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

Abstract

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

Thirty-Day Outcomes From Standalone Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion Patients in an Ambulatory Surgery Center vs. Hospital Setting

“…Of the 4992 patients who met inclusion criteria, 275 (5.5%) were re-admitted within 30 days of their index TLIF procedure and 179 (3.6%) required re-operation of their index TLIF procedure. Following the work by Garcia et al [13], Katz et al reported their review of the ACS-NSQIP database comparing anterior to posterior fusion approaches and the implications to 30-day outcomes [14]. PLIF and TLIF patients were grouped together into posterior fusion and ALIF with LLIF patients were grouped into anterior fusion.…”

“…Over the past several years, a gradual shift has been made toward lumbar fusion approaches that are less invasive and theoretically protective of the thecal sac and nerve roots. Several authors have reported on their experiences of operative and perioperative (30-day) safety via a transforaminal lumbar interbody fusion (TLIF) approach [1][2][3][4][5][6], and more recently, studies examining the safety of outpatient lumbar fusion are on the rise [7][8][9][10][11][12][13][14][15][16]. Depending on the study, complications can be significantly under-reported.…”

Ninety-Day Readmission in Elective Revision Lumbar Fusion Surgery in the Inpatient Setting

“…The study, however, found no significant difference between readmission rates in revision versus primary lumbar procedures. 21 There have been numerous studies to report 90-rates readmission rates following lumbar surgery, though the surgical approach and study designs certainly differ. Baaj et al conducted an analysis of 86 869 patients who received lumber spinal fusion surgery between 2005 and 2014 using the New York Statewide Planning and Research Cooperative System (SPARCS) and reported an overall 90-day readmission rate of 24.8%.…”

“…The study, however, found no significant difference between readmission rates in revision versus primary lumbar procedures. 21 There have been numerous studies to report 90rates readmission rates following lumbar surgery, though the surgical approach and study designs certainly differ.…”

Early Discharged Lumbar Spine Fusion Reduced Postoperative Readmissions: A Retrospective Cohort Study

“…The current study aims to investigate differences between patients who were discharged early and those who were not following lumbar fusion surgery, focusing on the rates of readmission and complications that required secondary surgery. Since the rates of success and patient satisfaction for common lumbar fusion surgery have become high in the past decades [16,17], the need for readmission or reoperation was low in each surgeon's or institute's series [18][19][20][21][22]. Therefore, there was rarely an adequate number of patients with high enough rates of follow-up for investigation of readmissions or reoperations in lumbar spinal fusion surgery.…”