Narcotic Consumption Following Minimally Invasive Lumbar Decompression: A Comparison Between Hospital and Ambulatory-Based Surgery Centers.

BACKGROUND: Several studies have compared outcomes between hospital-based centers (HBCs) and ambulatory surgery centers (ASCs) following minimally invasive lumbar decompression (MIS LD). However, the association between narcotic consumption and pain in the immediate postoperative period has not been well characterized. As such, this study aims to examine pain, narcotic consumption, and length of stay (LOS) among patients discharged on postoperative day 0 following a 1-level MIS LD between HBCs or ASCs. METHODS: Patients who underwent a primary, 1-level MIS LD were retrospectively reviewed and stratified by operative location. Differences between groups in patient demographics were assessed using independent-sample t tests for continuous variables and χ2 analysis for categoric variables. The operative location and its effect on perioperative characteristics, inpatient pain scores, and narcotics consumption were analyzed using multivariate linear regression adjusted for significant patient characteristics. RESULTS: There were 235 patients identified, of whom 90 and 145 underwent surgery at an HBC or ASC, respectively. The HBC cohort exhibited an increased comorbidity burden and had a greater percentage of privately insured patients. The HBC cohort recorded shorter operative time and greater total estimated blood loss. Patients in the HBC cohort experienced prolonged LOS, and consumed greater total oral morphine equivalents compared with the ASC cohort. No differences were observed in the remaining outcomes. CONCLUSIONS: The results of the current study suggest that patients who underwent MIS LD at an ASC received fewer narcotics than patients treated at an HBC, which may contribute to shortened LOS. Additionally, there was no difference in patient-reported pain between cohorts despite the differences in narcotic use. As such, postoperative narcotics administration varied, indicating HBC patients perhaps required more narcotic pain medications to achieve the same pain scores that were sufficient enough to allow patient discharge, thus prolonging LOS. LEVEL OF EVIDENCE: III.

The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review.

OBJECTIVEThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide a standardized measure of clinical outcomes that is valid and reliable across a variety of patient populations. PROMIS has exhibited strong correlations with many legacy patient-reported outcome (PRO) measures. However, it is unclear to what extent PROMIS has been used within the spine literature. In this context, the purpose of this systematic review was to provide a comprehensive overview of the PROMIS literature for spine-specific populations that can be used to inform clinicians and guide future work. Specifically, the authors aimed to 1) evaluate publication trends of PROMIS in the spine literature, 2) assess how studies have used PROMIS, and 3) determine the correlations of PROMIS domains with legacy PROs as reported for spine populations.METHODSStudies reporting PROMIS scores among spine populations were identified from PubMed/MEDLINE and a review of reference lists from obtained studies. Articles were excluded if they did not report original results, or if the study population was not evaluated or treated for spine-related complaints. Characteristics of each study and journal in which it was published were recorded. Correlation of PROMIS to legacy PROs was reported with 0.1 ≤ |r| < 0.3, 0.3 ≤ |r| < 0.5, and |r| ≥ 0.5 indicating weak, moderate, and strong correlations, respectively.RESULTSTwenty-one articles were included in this analysis. Twelve studies assessed the validity of PROMIS whereas 9 used PROMIS as an outcome measure. The first study discussing PROMIS in patients with spine disorders was published in 2012, whereas the majority were published in 2017. The most common PROMIS domain used was Pain Interference. Assessments of PROMIS validity were most frequently performed with the Neck Disability Index. PROMIS domains demonstrated moderate to strong correlations with the legacy PROs that were evaluated. Studies assessing the validity of PROMIS exhibited substantial variability in PROMIS domains and legacy PROs used for comparisons.CONCLUSIONSThere has been a recent increase in the use of PROMIS within the spine literature. However, only a minority of studies have incorporated PROMIS for its intended use as an outcomes measure. Overall, PROMIS has exhibited moderate to strong correlations with a majority of legacy PROs used in the spine literature. These results suggest that PROMIS can be effective in the assessment and tracking of PROs among spine populations.

Transabdominal Versus Subcuticular Sutures to Secure a Laparoscopic Gastrostomy.

PURPOSE: Traditional methods for securing a laparoscopic gastrostomy (LG) involve the placement of two monofilament transabdominal (TA) sutures to be removed after a short interval of 5 days. A modified technique employing an absorbable suture tunneled subcutaneously has been adopted by many surgeons. The aim of this study was to compare wound complications between these techniques. METHODS: A retrospective review of patients who underwent LG placement between 2010 and 2016 was conducted, dividing patients into two cohorts by securing stitch type, TA and subcutaneous (SC), and evaluating for complications. RESULTS: A total of 740 children underwent laparoscopic gastrostomy tube (GT) placement, of whom 554 (75%) patients had a TA stitch and the remaining 186 (25%) had a SC stitch. Demographic data were comparable in both groups. The most common wound complication was granulation tissue (22%), dislodgement (19%), external drainage (16%), cellulitis (10%), erosion (3%), and abscess formation (2%). Seven patients required operative revision for dislodgement; TA patients comprised the majority of these patients. Operative times were significantly longer in the SC group (22 minutes versus 28 minutes, P < .05). Rates of granulation, erosion, external and internal leakage, and dislodgement were equivalent between cohorts. There were higher rates of cellulitis (7.3% versus 19%, P < .05) and abscess (0.8% versus 7.6%, P < .05) noted in the SC group. Time to external leakage was significantly earlier in the SC group (P < .05); however, all other complications occurred at comparable times following initial operation. Persistent gastrocutaneous fistula requiring surgical closure occurred at equal rates with no difference in times to closure from GT discontinuation in both groups. CONCLUSION: While both techniques are feasible, there was a significant increase in infectious complications and operative times observed in the SC stitch patients, suggesting this may not be the optimal securing method.