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. 2023 Sep 4;8(1):29-34.
doi: 10.22603/ssrr.2023-0094. eCollection 2024 Jan 27.

Impact of the COVID-19 Pandemic on Outcomes and Perioperative Factors Associated with Posterior Cervical Fusion

Austen D Katz  1 , Junho Song  1 , Priya Duvvuri  1 , Alex Ngan  1 , Terence Ng  1 , Sayyida Hasan  1 , Sohrab Virk  1 , Jeff Silber  1 , David Essig  1
Affiliations

Impact of the COVID-19 Pandemic on Outcomes and Perioperative Factors Associated with Posterior Cervical Fusion

Austen D Katz et al. Spine Surg Relat Res. .

Abstract

Introduction: While there is anecdotal evidence that the coronavirus disease 2019 (COVID-19) pandemic altered perioperative decision-making in patients requiring posterior cervical fusion (PCF), a national-level analysis to examine the significance of this hypothesis has not yet been conducted. This study aimed to determine the potential differences in perioperative variables and surgical outcomes of PCF performed before vs. during the COVID-19 pandemic.

Methods: Adults who underwent PCF were identified in the 2019 (prepandemic) and 2020 (intrapandemic) NSQIP datasets. Differences in 30-day readmission, reoperation, and morbidity were evaluated using multivariate logistic regression. On the other hand, differences in operative time and relative value units (RVUs) were estimated using quantile regression. Furthermore, the odds ratios (OR) for length of stay (LOS) were estimated using negative binomial regression. Secondary outcomes included rates of nonhome discharge and outpatient surgery.

Results: A total of 3,444 patients were included in this study (50.7% from 2020). Readmission, reoperation, morbidity, operative time, and RVUs per minute were similar between cohorts (p>0.05). The LOS (OR 1.086, p<0.001) and RVUs-per-case (coefficient +0.360, p=0.037) were significantly greater in 2020 compared to 2019. Operation year 2020 was also associated with lower rates of nonhome discharge (22.3% vs. 25.8%, p=0.017) and higher rates of outpatient surgery (4.8% vs. 3.0%, p=0.006).

Conclusions: During the COVID-19 pandemic, a 28% decreased odds of nonhome discharge following PCF and a 72% increased odds of PCF being performed in an outpatient setting were observed. The readmission, reoperation, and morbidity rates remained unchanged during this period. This is notable given that patients in the 2020 group were more frail. This suggests that patients were shifted to outpatient centers possibly to make up for potentially reduced case volume, highlighting the potential to evaluate rehabilitation-discharge criteria. Further research should evaluate these findings in more detail and on a regional basis.

Keywords: COVID-19; cervical spine; coronavirus; outcomes; pandemic; posterior cervical fusion; spine surgery.

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

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References

    1. Wordie SJ, Tsirikos AI. The impact of the COVID-19 pandemic on spinal surgery. Orthop Trauma. 2021;35(6):314-20. - PMC - PubMed
    1. Wang KY, McNeely EL, Dhanjani SA, et al. COVID-19 significantly impacted hospital length of stay and discharge patterns for adult spinal deformity patients. Spine. 2021;46(22):1551-6. - PMC - PubMed
    1. Seetharam A, Ghosh P, Prado R, et al. Trends in outpatient shoulder arthroplasty during the COVID-19 (coronavirus disease 2019) era: increased proportion of outpatient cases with decrease in 90-day readmissions. J Shoulder Elbow Surg. 2022;31(7):1409-15. - PMC - PubMed
    1. Youssef JA, Heiner AD, Montgomery JR, et al. Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis. Spine J. 2019;19(10):1714-29. - PubMed
    1. Song J, Katz AD, Perfetti D, et al. Comparative analysis of 30-day readmission, reoperation, and morbidity between posterior cervical decompression and fusion performed in inpatient and outpatient settings. Asian Spine J. 2023;17(1):75-85. - PMC - PubMed

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