Study Design.Retrospective cohort study.Objective.Anterior cervical discectomy and fusions (ACDF) have become a common and effective means of decompression and stabilization of the cervical spine. Anterior instrumentation with plates and screws (ACDF-P) are increasingly utilized to increase rates of union. However, concerns with plate-related risks have led to the evolution of stand-alone ACDF (ACDF-S) constructs in hopes of reducing adjacent segment degeneration from plate prominence though critics have pointed out potential for subsidence, instability, and nonunions. We sought to evaluate reoperation risk following ACDF-S compared with ACDF-P in a multicenter US-based cohort.Summary of Background Data.Adult patients who underwent primary one to two-level ACDF between C3 and C7 for degenerative disc disease were identified using a health care system's spine registry (2009-2022). Three thousand nine hundred fifty-eight ACDF comprised the final study sample, 278 (7.0%) were ACDF-S. Procedures were performed by 59 surgeons at 16 hospitals.Methods.Multivariable Cox proportional-hazards regression was used to evaluate ACDF-S versus ACDF-P and risk of reoperation for any cause with confounder adjustment. Reoperation for adjacent segment disease (ASD) or nonunion were also evaluated. Secondary analysis stratified by one and two-level ACDF procedures.Results.In adjusted analyses, no differences in all-cause reoperation risk [hazard ratio (HR)=0.97, 95% CI=0.58-1.64] or reoperation for ASD (HR=1.11, 95% CI=0.61-1.99) was observed when comparing ACDF-S to ACDF-P. No differences in reoperation risks were also found when restricted to one-level procedures (all-cause: HR=0.92, 95% CI=0.50-1.68; ASD: HR=0.88, 95% CI=0.44-1.78). For two-level procedures, there were 49 ACDF-S and 1,886 ACDF-P. There were too few events observed for regression analysis.Conclusions.In this large, comparative study including a cohort of nearly 4000 patients, differences in reoperation rates for ACDF-S compared with ACDF-P constructs were not observed. This information could be used to better inform surgeons, patients, administrators, and policy makers between the 2 ACDF options.
Background and Aims:Safety concerns have been raised regarding the glucagon-like peptide-1 receptor agonist (GLP-1RA) use in patients undergoing procedural sedation and anesthesia. The objective of this study is to assess the association between GLP-1RA use and postprocedural risk of pneumonia and all causes of urgent care (UC), emergency department, and hospitalization. Methods:Using a propensity-matched retrospective cohort design, we matched patients with active GLP-1RA at the time of gastrointestinal endoscopic procedure between January 2008 and June 2023 to non-GLP-1RA-exposed controls (1:4) using propensity scores generated by logistic regression. The primary outcome was risk of postprocedural pneumonia and all-cause hospitalization further adjusted for type sedation (conscious sedation vs monitored anesthesia care) as well as study year. We further assessed association between pre-endoscopic GLP-1RA exposure and subsequent UC, emergency department visits, and 30-day mortality. Results:The propensity-matched cohort comprised 63% colonoscopy, 25% esophagogastroduodenoscopy and 12% bidirectional endoscopy among 3825 patients with active GLP-1RA matched to 14,920 controls. There was no significant association between active GLP-1RA use and postprocedure pneumonia (0.13% vs 0.25%, odds ratio 0.56 (95% confidence interval: 0.22, 1.45)) or 30-day postprocedural hospitalization (1.9% vs 2.6%, 0.76 (95% confidence interval: 0.59, 0.98)) compared to nonusers. No significant association was observed for UC, emergency department visits or mortality at 7- or 30-days postprocedure. Conclusion:Uninterrupted use of GLP-1RA was not associated with major adverse events among patients undergoing gastrointestinal endoscopy with sedation.
Background:. Tranexamic acid has been increasingly used in facial plastic surgery to improve perioperative hemostasis. While subcutaneous tranexamic acid has been found to not significantly decrease postoperative ecchymoses following upper blepharoplasty, systemic administration has not previously been studied. Methods:. A total of 325 patients undergoing upper blepharoplasty were randomly assigned to either receive intravenous tranexamic acid or serve as a control. Patients in the experimental group were administered 1 g of tranexamic acid intravenously 10 minutes before surgical incision. A similar upper blepharoplasty technique was performed by two American Society of Ophthalmic Plastic and Reconstructive Surgery-trained surgeons. Follow-up was conducted at a median of 8 days postsurgery. Patient photographs were evaluated by two independent graders to rate ecchymoses on a scale of 0 (least) to 10 (most). Results:. Of the 325 included patients, 138 patients received intravenous tranexamic acid and 187 patients did not. The average ecchymosis rating for the control group at day 8 was 5.8 ± 1.7, while the average rating for the tranexamic acid group at the same time point was 4.1 ± 1.6 (P < 0.0001). There was a trend toward decreased ecchymoses in the tranexamic acid group at earlier and later postoperative timepoints that did not reach statistical significance. No hemorrhagic or systemic embolic complications occurred. Conclusions:. Systemic tranexamic acid may reduce postoperative ecchymoses after upper blepharoplasty surgery, reaching significance at the eighth postoperative day, which may lead to improved patient satisfaction and decreased occupational downtime.
