PMID- 38465953
OWN - NLM
STAT- Publisher
LR  - 20240311
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
DP  - 2024 Mar 11
TI  - The Effects of Peri-Operative Adverse Events on Clinical and Patient-Reported 
      Outcomes After Surgery for Degenerative Cervical Myelopathy: An Observational 
      Cohort Study from the Canadian Spine Outcomes and Research Network.
LID - 10.1227/neu.0000000000002896 [doi]
AB  - BACKGROUND AND OBJECTIVES: There is a lack of data examining the effects of 
      perioperative adverse events (AEs) on long-term outcomes for patients undergoing 
      surgery for degenerative cervical myelopathy. We aimed to investigate 
      associations between the occurrence of perioperative AEs and coprimary outcomes: 
      (1) modified Japanese Orthopaedic Association (mJOA) score and (2) Neck 
      Disability Index (NDI) score. METHODS: We analyzed data from 800 patients 
      prospectively enrolled in the Canadian Spine Outcomes and Research Network 
      multicenter observational study. The Spine AEs Severity system was used to 
      collect intraoperative and postoperative AEs. Patients were assessed at up to 2 
      years after surgery using the NDI and the mJOA scale. We used a linear 
      mixed-effect regression to assess the influence of AEs on longitudinal outcome 
      measures as well as multivariable logistic regression to assess factors 
      associated with meeting minimal clinically important difference (MCID) thresholds 
      at 1 year. RESULTS: There were 167 (20.9%) patients with minor AEs and 36 (4.5%) 
      patients with major AEs. The occurrence of major AEs was associated with an 
      average increase in NDI of 6.8 points (95% CI: 1.1-12.4, P = .019) and reduction 
      of 1.5 points for mJOA scores (95% CI: -2.3 to -0.8, P < .001) up to 2 years 
      after surgery. Occurrence of major AEs reduced the odds of patients achieving 
      MCID targets at 1 year after surgery for mJOA (odds ratio 0.23, 95% CI: 
      0.086-0.53, P = .001) and for NDI (odds ratio 0.34, 95% CI: 0.11-0.84, P = .032). 
      CONCLUSION: Major AEs were associated with reduced functional gains and worse 
      recovery trajectories for patients undergoing surgery for degenerative cervical 
      myelopathy. Occurrence of major AEs reduced the probability of achieving mJOA and 
      NDI MCID thresholds at 1 year. Both minor and major AEs significantly increased 
      health resource utilization by reducing the proportion of discharges home and 
      increasing length of stay.
CI  - Copyright (c) Congress of Neurological Surgeons 2024. All rights reserved.
FAU - Malhotra, Armaan K
AU  - Malhotra AK
AUID- ORCID: 0009-0001-1759-7160
AD  - Division of Neurosurgery, Unity Health, University of Toronto, Toronto, Ontario, 
      Canada.
AD  - Institute of Health Policy Management and Evaluation, University of Toronto, 
      Toronto, Ontario, Canada.
AD  - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, 
      Canada.
FAU - Evaniew, Nathan
AU  - Evaniew N
AD  - University of Calgary Spine Program, University of Calgary, Alberta, Canada.
FAU - Dea, Nicolas
AU  - Dea N
AD  - Department of Orthopaedic Surgery, Combined Neurosurgical and Orthopaedic Spine 
      Program, University of British Columbia, Vancouver, British Columbia, Canada.
FAU - Fisher, Charles G
AU  - Fisher CG
AD  - Department of Orthopaedic Surgery, Combined Neurosurgical and Orthopaedic Spine 
      Program, University of British Columbia, Vancouver, British Columbia, Canada.
FAU - Street, John T
AU  - Street JT
AD  - Department of Orthopaedic Surgery, Combined Neurosurgical and Orthopaedic Spine 
      Program, University of British Columbia, Vancouver, British Columbia, Canada.
FAU - Cadotte, David W
AU  - Cadotte DW
AD  - University of Calgary Spine Program, University of Calgary, Alberta, Canada.
FAU - Jacobs, W Bradley
AU  - Jacobs WB
AD  - University of Calgary Spine Program, University of Calgary, Alberta, Canada.
FAU - Thomas, Kenneth C
AU  - Thomas KC
AD  - University of Calgary Spine Program, University of Calgary, Alberta, Canada.
FAU - Attabib, Najmedden
AU  - Attabib N
AD  - Division of Neurosurgery, Zone 2, Horizon Health Network, Canada East Spine 
      Centre, Saint John, New Brunswick, Canada.
FAU - Manson, Neil
AU  - Manson N
AD  - Division of Orthopaedics, Canada East Spine Centre and Horizon Health Network, 
      Saint John, New Brunswick, Canada.
FAU - Hall, Hamilton
AU  - Hall H
AD  - Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
FAU - Bailey, Christopher S
AU  - Bailey CS
AD  - Department of Surgery, London Health Science Centre Combined Neurosurgical and 
      Orthopaedic Spine Program, Schulich School of Medicine, Western University, 
      London, Ontario, Canada.
FAU - Nataraj, Andrew
AU  - Nataraj A
AD  - Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
FAU - Phan, Philippe
AU  - Phan P
AD  - Division of Orthopaedic Surgery, The Ottawa Hospital, Civic Campus, University of 
      Ottawa, Ottawa, Ontario, Canada.
FAU - Rampersaud, Y Raja
AU  - Rampersaud YR
AD  - Department of Surgery, Schroeder Arthritis Institute, Krembil Research Institute, 
      Orthopaedics, University of Toronto, Toronto, Ontario, Canada.
FAU - Paquet, Jerome
AU  - Paquet J
AD  - Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, 
      Quebec, Canada.
FAU - Weber, Michael H
AU  - Weber MH
AD  - Division of Orthopaedics, Department of Surgery, Montreal General Hospital, 
      McGill University, Montreal, Quebec, Canada.
FAU - Christie, Sean D
AU  - Christie SD
AD  - Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
FAU - McIntosh, Greg
AU  - McIntosh G
AD  - Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada.
FAU - Wilson, Jefferson R
AU  - Wilson JR
AD  - Division of Neurosurgery, Unity Health, University of Toronto, Toronto, Ontario, 
      Canada.
AD  - Institute of Health Policy Management and Evaluation, University of Toronto, 
      Toronto, Ontario, Canada.
AD  - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, 
      Canada.
LA  - eng
PT  - Journal Article
DEP - 20240311
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
EDAT- 2024/03/11 12:42
MHDA- 2024/03/11 12:42
CRDT- 2024/03/11 09:05
PHST- 2023/09/08 00:00 [received]
PHST- 2024/01/08 00:00 [accepted]
PHST- 2024/03/11 12:42 [medline]
PHST- 2024/03/11 12:42 [pubmed]
PHST- 2024/03/11 09:05 [entrez]
AID - 00006123-990000000-01080 [pii]
AID - 10.1227/neu.0000000000002896 [doi]
PST - aheadofprint
SO  - Neurosurgery. 2024 Mar 11. doi: 10.1227/neu.0000000000002896.