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The Impact of Comorbidity Burden on Complications, Length of Stay, and Direct Hospital Costs After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Khechen, Benjamin, BA; Haws, Brittany E., MD; Bawa, Mundeep S., BA; Patel, Dil V., BS; Cardinal, Kaitlyn L., BS; Guntin, Jordan A., BS; Lalehzarian, Simon P., MS; Singh, Kern, MD

doi: 10.1097/BRS.0000000000002834

Study Design. A retrospective cohort.

Objective. The aim of this study was to determine whether comorbidity as determined by Charlson Comorbidity Index (CCI) is associated with inpatient complication rate, length of stay (LOS), or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Summary of Background Data. In the spine literature, comorbidity burden has been associated with an increased risk for complications, prolonged LOS, and greater hospital costs. Few studies have investigated the influence of comorbidity burden on these outcomes in minimally invasive spine surgery populations.

Methods. A prospectively maintained surgical registry of patients undergoing primary, single-level MIS-TLIF was retrospectively reviewed. Patients were stratified by CCI and tested for association with preoperative demographics and perioperative characteristics using Chi-squared analysis or one-way analysis of variance for categorical and continuous variables, respectively. Complication rates, LOS, and direct hospital costs were compared between groups using a one-way analysis of variance.

Results. Two hundred ninety-eight patients were included. About 19.8% had a CCI of 0, 41.3% had a CCI of 1 to 2, 27.2% had a CCI of 3 to 4, and 11.7% had a CCI ≥ 5. Elevated CCI was associated with older age, smoking, and insurance status. Elevated CCI was significantly associated with a greater total inpatient complication rate. Regarding LOS and total direct hospital costs, there were no associations identified. However, elevated CCI was associated with greater costs accrued in the intensive care unit, laboratory costs, and cardiology-related costs.

Conclusion. Greater comorbidity burden as reflected by higher CCI was associated with increased postoperative complication rates following primary, single-level MIS-TLIF. However, this did not lead to prolongations in hospital stay or increased total direct hospital costs. This lack of association may suggest that the limited tissue trauma and operative exposure utilized in minimally invasive approaches may limit the utility of CCI as a predictor of surgical outcomes and costs.

Level of Evidence: 4

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612; E-mail:

Received 8 March, 2018

Revised 2 July, 2018

Accepted 27 July, 2018

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.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.