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Approach-based Comparative and Predictor Analysis of 30-day Readmission, Reoperation, and Morbidity in Patients Undergoing Lumbar Interbody Fusion Using the ACS-NSQIP Dataset

Katz, Austen David, BA; Mancini, Nickolas, BS; Karukonda, Teja, MD; Greenwood, Matthew, BS; Cote, Mark, PT, DPT, MS, CTR; Moss, Isaac L., MD, MASc, FRCSC

doi: 10.1097/BRS.0000000000002850
SURGERY
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SDC

Study Design. A retrospective cohort study.

Objective. The aim of this study was to determine the difference in 30-day readmission, reoperation, and morbidity for patients undergoing either posterior or anterior lumbar interbody fusion.

Summary of Background Data. Despite increasing utilization of lumbar interbody fusion to treat spinal pathology, few studies compare outcomes by surgical approach, particularly using large nationally represented cohorts.

Methods. Patients who underwent lumbar interbody fusion were identified using the NSQIP database. Rates of readmission, reoperation, morbidity, and associated predictors were compared between posterior/transforaminal (PLIF/TLIF) and anterior/lateral (ALIF/LLIF) lumbar interbody fusion using multivariate regression. Bonferroni-adjusted alpha-levels were utilized whereby variables were significant if their P values were less than the alpha-level or trending if their P values were between 0.05 and the alpha-level.

Results. We identified 26,336 patients. PLIF/TLIF had greater operative time (P = 0.015), transfusion (P < 0.001), UTI (P = 0.008), and stroke/CVA (P = 0.026), but lower prolonged ventilation (P < 0.001) and DVT (P = 0.002) rates than ALIF/LLIF. PLIF/TLIF independently predicted greater morbidity on multivariate analysis (odds ratio: 1.155, P = 0.0019).

In both groups, experiencing a complication and, in PLIF/TLIF, ASA-class ≥3 predicted readmission (P < 0.001). Increased age trended toward readmission in ALIF/LLIF (P = 0.003); increased white cell count (P = 0.003), dyspnea (P = 0.030), and COPD (P = 0.005) trended in PLIF/TLIF. In both groups, increased hospital stay and wound/site-related complication predicted reoperation (P < 0.001). Adjunctive posterolateral fusion predicted reduced reoperation in ALIF/LLIF (P = 0.0018). ASA-class ≥3 (P = 0.016) and age (P = 0.021) trended toward reoperation in PLIF/TLIF and ALIF/LLIF, respectively. In both groups, age, hospital stay, reduced hematocrit, dyspnea, ASA-class ≥3, posterolateral fusion, and revision surgery and, in PLIF/TLIF, bleeding disorder predicted morbidity (P < 0.001). Female sex (P = 0.010), diabetes (P = 0.042), COPD (P = 0.011), and disseminated cancer (P = 0.032) trended toward morbidity in PLIF/TLIF; obesity trended in PLIF/TLIF (P = 0.0022) and ALIF/LLIF (P = 0.020).

Conclusion. PLIF/TLIF was associated with a 15.5% increased odds of morbidity; readmission and reoperation were similar between approaches. Older age, higher ASA-class, and specific comorbidities predicted poorer 30-day outcomes, while procedural-related factors predicted only morbidity. These findings can guide surgical approach given specific factors.

Level of Evidence: 3

We compared 30-day readmission, reoperation, and morbidity rates between posterior lumbar interbody fusion/ transforaminal lumbar interbody fusion and anterior lumbar interbody fusion/lateral lumbar interbody fusion in 26,336 patients. Posterior lumbar interbody fusion /transforaminal lumbar interbody fusion independently predicted greater morbidity on multivariate analysis (odds ratio: 1.155, P ≡ 0.0019). Posterior lumbar interbody fusion /transforaminal lumbar interbody fusion also had greater operative time (P ≡ 0.015), transfusion (P < 0.001), urinary tract infection (P ≡ 0.008), and stroke/CVA (P ≡ 0.026), but lower prolonged ventilation (P < 0.001) and DVT/thrombophlebitis (P ≡ 0.002) rates.

University of Connecticut School of Medicine, UConn Health, Farmington, CT

Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT.

Address correspondence and reprint requests to Isaac L. Moss, MD, MASc, FRCSC, Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, Comprehensive Spine Center, 263 Farmington Avenue, Farmington, CT 06030-5353; E-mail: imoss@uchc.edu

Received 30 March, 2018

Revised 30 July, 2018

Accepted 9 August, 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: consultancy, royalties, stocks.

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