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The Effect of Modifiable Risk Factors on Postoperative Complications in Lumbar Spine Fusions

Ton, Andy and Shahrestani, Shane and Chen, Xiao T. and Ballatori, Alexander M. and Wang, Jeffrey C. and Buser, Zorica (2021) The Effect of Modifiable Risk Factors on Postoperative Complications in Lumbar Spine Fusions. Global Spine Journal . ISSN 2192-5682. doi:10.1177/21925682211022315. (In Press)

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Study Design: Retrospective cohort study. Objectives: The impact of modifiable risk factors (MRFs) on complications, costs, and readmission rates at 30, 90, and 180-days following lumbar spine fusion. Methods: Patients with lumbar spine fusions within the 2016-2017 Nationwide Readmissions Database (NRD). Patients were stratified by the following MRFs: Alcohol use, tobacco/nicotine use, nutritional malnourishment, dyslipidemia, and primary hypertension. Differences in complications, non-elective readmission rates, costs, and length of stay were compared between MRFs and the non-MRF group. Statistical analysis was conducted using Tukey multiple comparisons of means, 1-way ANOVA, Wald testing, unpaired Welch 2-sample t-tests, multivariate analysis, and predictive modeling. Results: The final analysis included 297,579 lumbar fusion patients. At 30 and 90 days, patients with nutritional malnutrition, dyslipidemia, and primary hypertension had significantly greater readmission rates than patients without MRFs (all P <0.01). At 180-days, all MRFs had significantly greater readmission rates than the non-MRF group (all P <0.001). Dyslipidemia demonstrated significantly greater rates of myocardial infarction at 90 days compared to all groups (all P <0.02). Nutritional malnutrition was associated with a significantly greater mortality rate than primary hypertension, non-MRF, and tobacco/nicotine use at 90 days (P<0.001) and only tobacco/nicotine use at 180 days (P=0.007). Predictive modeling showed increases of 0.77%, 1.70%, and 2.44% risk of readmission at 30, 90, and 180-days respectively per additional MRF (all P<0.001). Conclusions: These findings highlight the negative impact each MRF has on patients following lumbar spinal fusion. Further longitudinal research is necessary to comprehensively characterize the effects of various MRFs on spine surgery outcomes.

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Shahrestani, Shane0000-0001-7561-4590
Buser, Zorica0000-0002-5680-0643
Additional Information:© The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( Article first published online: June 22, 2021. The author(s) received no financial support for the research, authorship, and/or publication of this article. Disclosures outside of submitted work: JCW – Royalties – Biomet, Seaspine, Amedica, Synthes; Investments/Options – Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors – AO Foundation, Society for Brain Mapping and Therapeutics, Fellowship Funding (paid to institution): AO Foundation. ZB – consultancy: Cerapedics (past), The Scripps Research Institute (past), Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrics (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Educational Committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee-committee member.
Record Number:CaltechAUTHORS:20210701-154014035
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Official Citation:Ton A, Shahrestani S, Chen XT, Ballatori AM, Wang JC, Buser Z. The Effect of Modifiable Risk Factors on Postoperative Complications in Lumbar Spine Fusions. Global Spine Journal. June 2021. doi:10.1177/21925682211022315
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:109696
Deposited By: Tony Diaz
Deposited On:02 Jul 2021 20:32
Last Modified:06 Jul 2021 22:18

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