Readmission rate after adult scoliosis surgery on primary cases over 45 years-old with long term follow-up.

PURPOSE: Scoliosis surgery is becoming increasingly frequent. Rate of readmission is little discussed in the literature. It is an interesting data for the patient's information and for public authorities to calculate cost-effectiveness. Aim of the study was to evaluate rate and causes of short and long-term readmissions in patients > 45 years old operated on for a scoliosis primary cases, then to look for predictors of these readmissions. METHODS: In this monocentric retrospective cohort study, over 45 years-old scoliosis primary cases operated on between 2015 and 2018 and with a minimum of 2 years follow-up were included. The number of readmissions and their causes were analyzed. Rehospitalized patients (RH) were then compared to non-rehospitalized patients (NRH). Risk factors were sought using a multivariate analysis by logistic regression. RESULTS: 105 patients were included (90% female; 64 ± 8 years). 56% were readmitted at least once. Main cause of readmission as pseudarthrosis (70%). Among the RH patients, fifty-eight required at least one revision. We found no significant difference between RH and NRH, apart from the rate of immediate post-operative medical complications which was significantly higher in RH (17% (n = 11) vs. 4% (n = 2), p = 0.04). According to multivariate analysis, BMI and age were found as predictors of readmission of mechanical origin, and BMI for readmissions of septic origin. CONCLUSION: The readmission rate after scoliosis surgery was 56%. The main cause was pseudarthrosis. Rehospitalized patients had more immediate post-operative medical complications. The elderly and overweight patients are more likely to be readmitted for mechanical or septic reasons.

A tight anterosuperior intercondylar notch may increase the risk of cyclops syndrome after anterior cruciate ligament reconstruction using a quadruple semi-tendinosus short autograft.

BACKGROUND: Cyclops syndrome is loss of terminal knee extension caused by a fibrous nodule developed in the anterior intercondylar notch. The many known risk factors include preoperative motion-range limitation, tibial tunnel malposition, and tight hamstrings. The primary objective of this study was to assess whether intercondylar notch size was associated with the risk of cyclops syndrome or graft tear after anterior cruciate ligament (ACL) reconstruction using a quadruple semi-tendinosis autograft. The secondary objective was to determine whether intercondylar notch size was associated with functional outcomes. HYPOTHESIS: A narrow intercondylar notch is associated with higher risks of cyclops syndrome and poor functional outcomes. METHODS: Consecutive patients who underwent ACL reconstruction by quadruple semi-tendinosus autograft were included retrospectively. Preoperative magnetic resonance imaging scans were assessed by a single senior surgeon, who determined the conventional notch width index (NWI) and the anterior NWI (aNWI) for each patient. RESULTS: The 120 included patients had a mean follow-up of 2.4±0.8 years. Among them, 20 (16.7%) experienced cyclops syndrome and 7 (5.8%) graft rupture. At last follow-up, 26 (21.7%) had not returned to sports and only 47 (39.2%) had returned to sports at the pre-injury level. The mean Lysholm score was 87.9±13.5 and the main subjective IKDC score was 84±13. A narrow notch was significantly associated with lower likelihoods of returning to sports (p=0.001), returning to the same sport (p<0.0001), and returning to the pre-injury sport level (p=0.004). By multivariate analysis, only the aNWI index was significantly associated with the risk of cyclops syndrome (p<0.0001). An aNWI index lower than 0.18 had 85% sensitivity and 78% specificity for predicting cyclops syndrome. CONCLUSION: A narrow anterosuperior intercondylar notch may increase the risk of cyclops syndrome after ACL reconstruction using a quadruple semi-tendinosus graft but is not associated with the risk of graft rupture. LEVEL OF EVIDENCE: IV, retrospective observational cohort study.

Does Spinal Surgery in Elderly Patients (Over 80 Years-Old) Lead to More Early Post-Operative Complications Than Lower Limb Prosthetic Surgery?

Purpose: Patients and surgeons may be reluctant on spinal surgery over 80 years old, fearing medical complications despite the possible improvement on quality of life. However, fewer reservations for lower limb prosthetic surgery (LLPS) seem to be arisen in this population. Is spinal surgery after 80 years-old responsible of more complications than lower limb surgery? Methods: The consecutive files of 164 patients over 80 years that had spinal surgery or LLPS were analyzed. The data collected pre-operatively were demographic, clinical and post-operatively the number and types of medical complications and length of stay. Results: The mean number of medical complications was 1.11 ± 0.6 [0-6] for spinal surgery and 1.09 ± 1.0 [0-3] for LLPS, (p = 0,87). The length of stay in orthopedic unit was comparable between the two groups: 10.7 ± 4.9 days [2-36] for SS and 10.7 ± 3.0 days [5-11] for LLPS (p = 0,96). Conclusion: The global rate of peri-operative complications and the length of hospital stay were similar between spinal surgery and lower limb prosthetic surgery. These results may be explained by the rising cooperation between geriatric specialist and surgeons and the development of mini-invasive surgical technics, diminishing the early post-operative complication rates.