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Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion

Shahrestani, Shane and Chen, Xiao T. and Ballatori, Alexander M. and Ton, Andy and Bakhsheshian, Joshua and Hah, Raymond J. and Wang, Jeffrey C. and Buser, Zorica (2021) Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion. Spine . ISSN 0362-2436. doi:10.1097/BRS.0000000000004051. (In Press) https://resolver.caltech.edu/CaltechAUTHORS:20210415-124944199

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Abstract

Study Design. Retrospective Cohort Study Objectives. To compare different aspects of fusion surgery in patients with osteoporosis with regard to graft subtype and surgical approach. Summary of Background Data. Osteoporosis and chronic lower back pain (LBP) are common in elderly populations and significantly increase the risk of compression fractures within the spine. Methods. Using the 2016–2017 National Readmission Database we identified 11,086 osteoporotic patients who received lumbar fusion using ICD-10 coding. Information regarding biologic graft type and surgical approach was collected. Patients were stratified by number of levels fused. Perioperative complications were collected at 30, 90, and 180-day follow-up intervals. Statistical analysis included univariate testing and multivariate regression modelling, controlling for patient demographics and comorbidities. Results. Patients receiving single-level fusion with autologous grafts had higher rates of hardware failure (p = 0.00014) at 30-day follow-up and 90-day follow-up (p < 0.0001) and higher rates of lumbar vertebral fractures at 90-day follow-up (p = 0.045) compared to those treated with nonautologous grafts. Patients receiving lumbar fusion with anterior and posterior approaches had no difference in readmission or infection rates, but the anterior approach was associated with a higher cost. Conclusions. In this study, osteoporotic patients treated with autologous grafts had higher rates of complications compared to those treated with nonautologous grafts. Anterior and posterior approaches had similar complication rates; however, the anterior approach was associated with a higher total cost. Level of Evidence: 4


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.1097/brs.0000000000004051DOIArticle
ORCID:
AuthorORCID
Shahrestani, Shane0000-0001-7561-4590
Additional Information:© 2021 Wolters Kluwer Health, Inc. Received 4 December, 2020; Revised 9 February, 2021; Accepted 12 February, 2021. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties, stocks.
Subject Keywords:fusion, lumbar, multi-level, osteobiologic, osteoporosis, single-level
DOI:10.1097/BRS.0000000000004051
Record Number:CaltechAUTHORS:20210415-124944199
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20210415-124944199
Official Citation:Shahrestani, Shane MS; Chen, Xiao T. BA; Ballatori, Alexander M. BA; Ton, Andy BS; Bakhsheshian, Joshua MD; Hah, Raymond J. MD; Wang, Jeffrey C. MD; Buser, Zorica PhD. Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion, SPINE: April 02, 2021 - Volume Publish Ahead of Print - Issue - doi: 10.1097/BRS.0000000000004051
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:108744
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:19 Apr 2021 16:58
Last Modified:19 Apr 2021 16:58

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