SlideShare une entreprise Scribd logo
1  sur  14
Télécharger pour lire hors ligne
MAST/MISS TLIF
effect of Age, BMI & Comorbidity in 200 patients




     Petrus Stone, Neurosurgeon, Private Practice
             Bloemfontein, South Africa
                     2013-04-06
Disclosures

 MAST/MISS
  Teaching on behalf
  of Medtronic
 Sponsored
  attendance/travel
 Study at my own
  expense
 No animals were
  harmed
Literature

 OPEN surgery
   Age – more
    complicated
   BMI – more
    complicated
   Comorbidity - more
    complicated
 MI/MAST
   Age – some studies
   BMI – some studies
   Co-morbidity – no
    comparisons
Family debate– MISS Pros & Cons

 Advantages (theoretical)
    Cosmesis,
    Pain,
    Hospital Stay,
    Blood Loss,
    Infection
 Disadvantages (theoretical)
    Fusion Rate,
    Steep Learning Curve,
    Irradiation exposure
Objective


 To what degree does
  co-morbidity affect
  (short term) outcome
 Use of Information
    Patient/procedure
     selection
    Resource allocation
     (length of stay, High
     Care nights,
     transfusion,
     Physicians)
Patients / Materials And
Methods

 200 consecutive degenerative TLIF
  cases since 2009-08-31
 Review case notes, hospital notes
  (myself; senior nurse)
 Excluded 6 cases
    1x conversion to open
    1x aborted procedure (revision of
     open TLIF; screw holes too big)
    1x cancellation on table (medical
     aid interference)
    3 trauma thoraco-lumbar cases
 Stat analysis by UFS statistician
MI-TLIF - effect of age, BMI& comorbidity - 2013-04-06 - global spine congress, hong kong
Descriptive Stats – The Procedures
 Surgical Time
     Median 3 hours (1h25-9h30) (case
      no 9; 3 levels)
 Levels operated / Orange River TLIF
   Class
     1: 56.5%
            A: 39%
            B-F: 15%
     2: 40%
            A: 24.5%
                                         TLIF sub-classes to accommodate for extra
            B-F: 15.5%
                                         work
     3: 3.5%                            •   a – no extra work
            A: 2.5%                     •   b – 30 minutes
                                         •   c – 60 minutes
            B-F: 1.0%                   •   Etc
 Medtronic : n = 181 (90.5%)            Examples
                                         •   Vertebroplasty;
 Navigation: n = 8 (4%)                 •   adjacent level discectomy;
 Radiation exposure: median 3.1         •   Same level wide decompression/lami;
  minutes                                •   Remove instrumentation
Descriptive Stats – Short term Outcome
Major                              Duration follow up: 30-880
• threatening to life or limb       days
  function
• Early revision surgery           Length of ICU/High Care
Moderate                            stay
• prolonged hospital stay or          0 nights: 14,5%
  outpatient treatment required
Minor                                 1 night: 75.5%
• inconvenient                        2 nights: 9.5%
                                   Length of postoperative
                                    hospital stay
                                      Median 3.9 days (0.9 to
                                       17.9)
                                   Need for transfusion
                                      3.5%
Significant Complications

Moderate local complications                     %
                                                          Moderate systemic complications                   %
durotomies                                      7.5%

superficial sepsis                              1.0%      respiratory (chest infection, atelectasis,
                                                          sleep apnoea)                                  4.5%
iatrogenic end plate damage --> extra screws    0.5%

partial L5 weakness 1 (0.5%)                    0.5%
                                                          arrhythmia                                     0.5%
persisting dysesthetic leg pain                 0.5%

plunge with PAK needle (uncomplicated)          0.5%      quadriceps hematoma                            0.5%
screw too deep, Hb drop                         0.5%

                                                11.0%                                                    5.5%




Major local complications                 %             Major systemic complications                    %
decompression same stay                  1.0%           Pulmonary embolism                             1.5%
fusion extension same stay               0.5%           Unexpected epileptic fit                       0.5%
severe L4 nerve root damage              0.5%           tachy-arythmia -> cardioversion                0.5%
                                         2.0%                                                          2.5%
Age effect
Group name                     Age Group 2
Subgroup names                        <65               >65
Fisher’s Exact Test                    %                 %         p-value Sig?      Worse
Transfusion required                          2.41             8.82 0.0969 -         • Transfusion if >70:
Durotomy/CSF leak
Local (major)
                                              6.63
                                              1.81
                                                              11.76 0.2918 -
                                                               2.94 0.5284 -
                                                                                       15.8%
Local (moderate)                              9.64            17.65 0.2241 -         • LOS if >70: 3.8 vs
Local (minor)                                 0.60             0.00 1.0000 -           3.9 vs 5.7 days
                                                                                     • ICU stay (hours not
Local (All: M, M, M)                         12.05            20.59 0.4077 -
Systemic (major)                              2.41             2.94 1.0000 -
Systemic (moderate)                           4.82             8.82 0.4028 -           nights) if >65
Systemic (minor)                             18.07            29.41 0.1577 -
Systemic (all)                               25.30            41.17    0.1415 -
Local or Systemic (major)                     4.22             5.88    0.6515 -      Similar
Local or Systemic (moderate)                 14.46            26.47    0.1914 -      • Complications
Local or Systemic (minor)                    18.67            29.41    0.1577 -
                                                                                     • Theater, Cutting,
Significant blood loss
                               1 night: 75.9%; 2
                                                 1 night: 75.76%; 2
                                                                                       Radiation time
                               nights: 6.63%
ICU nights                                       nights 24.24%         0.0005 Yes
Kruskal-Wallis Test                 Median            Median          p-value Sig?
LOS postop (days)                             3.80             4.90    0.0451 Yes
Theater Time (hours)                          4.10             4.30    0.4115 -
Cutting Time (hours)                          3.00             3.10    0.5770 -
ICU stay (hours)                             20.50            21.70    0.0020 Yes
Radiation Exposure (mins)                     3.10             3.10    0.6888 -
BMI effect
Group name                  BMI                          BMI Group 3
Subgroup names              <35        >35               <35     35-40 >40
Fisher’s Exact Test         %          %          p-value %      %     %     p-value
Transfusion required            3.45       3.64    1.0000 3.45   0.00 7.69    0.2114
Durotomy/CSF leak               8.28       5.45    0.7642 8.28   6.90 3.85    0.9088
Local (major)                   1.38       3.64    0.3038 1.38   6.90 0.00    0.1821   Worse
                                                                                       • ICU nights
Local (moderate)             12.41         7.27    0.4478 12.41 10.34 3.85    0.5757
Local (minor)                   0.00       1.82    0.2750 0.00   0.00 3.85    0.1300

                                                                                       • Theater, Cutting, RE
Local (All: M, M, M)         13.79      12.73      0.1729 13.79 17.24 7.70    0.1149
Systemic (major)                2.76       1.82    1.0000 2.76   0.00 3.85    0.6015
Systemic (moderate)
Systemic (minor)
                                4.83
                             18.62
                                           7.27
                                        23.64
                                                   0.4985 4.83   6.90 7.69    0.6770
                                                   0.4338 18.62 24.14 23.08 0.6583
                                                                                         time
Systemic (all)               26.21      32.73      0.8746 26.21 31.04 34.62 0.9190
Local or Systemic (major)       4.14       5.46    0.7084 4.14   6.90 3.85    0.8519
Local or Systemic
(moderate)                   17.24      14.54      0.6623 17.24 17.24 11.54 0.9036
                                                                                       Similar
Local or Systemic (minor)
ICU - zero nights
                             18.62
                             17.36
                                        25.46
                                           7.27
                                                   0.4338 18.62 24.14 26.93 0.6583
                                                          17.36 13.79 0.00
                                                                                       • Complications
ICU - one night              75.69      76.36 0.0381 75.69 68.97 84.62 0.0312
                                                     6.94 17.24 15.38
                                                                                       • Hospital LOS
ICU - two night                 6.94    16.36
ICU nights
Kruskal-Wallis Test         median median p-value                            p-value
LOS postop (days)               3.90       4.00    0.1588 3.90   3.90 4.40    0.3392
Theater Time (hours)            4.00       4.70    0.0209 4.00   4.60 5.20    0.0245
Cutting Time (hours)            2.80       3.50    0.0163 2.80   3.20 3.80    0.0216
ICU stay (hours)             21.00      22.00      0.1765 21.00 20.40 23.00 0.1687
Radiation Exposure (mins)       3.00       3.70    0.0153 3.00   3.00 5.30    0.0012
Comorbidity (ASA) effect
Group name                     ASA score                                 ASA_Ex_BMI
Subgroup names                 ASA 1       ASA 2    ASA 3                ASA 1    ASA 2 ASA 3
Fisher’s Exact Test                %          %        %     p-value        %       %      %      p-value
Transfusion required              1.89      4.55     3.39       0.8867     1.59    4.69   0.00       0.5883
Durotomy/CSF leak                 9.43      7.95     5.08       0.6999     7.94    7.81   0.00       1.0000
Local (major)                     0.00      2.27     3.39       0.5810     0.00    3.13   0.00       0.4221   Summary
Local (moderate)                 15.09      11.36    6.78       0.3714 14.29      10.16   0.00       0.5071
Local (minor)                     0.00      0.00     1.69       0.5600     0.00    0.78   0.00       1.0000
                                                                                                              More likely
Local (All: M, M, M)             15.09      13.63    11.86      0.4548 14.29      14.07   0.00       0.6124
Systemic (major)                  3.77      2.27     1.69       0.7278     3.17    2.34   0.00       0.7349   • Minor & Moderate
Systemic (moderate)               1.89      6.82     6.78       0.4513     1.59    6.25   22.22      0.0491     systemic Cx
Systemic (minor)                 13.21      21.59    23.73      0.3462 11.11      22.66   44.44      0.0255   • Theater & Cutting
Systemic (all)                   18.87      30.68    32.20      0.6372 15.87      31.25   66.66      0.0358
                                                                                                                time
Local or Systemic (major)         3.77      4.54     5.08       1.0000     3.17    5.47   0.00       0.8168
Local or Systemic (moderate)     16.98      18.18    13.56      0.6589 15.88      16.41   22.22      0.7344
                                                                                                              • ICU stay? (integar
Local or Systemic (minor)        13.21      21.59    25.42      0.3462 11.11      23.44   44.44      0.0255     nights; not hours)
ICU - zero nights                26.42      12.64    6.78                 26.98    9.45   0.00
ICU - one night                  66.04      81.61    76.27    0.0115      66.67   81.10   66.67    0.0034
                                                                                                              Similar occurrence
                                                                                                              • Local Cx
ICU - two night                   7.55      5.75     16.95                 6.35    9.45   33.33
Kruskal-Wallis Test            median      median median p-value                                  p-value
LOS postop (days)                 3.80      3.90     4.00       0.2550     3.60    4.00   4.00       0.0857   • Major Systemic Cx
Theater Time (hours)              3.60      4.20     4.70       0.0063     3.50    4.50   4.10       0.0008   • Transfusion
Cutting Time (hours)              2.60      2.90     3.50       0.0153     2.40    3.30   2.90       0.0045   • ICU nights (hours
                                                                                                                not nights)
ICU stay (hours)                 20.20      21.10    22.00      0.1933 20.20      21.10   25.20      0.0362
Radiation Exposure (mins)         2.90      3.00     3.70       0.0509     2.90    3.30   2.90       0.1182
                                                                                                              • LOS
Summary
 Age
   >70: longer LOS (4 vs 6 days)
   >70: transfusion more likely
    (15 vs 2%)
   >65: ICU stay (hours not
    nights)
   ISQ complications
 BMI
   Longer procedure, theater
    time, irradiation time
   More ICU nights
   ISQ complications & LOS
 Comorbidity (ASA score)
   Longer procedure
   ISQ complications & LOS

Contenu connexe

En vedette

Lumbar interbody fusion indications techniques and complications
Lumbar interbody fusion indications techniques and complicationsLumbar interbody fusion indications techniques and complications
Lumbar interbody fusion indications techniques and complicationsDr Praveen kumar tripathi
 
Kenapa Mainan Edukatif
Kenapa Mainan EdukatifKenapa Mainan Edukatif
Kenapa Mainan Edukatifhanomanise
 
Presentation practice slides
Presentation practice slidesPresentation practice slides
Presentation practice slides17WeidingerN
 
Presentation2 why and how bears began
Presentation2  why and how bears beganPresentation2  why and how bears began
Presentation2 why and how bears beganClaire Goldstein
 
Kyle Roberts Visual Resume
Kyle Roberts Visual ResumeKyle Roberts Visual Resume
Kyle Roberts Visual ResumeKyleKar
 
VIDBOX_-Overview-june-15-2015
VIDBOX_-Overview-june-15-2015VIDBOX_-Overview-june-15-2015
VIDBOX_-Overview-june-15-2015Jorge Olson
 
Oriflame opportunity in Viet Nam
Oriflame opportunity in Viet NamOriflame opportunity in Viet Nam
Oriflame opportunity in Viet NamHương Nguyễn
 
Festa dell'Adesione di AC Crocetta
Festa dell'Adesione di AC CrocettaFesta dell'Adesione di AC Crocetta
Festa dell'Adesione di AC CrocettaMarco Mazzaglia
 
Evaluation for preliminary task
Evaluation for preliminary taskEvaluation for preliminary task
Evaluation for preliminary tasksammarlow
 
Konsument ok
Konsument okKonsument ok
Konsument okankowy
 
Green demo 2
Green demo 2 Green demo 2
Green demo 2 namie0422
 
Crown capital management
Crown capital managementCrown capital management
Crown capital managementFreddie Cotter
 
Changing Context
Changing ContextChanging Context
Changing Contextajevans55
 
La inteligencia
La inteligenciaLa inteligencia
La inteligenciaJuan1413
 

En vedette (20)

Lumbar interbody fusion indications techniques and complications
Lumbar interbody fusion indications techniques and complicationsLumbar interbody fusion indications techniques and complications
Lumbar interbody fusion indications techniques and complications
 
Religion diet
Religion dietReligion diet
Religion diet
 
Kenapa Mainan Edukatif
Kenapa Mainan EdukatifKenapa Mainan Edukatif
Kenapa Mainan Edukatif
 
Presentation practice slides
Presentation practice slidesPresentation practice slides
Presentation practice slides
 
Síntesis de evaluación
Síntesis de evaluaciónSíntesis de evaluación
Síntesis de evaluación
 
Jelly bean
Jelly beanJelly bean
Jelly bean
 
Presentation2 why and how bears began
Presentation2  why and how bears beganPresentation2  why and how bears began
Presentation2 why and how bears began
 
Kyle Roberts Visual Resume
Kyle Roberts Visual ResumeKyle Roberts Visual Resume
Kyle Roberts Visual Resume
 
South africa
South africaSouth africa
South africa
 
VIDBOX_-Overview-june-15-2015
VIDBOX_-Overview-june-15-2015VIDBOX_-Overview-june-15-2015
VIDBOX_-Overview-june-15-2015
 
Oriflame opportunity in Viet Nam
Oriflame opportunity in Viet NamOriflame opportunity in Viet Nam
Oriflame opportunity in Viet Nam
 
Festa dell'Adesione di AC Crocetta
Festa dell'Adesione di AC CrocettaFesta dell'Adesione di AC Crocetta
Festa dell'Adesione di AC Crocetta
 
Evaluation for preliminary task
Evaluation for preliminary taskEvaluation for preliminary task
Evaluation for preliminary task
 
Konsument ok
Konsument okKonsument ok
Konsument ok
 
5º tic en zootopia
5º tic en zootopia5º tic en zootopia
5º tic en zootopia
 
Green demo 2
Green demo 2 Green demo 2
Green demo 2
 
Crown capital management
Crown capital managementCrown capital management
Crown capital management
 
Changing Context
Changing ContextChanging Context
Changing Context
 
La inteligencia
La inteligenciaLa inteligencia
La inteligencia
 
Foods
FoodsFoods
Foods
 

Similaire à MI-TLIF - effect of age, BMI& comorbidity - 2013-04-06 - global spine congress, hong kong

Economic evaluation. Methods for adjusting survival estimates in the presence...
Economic evaluation. Methods for adjusting survival estimates in the presence...Economic evaluation. Methods for adjusting survival estimates in the presence...
Economic evaluation. Methods for adjusting survival estimates in the presence...HTAi Bilbao 2012
 
Impact of previous stenting on the outcome of (2)
Impact of previous stenting on the outcome of (2)Impact of previous stenting on the outcome of (2)
Impact of previous stenting on the outcome of (2)escts2012
 
Using NSQIP to calculate mortality risk from NSTIs
Using NSQIP to calculate mortality risk from NSTIsUsing NSQIP to calculate mortality risk from NSTIs
Using NSQIP to calculate mortality risk from NSTIsAmalia Cochran
 
ACE: The First Experience with Angiographic Reviews
ACE: The First Experience with Angiographic ReviewsACE: The First Experience with Angiographic Reviews
ACE: The First Experience with Angiographic Reviewsbnolke
 
Future Rt Cco (0sullivan)
Future Rt Cco (0sullivan)Future Rt Cco (0sullivan)
Future Rt Cco (0sullivan)fondas vakalis
 
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...Cristiano Amarelli
 
Now you see them, now you don't: the usefulness of data auditing in EHR devel...
Now you see them, now you don't: the usefulness of data auditing in EHR devel...Now you see them, now you don't: the usefulness of data auditing in EHR devel...
Now you see them, now you don't: the usefulness of data auditing in EHR devel...Health Informatics New Zealand
 
Robotic-Assisted Pyeloplasty
Robotic-Assisted PyeloplastyRobotic-Assisted Pyeloplasty
Robotic-Assisted PyeloplastyUrovideo.org
 
Aha2009 1055
Aha2009 1055Aha2009 1055
Aha2009 1055hospital
 
Radiosurgery in brain tumours
Radiosurgery in brain tumoursRadiosurgery in brain tumours
Radiosurgery in brain tumourselango mk
 
Accidents In Radiation Therapy
Accidents In Radiation TherapyAccidents In Radiation Therapy
Accidents In Radiation Therapyfondas vakalis
 

Similaire à MI-TLIF - effect of age, BMI& comorbidity - 2013-04-06 - global spine congress, hong kong (20)

Economic evaluation. Methods for adjusting survival estimates in the presence...
Economic evaluation. Methods for adjusting survival estimates in the presence...Economic evaluation. Methods for adjusting survival estimates in the presence...
Economic evaluation. Methods for adjusting survival estimates in the presence...
 
Tavi
TaviTavi
Tavi
 
Impact of previous stenting on the outcome of (2)
Impact of previous stenting on the outcome of (2)Impact of previous stenting on the outcome of (2)
Impact of previous stenting on the outcome of (2)
 
Using NSQIP to calculate mortality risk from NSTIs
Using NSQIP to calculate mortality risk from NSTIsUsing NSQIP to calculate mortality risk from NSTIs
Using NSQIP to calculate mortality risk from NSTIs
 
Revascularización miocárdica sin bomba; iguales resultados al año que la ciru...
Revascularización miocárdica sin bomba; iguales resultados al año que la ciru...Revascularización miocárdica sin bomba; iguales resultados al año que la ciru...
Revascularización miocárdica sin bomba; iguales resultados al año que la ciru...
 
Hamon M 201111
Hamon M 201111Hamon M 201111
Hamon M 201111
 
Vte予防 講義
Vte予防 講義Vte予防 講義
Vte予防 講義
 
Medical Sample 23
Medical  Sample 23Medical  Sample 23
Medical Sample 23
 
ACE: The First Experience with Angiographic Reviews
ACE: The First Experience with Angiographic ReviewsACE: The First Experience with Angiographic Reviews
ACE: The First Experience with Angiographic Reviews
 
Future Rt Cco (0sullivan)
Future Rt Cco (0sullivan)Future Rt Cco (0sullivan)
Future Rt Cco (0sullivan)
 
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...
 
Now you see them, now you don't: the usefulness of data auditing in EHR devel...
Now you see them, now you don't: the usefulness of data auditing in EHR devel...Now you see them, now you don't: the usefulness of data auditing in EHR devel...
Now you see them, now you don't: the usefulness of data auditing in EHR devel...
 
Schuez
SchuezSchuez
Schuez
 
Aha lbct
Aha lbctAha lbct
Aha lbct
 
AHA: LBCT
AHA: LBCTAHA: LBCT
AHA: LBCT
 
Robotic-Assisted Pyeloplasty
Robotic-Assisted PyeloplastyRobotic-Assisted Pyeloplasty
Robotic-Assisted Pyeloplasty
 
Aha2009 1055
Aha2009 1055Aha2009 1055
Aha2009 1055
 
Radiosurgery in brain tumours
Radiosurgery in brain tumoursRadiosurgery in brain tumours
Radiosurgery in brain tumours
 
Accidents In Radiation Therapy
Accidents In Radiation TherapyAccidents In Radiation Therapy
Accidents In Radiation Therapy
 
Bone sarcoma
Bone sarcomaBone sarcoma
Bone sarcoma
 

Dernier

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Understanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well essUnderstanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well essAbhishekKumar524514
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)MedicoseAcademics
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthGokuldas Hospital
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 

Dernier (20)

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Understanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well essUnderstanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well ess
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 

MI-TLIF - effect of age, BMI& comorbidity - 2013-04-06 - global spine congress, hong kong

  • 1. MAST/MISS TLIF effect of Age, BMI & Comorbidity in 200 patients Petrus Stone, Neurosurgeon, Private Practice Bloemfontein, South Africa 2013-04-06
  • 2. Disclosures  MAST/MISS Teaching on behalf of Medtronic  Sponsored attendance/travel  Study at my own expense  No animals were harmed
  • 3. Literature  OPEN surgery  Age – more complicated  BMI – more complicated  Comorbidity - more complicated  MI/MAST  Age – some studies  BMI – some studies  Co-morbidity – no comparisons
  • 4. Family debate– MISS Pros & Cons  Advantages (theoretical)  Cosmesis,  Pain,  Hospital Stay,  Blood Loss,  Infection  Disadvantages (theoretical)  Fusion Rate,  Steep Learning Curve,  Irradiation exposure
  • 5. Objective  To what degree does co-morbidity affect (short term) outcome  Use of Information  Patient/procedure selection  Resource allocation (length of stay, High Care nights, transfusion, Physicians)
  • 6. Patients / Materials And Methods  200 consecutive degenerative TLIF cases since 2009-08-31  Review case notes, hospital notes (myself; senior nurse)  Excluded 6 cases  1x conversion to open  1x aborted procedure (revision of open TLIF; screw holes too big)  1x cancellation on table (medical aid interference)  3 trauma thoraco-lumbar cases  Stat analysis by UFS statistician
  • 8. Descriptive Stats – The Procedures  Surgical Time  Median 3 hours (1h25-9h30) (case no 9; 3 levels)  Levels operated / Orange River TLIF Class  1: 56.5%  A: 39%  B-F: 15%  2: 40%  A: 24.5% TLIF sub-classes to accommodate for extra  B-F: 15.5% work  3: 3.5% • a – no extra work  A: 2.5% • b – 30 minutes • c – 60 minutes  B-F: 1.0% • Etc  Medtronic : n = 181 (90.5%) Examples • Vertebroplasty;  Navigation: n = 8 (4%) • adjacent level discectomy;  Radiation exposure: median 3.1 • Same level wide decompression/lami; minutes • Remove instrumentation
  • 9. Descriptive Stats – Short term Outcome Major  Duration follow up: 30-880 • threatening to life or limb days function • Early revision surgery  Length of ICU/High Care Moderate stay • prolonged hospital stay or  0 nights: 14,5% outpatient treatment required Minor  1 night: 75.5% • inconvenient  2 nights: 9.5%  Length of postoperative hospital stay  Median 3.9 days (0.9 to 17.9)  Need for transfusion  3.5%
  • 10. Significant Complications Moderate local complications % Moderate systemic complications % durotomies 7.5% superficial sepsis 1.0% respiratory (chest infection, atelectasis, sleep apnoea) 4.5% iatrogenic end plate damage --> extra screws 0.5% partial L5 weakness 1 (0.5%) 0.5% arrhythmia 0.5% persisting dysesthetic leg pain 0.5% plunge with PAK needle (uncomplicated) 0.5% quadriceps hematoma 0.5% screw too deep, Hb drop 0.5% 11.0% 5.5% Major local complications % Major systemic complications % decompression same stay 1.0% Pulmonary embolism 1.5% fusion extension same stay 0.5% Unexpected epileptic fit 0.5% severe L4 nerve root damage 0.5% tachy-arythmia -> cardioversion 0.5% 2.0% 2.5%
  • 11. Age effect Group name Age Group 2 Subgroup names <65 >65 Fisher’s Exact Test % % p-value Sig? Worse Transfusion required 2.41 8.82 0.0969 - • Transfusion if >70: Durotomy/CSF leak Local (major) 6.63 1.81 11.76 0.2918 - 2.94 0.5284 - 15.8% Local (moderate) 9.64 17.65 0.2241 - • LOS if >70: 3.8 vs Local (minor) 0.60 0.00 1.0000 - 3.9 vs 5.7 days • ICU stay (hours not Local (All: M, M, M) 12.05 20.59 0.4077 - Systemic (major) 2.41 2.94 1.0000 - Systemic (moderate) 4.82 8.82 0.4028 - nights) if >65 Systemic (minor) 18.07 29.41 0.1577 - Systemic (all) 25.30 41.17 0.1415 - Local or Systemic (major) 4.22 5.88 0.6515 - Similar Local or Systemic (moderate) 14.46 26.47 0.1914 - • Complications Local or Systemic (minor) 18.67 29.41 0.1577 - • Theater, Cutting, Significant blood loss 1 night: 75.9%; 2 1 night: 75.76%; 2 Radiation time nights: 6.63% ICU nights nights 24.24% 0.0005 Yes Kruskal-Wallis Test Median Median p-value Sig? LOS postop (days) 3.80 4.90 0.0451 Yes Theater Time (hours) 4.10 4.30 0.4115 - Cutting Time (hours) 3.00 3.10 0.5770 - ICU stay (hours) 20.50 21.70 0.0020 Yes Radiation Exposure (mins) 3.10 3.10 0.6888 -
  • 12. BMI effect Group name BMI BMI Group 3 Subgroup names <35 >35 <35 35-40 >40 Fisher’s Exact Test % % p-value % % % p-value Transfusion required 3.45 3.64 1.0000 3.45 0.00 7.69 0.2114 Durotomy/CSF leak 8.28 5.45 0.7642 8.28 6.90 3.85 0.9088 Local (major) 1.38 3.64 0.3038 1.38 6.90 0.00 0.1821 Worse • ICU nights Local (moderate) 12.41 7.27 0.4478 12.41 10.34 3.85 0.5757 Local (minor) 0.00 1.82 0.2750 0.00 0.00 3.85 0.1300 • Theater, Cutting, RE Local (All: M, M, M) 13.79 12.73 0.1729 13.79 17.24 7.70 0.1149 Systemic (major) 2.76 1.82 1.0000 2.76 0.00 3.85 0.6015 Systemic (moderate) Systemic (minor) 4.83 18.62 7.27 23.64 0.4985 4.83 6.90 7.69 0.6770 0.4338 18.62 24.14 23.08 0.6583 time Systemic (all) 26.21 32.73 0.8746 26.21 31.04 34.62 0.9190 Local or Systemic (major) 4.14 5.46 0.7084 4.14 6.90 3.85 0.8519 Local or Systemic (moderate) 17.24 14.54 0.6623 17.24 17.24 11.54 0.9036 Similar Local or Systemic (minor) ICU - zero nights 18.62 17.36 25.46 7.27 0.4338 18.62 24.14 26.93 0.6583 17.36 13.79 0.00 • Complications ICU - one night 75.69 76.36 0.0381 75.69 68.97 84.62 0.0312 6.94 17.24 15.38 • Hospital LOS ICU - two night 6.94 16.36 ICU nights Kruskal-Wallis Test median median p-value p-value LOS postop (days) 3.90 4.00 0.1588 3.90 3.90 4.40 0.3392 Theater Time (hours) 4.00 4.70 0.0209 4.00 4.60 5.20 0.0245 Cutting Time (hours) 2.80 3.50 0.0163 2.80 3.20 3.80 0.0216 ICU stay (hours) 21.00 22.00 0.1765 21.00 20.40 23.00 0.1687 Radiation Exposure (mins) 3.00 3.70 0.0153 3.00 3.00 5.30 0.0012
  • 13. Comorbidity (ASA) effect Group name ASA score ASA_Ex_BMI Subgroup names ASA 1 ASA 2 ASA 3 ASA 1 ASA 2 ASA 3 Fisher’s Exact Test % % % p-value % % % p-value Transfusion required 1.89 4.55 3.39 0.8867 1.59 4.69 0.00 0.5883 Durotomy/CSF leak 9.43 7.95 5.08 0.6999 7.94 7.81 0.00 1.0000 Local (major) 0.00 2.27 3.39 0.5810 0.00 3.13 0.00 0.4221 Summary Local (moderate) 15.09 11.36 6.78 0.3714 14.29 10.16 0.00 0.5071 Local (minor) 0.00 0.00 1.69 0.5600 0.00 0.78 0.00 1.0000 More likely Local (All: M, M, M) 15.09 13.63 11.86 0.4548 14.29 14.07 0.00 0.6124 Systemic (major) 3.77 2.27 1.69 0.7278 3.17 2.34 0.00 0.7349 • Minor & Moderate Systemic (moderate) 1.89 6.82 6.78 0.4513 1.59 6.25 22.22 0.0491 systemic Cx Systemic (minor) 13.21 21.59 23.73 0.3462 11.11 22.66 44.44 0.0255 • Theater & Cutting Systemic (all) 18.87 30.68 32.20 0.6372 15.87 31.25 66.66 0.0358 time Local or Systemic (major) 3.77 4.54 5.08 1.0000 3.17 5.47 0.00 0.8168 Local or Systemic (moderate) 16.98 18.18 13.56 0.6589 15.88 16.41 22.22 0.7344 • ICU stay? (integar Local or Systemic (minor) 13.21 21.59 25.42 0.3462 11.11 23.44 44.44 0.0255 nights; not hours) ICU - zero nights 26.42 12.64 6.78 26.98 9.45 0.00 ICU - one night 66.04 81.61 76.27 0.0115 66.67 81.10 66.67 0.0034 Similar occurrence • Local Cx ICU - two night 7.55 5.75 16.95 6.35 9.45 33.33 Kruskal-Wallis Test median median median p-value p-value LOS postop (days) 3.80 3.90 4.00 0.2550 3.60 4.00 4.00 0.0857 • Major Systemic Cx Theater Time (hours) 3.60 4.20 4.70 0.0063 3.50 4.50 4.10 0.0008 • Transfusion Cutting Time (hours) 2.60 2.90 3.50 0.0153 2.40 3.30 2.90 0.0045 • ICU nights (hours not nights) ICU stay (hours) 20.20 21.10 22.00 0.1933 20.20 21.10 25.20 0.0362 Radiation Exposure (mins) 2.90 3.00 3.70 0.0509 2.90 3.30 2.90 0.1182 • LOS
  • 14. Summary  Age  >70: longer LOS (4 vs 6 days)  >70: transfusion more likely (15 vs 2%)  >65: ICU stay (hours not nights)  ISQ complications  BMI  Longer procedure, theater time, irradiation time  More ICU nights  ISQ complications & LOS  Comorbidity (ASA score)  Longer procedure  ISQ complications & LOS