5-Year Revision Rates After Elective Multilevel Lumbar/Thoracolumbar Instrumented Fusions in Older Patients: An Analysis of State Databases

The purpose of this study wasto evaluate cause-specific 5-year revision rates and risk factors for revision after elective multilevel lumbar instrumented fusion in older patients. Older patients (>60 years) who underwent elective multilevel (3+) lumbar instrumented fusions were identified in Heal...

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Bibliographic Details
Published in:Journal of the American Academy of Orthopaedic Surgeons Vol. 30; no. 10; p. 476
Main Authors: Cummins, Daniel D, Callahan, Matthew, Scheffler, Aaron, Theologis, Alekos A
Format: Journal Article
Language:English
Published: United States 15.05.2022
Subjects:
Aged
Constriction, Pathologic - etiology
Constriction, Pathologic - surgery
Female
Humans
Laminectomy
Lumbar Vertebrae - surgery
Male
Reoperation
Retrospective Studies
Spinal Fusion - adverse effects
Spinal Fusion - methods
Treatment Outcome
ISSN:1940-5480, 1940-5480
Online Access:Get more information
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Summary:The purpose of this study wasto evaluate cause-specific 5-year revision rates and risk factors for revision after elective multilevel lumbar instrumented fusion in older patients. Older patients (>60 years) who underwent elective multilevel (3+) lumbar instrumented fusions were identified in Healthcare Cost and Utilization Project state inpatient databases and followed for 5 years for revision operations because of mechanical failure, degenerative disease (DD), infection, postlaminectomy syndrome, and stenosis. Cox proportional hazards multivariate analyses were conducted to determine risk factors associated with revision for each diagnostic cause. The cohort included 5,636 patients (female-3,285; average age-71.6 years). Most of the operations were 3 to 7 levels (97.4%), and the mean length of stay was 5.4 days. The overall 5-year revision rate was 16.5% with predominant etiologies of DD (50.7%), mechanical failure (32.2%), and stenosis (8.0%). The revision procedure at the index operation was associated with an increased revision risk for DD (hazards ratio [HR] = 1.59, 95% confidence interval [CI], 1.29 to 1.98, P < 0.001) and mechanical failure (HR = 1.56, 95% CI, 1.19 to 2.04, P = 0.020). Male sex was associated with a significantly reduced revision risk for DD (HR = 0.75, 95% CI, 0.62 to 0.91, P = 0.04). Age, race, and number of comorbidities had no notable effect on the overall or cause-specific risk of revision. In this large database analysis, DD and mechanical failure were the most common etiologies comprising a 5-year revision rate of 16.5% after elective multilevel lumbar instrumented fusion in older patients. Revision operations and female patients carried the strongest risks for revision.
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ISSN:1940-5480
1940-5480
DOI:10.5435/JAAOS-D-21-00643