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.

Conclusion

In this study, osteoporotic patients treated with autologous grafts had higher rates of complications compared to those treated with nonautologous grafts. Anterior and posterior approaches had similar complication rates; however, the anterior approach was associated with a higher total cost. Future studies with in-depth clinical data will need to validate the results of this study and further describe variables that are meaningful to the clinical management of osteoporotic patients in need of lumbar spine fusion.

1 2 3 4 5

Next Section

No funds were received in support of this work.

Table 1. Patient Demographics
Biologics Demographics	Autologous, Single-level	Nonautologous Single-level	P
N	2710	393	—
Age (±SD)	70.1 ± 9.4	69.8 ± 9.3	0.52
Female (%)	88.4	89.1	0.70
CCI (±SD)	4.0 ± 1.6	3.9 ± 1.1	0.19
	Autologous, Multi-level	Nonautologous Multi-level	P
N	3265	473	—
Age (±SD)	70.1 ± 10.2	69.7 ± 10.4	0.40
Female (%)	82.2	83.1	0.65
CCI (±SD)	4.18 ± 1.2	4.2 ± 1.3	0.80
Column Demographics	Anterior, Single-level	Posterior Single-level	P
N	2573	1881	—
Age (±SD)	68.6 ± 9.1	70.9 ± 9.3	<0.0001*
Female (%)	87.8	88.3	0.63
CCI (±SD)	3.96 ± 1.2	4.15 ± 1.1	0.0001*
	Anterior, Multi-level	Posterior Multi-level	P
N	1198	2692	—
Age (±SD)	69.2 ± 8.9	70.7 ± 10.3	<0.0001*
Female (%)	85.2	82.7	0.04*
CCI (±SD)	4.1 ± 1.2	4.2 ± 1.3	0.004*

CCI indicates Charlson Comorbidity Index; SD, standard deviation.
*annotates significance.

Table 2. Postoperative Complications at 30-, 90-, and 180 Days in Patients Receiving Single- or Multilevel Lumbar Fusion With Autologous or Nonautologous Graft Material
Biologics Complications, 30 Days	Autologous, Single-level	Nonautologous Single-level	P
Infection (%)	22.8	25.5	0.68
Postoperative pain (%)	2.0	2.0	0.98
Wound dehiscence (%)	7.8	7.8	0.99
Hardware failure (%)	8.4	0.0	0.00014*
Lumbar vertebral fracture (%)	2.6	4.2	0.16
	Autologous, Multi-level	Nonautologous Multi-level	P
Infection (%)	29.5	24.40.32
Postoperative pain (%)	5.0	3.7	0.56
Wound dehiscence (%)	10.0	8.5	0.66
Hardware failure (%)	6.9	6.1	0.84
Lumbar vertebral fracture (%)	6.9	7.8	0.54
Biologics Complications, 90 Days	Autologous, Single-level	Nonautologous Single-level	P
Postoperative pain (%)	2.3	2.2	0.98
Hardware failure (%)	8.9	0.0	<0.0001*
Lumbar vertebral fracture (%)	1.6	0.0	0.045*
	Autologous, Multi-level	Nonautologous Multi-level	P
Postoperative pain (%)	4.8	4.1	0.76
Hardware failure (%)	7.8	6.3	0.66
Lumbar vertebral fracture (%)	3.4	3.2	0.93
Biologics Complications, 180 Days	Autologous, Single-level	Nonautologous Single-level	P
Hardware failure (%)	9.3	4.0	0.24
Lumbar vertebral fracture (%)	0.8	0.0	0.16
	Autologous, Multi-level	Nonautologous Multi-level	P
Hardware failure (%	8.3	4.7	0.24
Lumbar vertebral fracture (%)	1.7	3.1	0.53

*annotates significance.

Table 3. Multivariate Analysis in Patients Receiving Single- or Multi-level Lumbar Fusion of the Anterior or Posterior Column
	Anterior vs. Posterior, Single-level (Anterior = 1)			Anterior vs. Posterior, Multi-level (Anterior = 1)
	OR	95% CI	P	OR	95% CI	P
30-Day readmission*	1.03	0.70–1.52	0.88	1.05	0.72–1.52	0.79
90-Day readmission*	1.03	0.75–1.42	0.85	0.97	0.70–1.32	0.83
180-Day readmission*	0.91	0.65–1.27	0.57	1.11	0.78–1.56	0.56
30-Day infection*	1.44	0.84–2.47	0.19	1.32	0.79–2.17	0.29
LOS^†	0.95	0.62–1.46	0.81	0.9	0.49–1.65	0.73
Ln transformed total charge^†	1.36	1.29–1.44	<0.0001*	1.29	1.21–1.38	<0.0001

CI indicates confidence interval; LOS, length of stay; OR, odds ratio.
*Multivariate analysis using binomial logistic regression with age, sex, and CCI as covariates.
^†Multivariate analysis using gaussian generalized linear regression modeling with age, sex, and CCI as covariates.