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Experience With 161 Cases of Anterior Exposure of the Thoracic and Lumbar Spine in an Acute Care Surgery Model: Impact of Exposure Level and Underlying Pathology on Morbidity

Seoudi, Hani MD, FACS; LaPorta, Matthew DO; Griffen, Margaret MD; Rizzo, Anne MD; Pullarkat, Ranjit MD

doi: 10.1097/BRS.0b013e31829aa177
Surgery

Study Design. Retrospective chart review.

Objective. To evaluate the outcomes of anterior exposure of the thoracic and lumbar spine by an acute care surgery service.

Summary of Background Data. Spine surgeons typically require an “approach surgeon” to provide anterior exposure of the thoracic and lumbar spine. We hypothesized that a dedicated acute care surgery service can perform those operations with acceptable morbidity and mortality.

Methods. A retrospective review of 161 trauma and nontrauma patients was performed. All cases were performed at a level I trauma center with a dedicated acute care surgery service. In-hospital morbidity and mortality were evaluated. A brief description of the operative techniques used by our group is also provided.

Results. Of the 161 patients, 59 (37%) were trauma patients. Ninety-three patients (58%) had anterolateral retroperitoneal exposure of the thoracic and lumbar spine. Sixty-eight patients (42%) had anterior retroperitoneal midline exposure of the lumbar and lumbosacral spine. Total morbidity was 9.3% (7.4% for trauma patients and 1.8% for non trauma patients). Morbidity was highest in patients who had anterolateral exposure of the thoracic and lumbar spine (6.8%). Morbidity in patients who had midline exposure of L4 to S1 was 0%. Total mortality was 1.2% (3.3% for trauma patients and 0% for nontrauma patients). The acute care surgery service gained 3141 physician work relative value units (RVU) by performing those operations.

Conclusion. Anterior exposure of the thoracic and lumbar spine both for trauma and nontrauma related indications can be performed with acceptable morbidity and mortality by a dedicated acute care surgery service. Morbidity and mortality were higher in trauma patients and in those who underwent thoracolumbar procedures. Patients who had midline exposure of L4 to S1 for degenerative disc disease had the lowest morbidity.

Level of Evidence: 4

A retrospective review of 161 trauma and nontrauma patients was performed. Total morbidity was 9.3% (7.4% for trauma and 1.8% for nontrauma patients). Morbidity was highest in patients who had anterolateral exposure of the T and L spine (6.8%). Total mortality was 1.2% (3.3% for trauma and 0% for nontrauma patients).

From the VCU Medical School-Inova Campus, Falls Church, VA.

Address correspondence and reprint requests to Hani Seoudi, MD, FACS, Associate Professor of Surgery, VCU Medical School-Inova Campus, 3300 Gallows Rd, Falls Church, VA 22042; E-mail: hani.seoudi@inova.org

Acknowledgment date: January 31, 2013. First revision date: April 30, 2013. Acceptance date: May 6, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins