Agarwal, Amil

Bernstein, Sophie

Malyavko, Alisa

Patel, Shalin

Sproul, David

Stoll, William T.

Thakkar, Savyasachi C.

Weinreb, Jeffrey

English

George Washington University: Health Sciences Research Commons (HSRC)

Revision Rate Following Anterior and Posterior Lumbar Fusion Based on Age David Sproul PharmD1, Alisa Malyavko MS1, Amil Agarwal BS1, Sophie Bernstein2, William T. Stoll MD1, Jeffrey Weinreb MD1, Alex Gu MD1,Savyasachi C. Thakkar MD3, Shalin Patel MD11Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M St NW, Washington DC, 200372University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO 641083Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD 21044Purpose• Spinal arthrodesis is the fusion of two ormore vertebrae for the purpose ofimmobilizing the joint(s) of the adjacentvertebrae• Our study looks at creating stratum-specificlikelihood ratios (SSLR) to determine anage range, if one exists where the risk ofrequiring a revision surgery for lumbarfusion and the associated morbidity mayimpact perioperative planning or evenoutweigh the benefit of the surgery itselfMethods Data was collected using the Marinerdataset of the PearlDiver Patient RecordsDatabase from 2010 to 2019. CurrentProcedural Terminology (CPT) codesidentified surgical procedures Patients who underwent anterior orposterior lumbar fusion were identifiedusing CPT codes We defined a revision procedure as anotherlumbar fusion performed after 30 days fromthe initial procedure. Stratum specific likelihood ratio (SSLR)analysis was performed within each cohortto determine age intervals corresponding toincreased revision rates. Analysis was performed using thePearlDiver Patient Records DatabasePearlDiver Database from 2010 to 2019(>121 Million patients)Patients identified by CPT codes (separated by approach)Patients filtered for exclusion criteria using ICD codesPatients for SSLR analysisPosterior N=175,56 Anterior N=40,147Flow chart showing how sample population was identifiedResults• In identifying those undergoing posteriorlumbar fusion, 175,567 patients wereidentified• 13,947 patients (7.94%) betweenthe ages of 18 and 40• 73,434 (41.83%) between theages of 41 and 62• 88,186 (50.23%) between theages of 63 and 80• In identifying those undergoing anteriorlumbar fusion, 40,147 patients wereidentified• 9,859 patients (24.56%) betweenthe ages of 18 and 44• 5,611 (13.98%) between the agesof 45 and 50• 24,677 (61.47%) between theages of 51 and 80• For both approaches, older patients had aincreased risk for 90-day postoperativecomplicationsTake Home Points• Older patients undergoing posteriorfusion surgery were found to have alower likelihood of needing revisionsurgery following the initial procedure• Older patients undergoing anteriorlumbar fusion had a higher likelihood ofneeding revision surgery• Further investigation should be done todetermine reasons for differences inrevision ratesPLF Ages 41-62 PLF Ages 63-80Odds Ratio 5% 95% P-value Odds Ratio 5% 95% P-value1-year Revision 0.726 0.649 0.813 <0.001 0.512 0.446 0.587 <0.0012-year Revision 0.731 0.665 0.803 <0.001 0.476 0.425 0.534 <0.001All Complications 1.085 1.028 1.144 0.003 1.302 1.229 1.379 <0.001SSI 0.731 0.660 0.811 <0.001 0.571 0.508 0.643 <0.001Renal Failure 1.536 1.206 1.986 0.001 1.998 1.565 2.588 <0.001Anemia 1.406 1.287 1.540 <0.001 1.625 1.478 1.789 <0.001Blood Transfusion 1.154 1.006 1.328 0.043 1.279 1.105 1.485 0.001Pneumonia 0.934 0.794 1.105 0.420 1.001 0.841 1.196 0.995Stroke 1.466 1.076 2.049 0.020 2.448 1.792 3.427 <0.001DVT 1.188 0.968 1.472 0.107 1.200 0.966 1.503 0.106Heart Failure 1.127 0.832 1.559 0.453 1.621 1.202 2.231 0.002Respiratory Complications0.870 0.701 1.090 0.217 1.047 0.834 1.326 0.696Readmission 0.970 0.896 1.050 0.447 0.961 0.880 1.050 0.377ALF Ages 45-50 ALF Ages 51-80Odds Ratio 5% 95% P-value Odds Ratio 5% 95% P-value1-year Revision 1.164 1.024 1.323 0.020 2.388 2.176 2.624 <0.0012-year Revision 1.183 1.051 1.332 0.005 2.188 2.005 2.391 <0.001All Complications 1.110 1.002 1.229 0.045 1.439 1.332 1.556 <0.001SSI 1.042 0.834 1.298 0.714 1.047 0.881 1.248 0.603Renal Failure 1.392 0.908 2.134 0.128 2.484 1.827 3.453 <0.001Anemia 1.217 1.021 1.447 0.027 1.817 1.597 2.073 <0.001Blood Transfusion 1.359 1.000 1.839 0.048 1.281 1.010 1.636 0.044Pneumonia 1.135 0.856 1.502 0.375 1.195 0.960 1.498 0.116Stroke 1.213 0.568 2.581 0.614 3.516 2.092 6.350 <0.001DVT 1.072 0.790 1.448 0.652 1.074 0.851 1.365 0.551Heart Failure 1.073 0.603 1.931 0.812 1.931 1.268 3.060 0.003Respiratory Complication1.064 0.712 1.580 0.760 2.030 1.534 2.729 <0.001Readmission 1.176 1.031 1.340 0.015 1.649 1.493 1.823 <0.001Multivariate Analysis of 1-Year and 2-Year Revision as well as 90-Day Postoperative Complications in Patients Undergoing Posterior Lumbar Fusion (PLF) Between the Ages of 41-62 and 63-80 Years Compared to the 18-40 Years Old CohortMultivariate Analysis of 1-Year and 2-Year Revision as well as 90-Day Postoperative Complications in Patients Undergoing Anterior Lumbar Fusion (ALF) Between the Ages of 45-50 and 51-80 Years Compared to the 18-44 Years Old Cohort

Revision Rate Following Anterior and Posterior Lumbar Fusion Based on Age

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1294&context=gw_research_showcase

Revision Rate Following Anterior and Posterior Lumbar Fusion Based on Age

Abstract

Similar works

Full text

Available Versions

George Washington University: Health Sciences Research Commons (HSRC)