The Impact of Crossing the Cervicothoracic Junction on Opioid Consumption, Readmission, and Revision Rates.

IF 2.6 2区医学 Q1 ORTHOPEDICS

Journal of the American Academy of Orthopaedic Surgeons Pub Date : 2025-03-25 DOI:10.5435/JAAOS-D-24-01197

Gregory Toci, Rajkishen Narayanan, Michael Carter, Jonathan Dalton, Rachel Huang, Andrew Vanichkachorn, Andrew Kim, Asad Pasha, Nathaniel Pineda, Mark Kurd, Ian David Kaye, Thomas Cha, Barrett Woods, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder

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引用次数: 0

Abstract

Introduction: The risks and benefits of extending posterior cervical decompression and fusion (PCDF) constructs across the cervicothoracic junction (CTJ) remain controversial. Previous studies have used fusions beginning at different levels and varying in construct length. There are no studies that examine the effect of crossing the CTJ on opioid consumption. This study aims to compare short-term and long-term postoperative outcomes among patients undergoing PCDF at C3 and ending at C7, T1, or T2.

Methods: Adult patients who underwent C3-C7, C3-T1, and C3-T2 PCDF from 2017 to 2022 were identified. All patients were retrospectively reviewed for demographic and surgical information. Perioperative opioid utilization from 1 year preoperatively to 1 year postoperatively was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Acute postoperative outcomes included rates of 30-day and 90-day readmission and any revision surgery.

Results: This study included 72 (C3-C7: 30.2%), 143 (C3-T1: 60.1%), and 23 (C3-T2: 9.7%) patients-groups were demographically similar. The average length of follow-up was 503 ± 433 days. Cut-to-close time differed between groups (166 ± 37.9 [C3-C7] vs. 182 ± 43.2 vs. 199 ± 40.9 minutes [C3-T2]; P = 0.003). Total in-hospital morphine milligram equivalents (205 ± 136 [C3-C7] vs. 247 ± 191 vs. 285 ± 136 [C3-T2]; P = 0.007) and average daily in-hospital morphine milligram equivalents (59.5 ± 29.9 [C3-C7] vs. 73.2 ± 52.1 vs. 81.0 ± 22.9 [C3-T2]; P = 0.008) were highest among C3-T2 fusions. Patients who underwent C3-T2 fusion consumed higher MMEs from 0 to 90 days postoperatively (148 ± 197 [C3-C7] vs. 223 ± 307 vs. 260 ± 363 [C3-T2]; P = 0.027). Length of stay, opioid use beyond 90 days, 30-day and 90-day readmission rates, revision surgery rates, and revision rates were similar between groups.

Conclusion: Crossing the CTJ increased cut-to-close time and early postoperative opioid consumption but did not affect length of stay, readmission rates, long-term opioid misuse, or revision surgery rates.

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穿过颈胸交界处对阿片类药物消耗、再入院和翻修率的影响。

导论：将后路颈椎减压融合（PCDF）置入颈胸交界处（CTJ）的风险和益处仍存在争议。以前的研究使用的融合开始于不同的水平和不同的结构长度。目前还没有研究检查穿过CTJ对阿片类药物消耗的影响。本研究旨在比较C3和C7、T1或T2结束的PCDF患者的短期和长期术后结果。方法：对2017年至2022年接受C3-C7、C3-T1和C3-T2 PCDF的成年患者进行分析。回顾性分析所有患者的人口学和手术信息。术前1年至术后1年的围手术期阿片类药物使用情况来自宾夕法尼亚州处方药监测计划（PDMP）。急性术后结果包括30天和90天的再入院率和任何翻修手术。结果：本研究纳入72例（C3-C7: 30.2%）， 143例（C3-T1: 60.1%）和23例（C3-T2: 9.7%）患者，人口统计学相似。平均随访时间503±433天。切至闭合时间组间差异为（166±37.9）min [C3-C7] vs(182±43.2)min vs(199±40.9)min [C3-T2]；P = 0.003)。院内吗啡总毫克当量（205±136 [C3-C7] vs. 247±191 vs. 285±136 [C3-T2]）；P = 0.007)和日均院内吗啡毫克当量（59.5±29.9 [C3-C7] vs. 73.2±52.1 vs. 81.0±22.9 [C3-T2]）；P = 0.008)。接受C3-T2融合的患者术后0 ~ 90天MMEs消耗较高（148±197 [C3-C7] vs. 223±307 vs. 260±363 [C3-T2]）；P = 0.027)。住院时间、阿片类药物使用超过90天、30天和90天再入院率、翻修手术率和翻修率在两组之间相似。结论：穿过CTJ增加了切口闭合时间和术后早期阿片类药物消耗，但不影响住院时间、再入院率、长期阿片类药物滥用或翻修手术率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Academy of Orthopaedic Surgeons 医学-整形外科

CiteScore

6.10

自引率

6.20%

发文量

529

审稿时长

4-8 weeks

期刊介绍： The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues. Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.