Reoperation and Mortality Rates Following Elective 1 to 2 Level Lumbar Fusion: A Large State Database Analysis

Abstract

Study Design: Retrospective cohort. Objective: Reoperation to lumbar spinal fusion creates significant burden on patient quality of life and healthcare costs. We assessed rates, etiologies, and risk factors for reoperation following elective 1 to 2 level lumbar fusion. Methods: Patients undergoing elective 1 to 2 level lumbar fusion were identified using the Health Care Utilization Project (HCUP) state inpatient databases from Florida and California. Patients were tracked for 5 years for any subsequent lumbar fusion. Cox proportional hazard analyses for reoperation were assessed using the following covariates: fusion approach type, age, race, Charlson comormidity index, gender, and length of stay. Distribution of etiologies for reoperation was then assessed. Results: 71, 456 patients receiving elective 1 to 2 level lumbar fusion were included. A 5-year reoperation rate of 13.53% and mortality rate of 2.22% was seen. Combined anterior-posterior approaches (HR = 0.904, p < 0.05) and TLIF (HR = 0.867, p < 0.001) were associated with reduced risk of reoperation compared to stand-alone anterior approaches and non-TLIF posterior approaches. Age, gender, and number of comorbidities were not associated with risk of reoperation. From 1 to 5 years, degenerative disease rose from 43.50% to 50.31% of reoperations; mechanical failure decreased from 37.65% to 29.77%. Conclusions: TLIF and combined anterior-posterior approaches for 1 to 2 level lumbar fusion are associated with the lowest rate of reoperation. Number of comorbidities and age are not predictive of reoperation. Primary etiologies leading to reoperation were degenerative disease and mechanical failure. Mortality rate is not increased from baseline following 1 to 2 level lumbar fusion.

A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis

“…Of note, only 1 patient required reoperation for a device-related complication (ie, pedicle screw loosening) and is described in detail below; the remaining 8 patients required reoperation for complications related to the decompression, pedicle screw placement, and retained drain specimens. The 5.9% overall rate of reoperation in this TOPS cohort is lower than reported 1-year reoperation rates in the literature following single-level lumbar fusions (13.5%) and similar to rates reported following single-level TLIF (4%) 33. However, further exploration of the indication for reoperation reveals important differences.…”

“…In a large database study of 71,456 patients undergoing one- or two-level lumbar fusions, Cummins et al found that 43.5% of the 9670 reoperations performed within 1-year from the index surgery were owing to adjacent segment degeneration, 37.65% were owing to mechanical failure, and 7.17% were owing to stenosis. 33 No patient in the present study required reoperation for adjacent segment disease at 1 year postoperatively, and only 1 patient (0.7%) required reoperation owing to hardware complications. Biomechanical studies have demonstrated that preservation of the posterior ligamentous complex, which is not feasible with implantation of the TOPS device, may lead to decreased strain at the adjacent segments; long-term follow-up of the TOPS cohort will be necessary to determine whether the motion preserved by the TOPS device outweighs the potential downside of sacrificing the posterior ligamentous complex in terms of precipitating adjacent segment disease.…”

“…The 5.9% overall rate of reoperation in this TOPS cohort is lower than reported 1-year reoperation rates in the literature following single-level lumbar fusions (13.5%) and similar to rates reported following single-level TLIF (4%). 33 However, further exploration of the indication for reoperation reveals important differences. In a large database study of 71,456 patients undergoing one- or two-level lumbar fusions, Cummins et al found that 43.5% of the 9670 reoperations performed within 1-year from the index surgery were owing to adjacent segment degeneration, 37.65% were owing to mechanical failure, and 7.17% were owing to stenosis.…”

“…However, further exploration of the indication for reoperation reveals important differences. In a large database study of 71,456 patients undergoing one- or two-level lumbar fusions, Cummins et al found that 43.5% of the 9670 reoperations performed within 1-year from the index surgery were owing to adjacent segment degeneration, 37.65% were owing to mechanical failure, and 7.17% were owing to stenosis 33. No patient in the present study required reoperation for adjacent segment disease at 1 year postoperatively, and only 1 patient (0.7%) required reoperation owing to hardware complications.…”