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

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