Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan N. Grauer

Abstract

Introduction: Patients with Parkinson’s Disease (PD), the second most prevalent neurodegenerative disorder, are at higher risk of musculoskeletal problems due to rigidity and akathisia. Likewise, patients with Cerebral Palsy (CP) are at increased risk for cervical spine pathology. Cervical fusion surgery may be considered in these populations, though perioperative outcomes relative to patients without such conditions remains poorly characterized.

Objectives: The aim of the present study was two-fold. 1) To compare the in-hospital postoperative courses of non-PD and PD cases undergoing elective anterior cervical discectomy and fusion (ACDF). 2) To compare in-hospital complications after cervical fusion (both anterior and posterior) in non-Cerebral Palsy (CP) and CP cases. Retrospective cohort designs were utilized in both investigations.

Methods: For both aims, the large size of the 2008-2018 National Inpatient Sample (NIS) database was leveraged to identify the relatively rare overlap between non-spinal neurological disorders and elective cervical spine surgery. For aim 1, elective ACDF procedures were identified in the NIS. PD cases were identified using International Classification of Diseases (ICD) codes. For aim 2, elective cervical fusion cases were identified within the NIS. CP cases were identified using ICD codes.

For both aims, the following was performed. Case demographics and comorbidities were extracted using ICD codes. Cases were propensity matched based on demographic and comorbidity burden. In-hospital adverse events were tabulated and grouped into any (AAE), serious (SAE) and events (MAE). Length of hospital stay (LOS) and mortality were assessed. Multiple logistic regression models with and without 1:1 propensity matching were used to compare outcomes between cases with and without neurological disease, controlling for demographic and preoperative variables. Previously established best practices for analyzing NIS data were followed in research design, data interpretation, and data analysis.

Results: For aim 1, after weighting, a total of 1,273,437 elective ACDF cases were identified, of which 3,948 (0.31%) involved cases with Parkinson’s disease. After 1:1 propensity score matching on demographic and comorbidity variables, there were no differences between the PD and non-PD cohorts. Logistic regression models constructed on the matched and unmatched populations showed that PD cases have greater odds of in-hospital MAE There were no differences in odds of serious adverse events or mortality.

For aim 2, after weighting, 1,518,012 cases were included in the study population, of which 4,554 (0.30%) had CP. After 1:1 propensity score matching on demographic and comorbidity variables, there were no differences between the CP and non-CP cohorts. Multiple logistic regression after matching showed that CP cases had higher odds of AAE and MAE. There were no differences in odds of SAE or in-hospital mortality.

Conclusions: After matching for demographics and comorbidity burden, PD cases undergoing elective ACDF had significantly increased odds of minor adverse events, but not of serious adverse events or mortality. Likewise, CP cases undergoing all cervical fusions had significantly increased odds of minor adverse events but were not at higher odds of serious adverse events or mortality. While CP and PD cases have greater comorbidity burden, in-hospital outcomes were relatively similar after propensity score matching. These findings suggest that elective surgical intervention for these populations can be appropriately considered without severe in-hospital morbidity or morbidity.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

Download

Share

COinS