Matched Cohort Analysis of Elective Lumbar Spinal Fusion in Patients With and Without Parkinson’s Disease: In-hospital Complications, Length of Stay, and Hospital Charges

Abstract

Study Design: Retrospective cohort. Objectives: Parkinson's disease (PD) is a neurodegenerative condition associated with significant morbidity and mortality. PD patients often develop spinal conditions and are known to have high complication rates following surgery. This study evaluated the outcomes of lumbar fusion surgery in patients with PD using a large, public, national database. Methods:The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) was used to identify elective lumbar spinal fusion patients with and without PD for the years 2000 to 2012. PD patients were matched with non-PD controls for comorbidity and age using propensity score matching. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort.Results: A total of 231 351 elective lumbar fusion patients were examined, of which 1332 had PD. Before matching, elective lumbar fusion patients with PD were significantly older (P < .001) and more likely male (P < .001) compared with non-PD patients. In the matched cohort, PD was associated with increased length of stay (6.91 vs 5.78 days) (P < .001) and total hospital charges ($129 212.40 vs $110 324.40) (P < .001). There was no significant difference in overall in-hospital complication rate between PD patients and matched non-PD patients (22.3% vs 21.4%) (P ¼ .524).Conclusions: Analysis demonstrated significant increases in length and cost of hospitalization for elective lumbar spinal fusion in patients with PD. However, inpatient complication rates in PD patients were not significantly increased. As a growing number of PD patients undergo elective spine surgery, further studies are needed to optimize operative planning. Further study is needed to assess the long-term outcomes of lumbar spinal fusion in PD.

Complications, Readmissions, Revisions, and Patient-reported Outcomes in Patients With Parkinson Disease Undergoing Elective Spine Surgery: A Propensity-matched Analysis

“…Life expectancy for patients with PD continues to increase due to improved care, which has resulted in a greater number of patients undergoing elective surgery 3. Postural instability, dystonia, bradykinesia, and the increased fall risk associated with PD present unique challenges to spine surgeons 4–8…”

“…3 Postural instability, dystonia, bradykinesia, and the increased fall risk associated with PD present unique challenges to spine surgeons. [4][5][6][7][8] Previous studies report conflicting evidence regarding the effectiveness of elective lumbar surgery in patients with PD, with multiple studies reporting higher rates of complications and implant failure in those with PD. [9][10][11] While many studies have cautioned routine elective surgical treatment for lumbar pathology in patients with PD, several studies have reported similar complication rates between patients with and without PD, as well as significant improvement in patient-reported outcomes (PROs).…”

“…[9][10][11] While many studies have cautioned routine elective surgical treatment for lumbar pathology in patients with PD, several studies have reported similar complication rates between patients with and without PD, as well as significant improvement in patient-reported outcomes (PROs). 8,9,12 Literature concerning the effectiveness of elective cervical surgery for myelopathy and/or radiculopathy has also provided mixed results. While several case series describe higher complication and reoperation rates as well as poor improvement in quality of life measure scores for patients with PD, some studies have shown evidence for clinical improvement in patients with PD undergoing surgery to address spinal pathology including deformity and myelopathy.…”

“…Previous studies report conflicting evidence regarding the effectiveness of elective lumbar surgery in patients with PD, with multiple studies reporting higher rates of complications and implant failure in those with PD 9–11. While many studies have cautioned routine elective surgical treatment for lumbar pathology in patients with PD, several studies have reported similar complication rates between patients with and without PD, as well as significant improvement in patient-reported outcomes (PROs) 8,9,12. Literature concerning the effectiveness of elective cervical surgery for myelopathy and/or radiculopathy has also provided mixed results.…”