FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4386041710> ?p ?o ?g. }

• W4386041710 endingPage "S150" @default.
• W4386041710 startingPage "S150" @default.
• W4386041710 abstract "BACKGROUND CONTEXT Comorbidity burden is a known factor in perioperative outcomes for adult spinal deformity patients and the consequences of delaying operative treatment have been previously described. The threshold at which surgery should be delayed to optimize comorbidities and achieve the best surgical outcomes is unknown. PURPOSE To determine which patients benefit from delaying surgery for optimization versus early surgical intervention. STUDY DESIGN/SETTING Retrospective review of prospective single-center database. PATIENT SAMPLE A total of 689 ASD patients. OUTCOME MEASURES Complications, optimal clinical outcomes, patient-reported outcomes METHODS ASD patients with available perioperative and up to 2 year data were included. Optimizable risk factors examined were BMI, frailty, osteoporosis, diabetes, and smoking status. These factors were considered optimized with BMI between 18.5-24.9, modified frailty index <7, treated or no osteoporosis, HgbA1c6 months ago, respectively. A “good outcome” was defined as: 1) no mechanical failure or reoperation in 2 years, 2) met MCID for ODI, and 3) improvement in at least 1 SRS-Schwab modifier. Multivariate regression modeling was used to predict achieving a good outcome based on the modifiable risk factors. For those that were predictive of a good outcome, a conditional inference tree defined a threshold which was used to represent the point at which surgical correction should be delayed to optimize the risk factor. RESULTS A total of 234 ASD patients were isolated with average age of 60.1±10.5 years, 52% female, BMI of 33.4±7.2 kg/m2, and CCI of 3.2±1.6 with average operative time of 525.2±162.2 mins, levels fused 7.4±4.6, EBL of 1407.8±1724.5 mL, and LOS 7.7±5.2 days. Severe and not severe deformity patients were similar in age, gender, BMI, operative time, EBL, and length of stay (all p>.05) but differed in levels fused (10.3±3.9 vs 6.9±4.5, p=.012). 30.1% achieved good outcome. Those that achieved good outcome had significantly lower BMI (26.8 vs 30 kg/m2, p=.023), less operative time (403.6 vs 511.1 mins, p=.002), and fewer levels fused (10.3 vs 13.2, p=.005) but were similar in age, gender, CCI, EBL, and length of stay (all p>.05). A multivariate logistic regression was significant for prehab predicting good outcome (OR: 18.831 [1.061-334.1], p=.045), as well as HgbA1c (OR: 2.495 [2.050-6.523], p=.003), vitamin D level (OR: 4.045 [3.999-6.480], p=.036), osteoporosis (OR: 5.001[5.000-5.901], p<.001) or smoking (OR: 9.205 [8.990-10.294], p=.040). CONCLUSIONS Delaying adult spinal deformity surgery for patients may decrease the relative ceiling of clinical improvement. However, for those patients who can tolerate delayed surgery, concurrent modification and optimization based upon conduction of prehabilitation protocols, as well as improvement in diabetes markers (HgA1C), Vit D Hydroxy, osteoporosis, and smoking can significantly increase the likelihood of achieving optimal post-operative outcomes. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Comorbidity burden is a known factor in perioperative outcomes for adult spinal deformity patients and the consequences of delaying operative treatment have been previously described. The threshold at which surgery should be delayed to optimize comorbidities and achieve the best surgical outcomes is unknown. To determine which patients benefit from delaying surgery for optimization versus early surgical intervention. Retrospective review of prospective single-center database. A total of 689 ASD patients. Complications, optimal clinical outcomes, patient-reported outcomes ASD patients with available perioperative and up to 2 year data were included. Optimizable risk factors examined were BMI, frailty, osteoporosis, diabetes, and smoking status. These factors were considered optimized with BMI between 18.5-24.9, modified frailty index <7, treated or no osteoporosis, HgbA1c6 months ago, respectively. A “good outcome” was defined as: 1) no mechanical failure or reoperation in 2 years, 2) met MCID for ODI, and 3) improvement in at least 1 SRS-Schwab modifier. Multivariate regression modeling was used to predict achieving a good outcome based on the modifiable risk factors. For those that were predictive of a good outcome, a conditional inference tree defined a threshold which was used to represent the point at which surgical correction should be delayed to optimize the risk factor. A total of 234 ASD patients were isolated with average age of 60.1±10.5 years, 52% female, BMI of 33.4±7.2 kg/m2, and CCI of 3.2±1.6 with average operative time of 525.2±162.2 mins, levels fused 7.4±4.6, EBL of 1407.8±1724.5 mL, and LOS 7.7±5.2 days. Severe and not severe deformity patients were similar in age, gender, BMI, operative time, EBL, and length of stay (all p>.05) but differed in levels fused (10.3±3.9 vs 6.9±4.5, p=.012). 30.1% achieved good outcome. Those that achieved good outcome had significantly lower BMI (26.8 vs 30 kg/m2, p=.023), less operative time (403.6 vs 511.1 mins, p=.002), and fewer levels fused (10.3 vs 13.2, p=.005) but were similar in age, gender, CCI, EBL, and length of stay (all p>.05). A multivariate logistic regression was significant for prehab predicting good outcome (OR: 18.831 [1.061-334.1], p=.045), as well as HgbA1c (OR: 2.495 [2.050-6.523], p=.003), vitamin D level (OR: 4.045 [3.999-6.480], p=.036), osteoporosis (OR: 5.001[5.000-5.901], p<.001) or smoking (OR: 9.205 [8.990-10.294], p=.040). Delaying adult spinal deformity surgery for patients may decrease the relative ceiling of clinical improvement. However, for those patients who can tolerate delayed surgery, concurrent modification and optimization based upon conduction of prehabilitation protocols, as well as improvement in diabetes markers (HgA1C), Vit D Hydroxy, osteoporosis, and smoking can significantly increase the likelihood of achieving optimal post-operative outcomes." @default.
• W4386041710 created "2023-08-22" @default.
• W4386041710 creator A5002990814 @default.
• W4386041710 creator A5004868833 @default.
• W4386041710 creator A5005180947 @default.
• W4386041710 creator A5033876943 @default.
• W4386041710 creator A5036085557 @default.
• W4386041710 creator A5036688363 @default.
• W4386041710 creator A5042278898 @default.
• W4386041710 creator A5072719924 @default.
• W4386041710 creator A5080429360 @default.
• W4386041710 creator A5083065310 @default.
• W4386041710 creator A5089291690 @default.
• W4386041710 creator A5091682274 @default.
• W4386041710 date "2023-09-01" @default.
• W4386041710 modified "2023-10-09" @default.
• W4386041710 title "P89. Correct now or wait? An analysis of comorbidity burden and optimization thresholds in surgical adult spinal deformity patients" @default.
• W4386041710 doi "https://doi.org/10.1016/j.spinee.2023.06.314" @default.
• W4386041710 hasPublicationYear "2023" @default.
• W4386041710 type Work @default.
• W4386041710 citedByCount "0" @default.
• W4386041710 crossrefType "journal-article" @default.
• W4386041710 hasAuthorship W4386041710A5002990814 @default.
• W4386041710 hasAuthorship W4386041710A5004868833 @default.
• W4386041710 hasAuthorship W4386041710A5005180947 @default.
• W4386041710 hasAuthorship W4386041710A5033876943 @default.
• W4386041710 hasAuthorship W4386041710A5036085557 @default.
• W4386041710 hasAuthorship W4386041710A5036688363 @default.
• W4386041710 hasAuthorship W4386041710A5042278898 @default.
• W4386041710 hasAuthorship W4386041710A5072719924 @default.
• W4386041710 hasAuthorship W4386041710A5080429360 @default.
• W4386041710 hasAuthorship W4386041710A5083065310 @default.
• W4386041710 hasAuthorship W4386041710A5089291690 @default.
• W4386041710 hasAuthorship W4386041710A5091682274 @default.
• W4386041710 hasConcept C126322002 @default.
• W4386041710 hasConcept C141071460 @default.
• W4386041710 hasConcept C151730666 @default.
• W4386041710 hasConcept C2779159551 @default.
• W4386041710 hasConcept C2779343474 @default.
• W4386041710 hasConcept C31174226 @default.
• W4386041710 hasConcept C71924100 @default.
• W4386041710 hasConcept C86803240 @default.
• W4386041710 hasConceptScore W4386041710C126322002 @default.
• W4386041710 hasConceptScore W4386041710C141071460 @default.
• W4386041710 hasConceptScore W4386041710C151730666 @default.
• W4386041710 hasConceptScore W4386041710C2779159551 @default.
• W4386041710 hasConceptScore W4386041710C2779343474 @default.
• W4386041710 hasConceptScore W4386041710C31174226 @default.
• W4386041710 hasConceptScore W4386041710C71924100 @default.
• W4386041710 hasConceptScore W4386041710C86803240 @default.
• W4386041710 hasIssue "9" @default.
• W4386041710 hasLocation W43860417101 @default.
• W4386041710 hasOpenAccess W4386041710 @default.
• W4386041710 hasPrimaryLocation W43860417101 @default.
• W4386041710 hasRelatedWork W1506200166 @default.
• W4386041710 hasRelatedWork W1995515455 @default.
• W4386041710 hasRelatedWork W2048182022 @default.
• W4386041710 hasRelatedWork W2080531066 @default.
• W4386041710 hasRelatedWork W2604872355 @default.
• W4386041710 hasRelatedWork W2748952813 @default.
• W4386041710 hasRelatedWork W2899084033 @default.
• W4386041710 hasRelatedWork W3031052312 @default.
• W4386041710 hasRelatedWork W3032375762 @default.
• W4386041710 hasRelatedWork W3108674512 @default.
• W4386041710 hasVolume "23" @default.
• W4386041710 isParatext "false" @default.
• W4386041710 isRetracted "false" @default.
• W4386041710 workType "article" @default.