.001). The overall complication rate was not significantly different between the two groups (22.0% same-day vs 29.8% staged, p=0.748). Analysis of specific complications demonstrated an increase in DVT/PE (1.4% same-day vs 11.6% staged, p < 0.001) and postoperative ileus (4.2% same-day vs 15.7% staged, p < 0.001) in the staged group. The length of hospital admission was longer in the staged group (4.6 days same-day vs 7.7 days staged, p < 0.0001). CONCLUSIONS Staging circumferential surgery did not demonstrate statistical increase in complications at 90 days. However, review of specific postoperative complications including DVT/PE and postoperative ileus demonstrated significant increase in the staged group compared to the same-day group. The staged patients had a significantly longer hospital stay and their total surgery time was significantly longer. These would ultimately contribute heavily to hospital costs. There were potential limitations in the comparison of the groups with the staged patients being older and more likely to smoke. The study group recommends considering if staging the surgery is required as it can lead to increase in DVT/PE and postoperative ileus with prolonged stay in hospital. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Complexity and potential risk to the patient in the perioperative period have led to circumferential spine fusion surgery often being performed in a staged fashion, whether in the same admission or split admission. There is no established protocol or clear evidence that this is beneficial to the patient. Previous studies of this topic have tended to favor same-day surgery to staged surgery with decreased blood loss, length of stay and cost. Multiple factors can potentially contribute to morbidity for these patients, including multiple insults activating inflammatory response and repeated exposures to anesthetics. To determine if there is a difference in complication profile between staged vs same-day circumferential, multi-approach thoracolumbar spine surgery. A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021 in an academic center. All patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion Primary outcome: complication rate at 90 days. Secondary outcomes: complication profile - readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection. Surgical characteristics - length of stay, operative time, estimated blood loss, transfusion rates. Demographic characteristics -ages, sex, BMI, diabetes, smoking habits. A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021. Patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion. Statistical comparison of demographic data (ages, sex, BMI, diabetes, smoking habits), complication rates (readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection) and surgical characteristics (operative time, length of stay, estimated blood loss, transfusion rates) was made between the two groups. A total of 1039 patients (918 same-day vs 121 staged) underwent circumferential thoracolumbar spine surgery from 2012 to 2021. The groups differed slightly in demographics with the staged group being slightly older (56.7 yrs same-day vs 59.6 yrs staged, p < 0.05) and had a higher incidence of smoking (6.6% same-day vs 22.3% staged, p < 0.001). The average time between stages was 2.5 days (SD 2.15). The total operative time was significantly longer in the staged group (354 min same-day vs 523 min staged, p < 0.001). The overall complication rate was not significantly different between the two groups (22.0% same-day vs 29.8% staged, p=0.748). Analysis of specific complications demonstrated an increase in DVT/PE (1.4% same-day vs 11.6% staged, p < 0.001) and postoperative ileus (4.2% same-day vs 15.7% staged, p < 0.001) in the staged group. The length of hospital admission was longer in the staged group (4.6 days same-day vs 7.7 days staged, p < 0.0001). Staging circumferential surgery did not demonstrate statistical increase in complications at 90 days. However, review of specific postoperative complications including DVT/PE and postoperative ileus demonstrated significant increase in the staged group compared to the same-day group. The staged patients had a significantly longer hospital stay and their total surgery time was significantly longer. These would ultimately contribute heavily to hospital costs. There were potential limitations in the comparison of the groups with the staged patients being older and more likely to smoke. The study group recommends considering if staging the surgery is required as it can lead to increase in DVT/PE and postoperative ileus with prolonged stay in hospital.