Document Type

Article

Publication Date

12-2022

Abstract

OBJECTIVE: The American College of Surgeons (ACS) u pdated its guidelines on overlapping surgery in 2016. The objective was to examine differences in postoperative outcomes after overlapping surgery either pre-ACS guide-line revision or post-guideline revision, in a coarsened exact matching sample. -METHODS: A total of 3327 consecutive adult patients u ndergoing single-level posterior lumbar fusion from 2013 to 2019 were retrospectively analyzed. Patients were separated into a pre-ACS guideline revision cohort (surgery before April 2016) or a post-guideline revision cohort (surgery after October 2016) for comparison. The primary outcomes were proportion of cases performed with any degree of overlap, and adverse events including 30-day and 90-day rates of readmission, reoperation, emergency department visit, morbidity, and mortality. Subsequently, coarsened exact matching was used among overlapping surgery patients only to assess the impact of the ACS guideline revision on overlapping outcomes, and control-ling for attending surgeon and key patient characteristics known to affect surgical outcomes. -RESULTS: After the implementation of the ACS guide-lines, fewer cases were performed with overlap (22.0% vs. 53.7%; P < 0.001). Patients in the post-ACS guideline revi-sion cohort experienced improved rates of readmission and reoperation within 30 and 90 days. However, when limited to overlapping cases only, no differences were observed in overlap outcomes pre-ACS versus post-ACS guideline revision. Similarly, when exact matched on risk-associated patient characteristics and attending surgeon, overlapping surgery patients pre-ACS and post-ACS guideline revision experienced similar rates of 30-day and 90-day outcomes. -CONCLUSIONS: After the ACS guideline revision, no discernable impact was observed on postoperative out-comes after lumbar fusion performed with overlap.

Publication Title

World Neurosurgery

ISSN

1878-8750

Publisher

Elsevier Science, Inc.

Volume

168

First Page

E76

Last Page

E86

DOI

10.1016/j.wneu.2022.09.028

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Surgery Commons

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