Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion

Shane Shahrestani, MS; Xiao T. Chen, BA; Alexander M. Ballatori, BA; Andy Ton, BS; Joshua Bakhsheshian, MD; Raymond J. Hah, MD; Jeffrey C. Wang, MD; Zorica Buser, PhD

Disclosures

Spine. 2021;46(21):1478-1484. 

In This Article

Results

Demographics

A total of 239,480 individuals received a primary lumbar spine fusion in 2016 or 2017 within the NRD, of which 11,086 (4.63%) had ICD-10 diagnosis codes for osteoporosis of the lumbar spine. Within the osteoporotic cohort, 2710 (24.4%) individuals received single-level lumbar fusion with autologous graft material, 393 (3.5%) received single-level fusion with nonautologous graft material, 3265 (29.5%) received multi-level fusion with autologous graft material, and 473 (4.3%) received multi-level fusion with nonautologous graft material. Of the same cohort, 2573 (23.2%) individuals received single-level fusion of the anterior column, 1881 (17.0%) received single-level fusion of the posterior column, 1198 (10.8%) received multilevel fusion of the anterior column, and 2692 (24.3%) received multilevel fusion of the posterior column (Figure 1). The average ages, percentage of female patients, and CCI for all patients in all cohorts are shown in Table 1.

Figure 1.

Patient selection flowchart.

Autologous Versus Nonautologous Grafts

Univariable analysis comparing usage of autologous and nonautologous biologics revealed no differences in age, sex, or CCI at the time of primary admission within single and multilevel fusion groups. Osteoporotic patients receiving single-level lumbar fusion with nonautologous biologic graft material had significantly lower rates of hardware failure (autologous: 8.4%, nonautologous: 0.0%, P = 0.00014) at 30-day follow-up and 90-day follow-up (autologous: 8.9%, nonautologous: 0.0%, P < 0.0001) and lower rates of lumbar vertebral fractures at 90-day follow-up (autologous: 1.6%, nonautologous: 0.0%, P = 0.045) compared with those receiving single-level lumbar fusion with autologous biologic augmentation (Table 2). However, patients receiving fusion with autologous graft material had lower total inpatient charges compared to those receiving fusion with nonautologous graft material. No significant differences in readmission rates, or LOS were found between osteoporotic patients receiving single-level fusion with autologous and nonautologous graft materials.

No significant differences in total inpatient charge, readmission rates, LOS, postoperative pain, lumbar vertebral fracture, or hardware failure were found between osteoporotic patients receiving multilevel fusion with autologous and nonautologous graft materials.

Anterior Versus Posterior Column

On multivariable logistic regression analysis, osteoporotic patients receiving single-level anterior column lumbar fusion did not have significant differences in 30-day infection rates or 30-day, 60-day, and 180-day readmission rates compared with those receiving single-level posterior column lumbar fusion. Generalized linear modeling revealed no significant difference in LOS between patients who received single-level fusion of the anterior or posterior column but did find a significant difference in the log-transformed total inpatient charge between the two cohorts. Namely, single-level anterior column fusions were associated with significantly higher primary total hospital charge (anterior: $169,106 ± $139,248, posterior: $125,404 ± $108,614, P < 0.0001) (Table 3, Supplemental Tables 2–5, http://links.lww.com/BRS/B764).

Osteoporotic patients receiving multilevel, anterior lumbar fusions did not have significant differences in 30-day infection rates or 30-day, 60-day, and 180-day readmission rates compared with those receiving multilevel posterior lumbar fusion. Generalized linear modeling revealed no significant difference in LOS between patients who received multilevel fusion of the anterior or posterior column but did find a significant difference in the log-transformed total inpatient charge between the two cohorts. Multilevel anterior fusions were associated with significantly higher primary total hospital charge compared with multilevel posterior fusions (anterior: $256,527 ± $196,479, posterior: $196,036 ± $163,195, P < 0.0001) (Table 3, Supplemental Tables 6–9, http://links.lww.com/BRS/B764).

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