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Reoperation Rates Following Lumbar Spine Surgery and the Influence of Spinal Fusion Procedures

Martin, Brook I., MPH*†; Mirza, Sohail K., MD, MPH†‡; Comstock, Bryan A., MS*†; Gray, Darryl T., MD, ScD†§∥; Kreuter, William, MPA†§; Deyo, Richard A., MD, MPH*†‡§

doi: 10.1097/01.brs.0000254104.55716.46
Health Services Research

Study Design. Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state.

Objectives. To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone.

Summary of Background Data. Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear.

Methods. Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990–1993 (n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups.

Results. Patients who had surgery in 1990–93 had a 19% cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1% vs. 28.0%, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5% vs. 18.8%, P = 0.008). After fusion surgery, 62.5% of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis.

Conclusion. Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone.

Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. We used a hospital discharge registry to determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and found that the likelihood of reoperation is substantial.

From the Department of *Medicine, †Center for Cost and Outcomes Research, ‡Department of Orthopaedics and Sports Medicine, and §Department of Health Services, University of Washington; and the ∥Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Seattle, WA.

Acknowledgment date: March 31, 2006. Acceptance date: April 24, 2006.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

Presented in part at the 2002 Western Regional Epidemiology Network Conference, Ashland, OR.

Address correspondence and reprint requests to Brook I. Martin, MPH, Center for Cost and Outcomes Research, Box 359736/PSB5073, 325 Ninth Avenue, Seattle, WA 98104; E-mail: bim@u.washington.edu

© 2007 Lippincott Williams & Wilkins, Inc.