TY - JOUR
T1 - Risk of Pseudoarthrosis After Spinal Fusion
T2 - Analysis From the Healthcare Cost and Utilization Project
AU - Hofler, Ryan C.
AU - Swong, Kevin
AU - Martin, Brendan
AU - Wemhoff, Michael
AU - Jones, George Alexander
N1 - Funding Information:
Conflict of interest statement: G. A. Jones has received research support, paid directly to the institution, from Medtronic, owns stock in InVivo Therapeutics, received an honorarium from the Chicago Review Course, and has received compensation for travel expenses from the Cleveland Spine Review. The remaining authors have no disclosures to report.
Funding Information:
The State Inpatient Databases (SID), a family of administrative databases developed by the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality, were queried to identify patients who had undergone spinal fusion procedures in New York, California, Florida, and Washington from 2009 through 2011. These databases provide robust data regarding inpatient admissions from participating hospitals, including diagnoses and procedures performed, in the form of International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) codes and specialized database specific codes. Additionally, information on demographic data, cost, and service usage can be extracted from HCUP-defined data elements. 7
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Background: Pseudoarthrosis after spinal fusion is an important cause of pain, neurologic decline, and reoperation. Methods: The Healthcare Cost and Utilization Project State Inpatient Databases were queried in New York, California, Florida, and Washington for adult patients who had undergone new spinal fusion from 2009 to 2011. In accordance with the Healthcare Cost and Utilization Project methods series and analysis guidelines, generalized linear mixed effects models were used to estimate the odds of experiencing postoperative pseudoarthrosis as a function of multivariable patient characteristics, comorbidities, and surgical approach. Results: Of the 107,420 patients who had undergone cervical fusion, 1295 (1.2%) developed pseudoarthrosis requiring reoperation. On multivariable analysis, the risk factors included posterior (odds ratio [OR], 4.47; 95% confidence interval [CI], 3.92–5.10) and combined (OR, 1.77; 95% CI, 1.33–2.36) approaches, fusion of ≥9 vertebrae (OR, 2.54; 95% CI, 1.38–4.68), smoking (OR, 1.19; 95% CI, 1.05–1.34), and long-term steroid use (OR, 1.89; 95% CI, 1.18–3.00). Of the 148,081 patients who underwent thoracic or lumbar fusion, 2665 (1.8%) developed pseudoarthrosis. Posterior (OR, 0.58; 95% CI, 0.51–0.56) and combined (OR, 0.46; 95% CI, 0.40–0.54) approaches resulted in reduced rates. Fusion of 4–8 vertebrae (OR, 1.52; 95% CI, 1.39–1.67), ≥9 vertebrae (OR, 1.87; 95% CI, 1.49–2.34), hypertension (OR, 1.18; 95% CI, 1.09–1.28), sleep apnea (OR, 1.48; 95% CI, 1.26–1.72), smoking (OR, 1.22; 95% CI, 1.12–1.33), and long-term steroid use (OR, 1.53, 95% CI, 1.08–2.18) resulted in increased rates. Conclusions: These findings strongly associate several diagnoses with the development of pseudoarthrosis. However, further prospective studies are warranted to establish causation.
AB - Background: Pseudoarthrosis after spinal fusion is an important cause of pain, neurologic decline, and reoperation. Methods: The Healthcare Cost and Utilization Project State Inpatient Databases were queried in New York, California, Florida, and Washington for adult patients who had undergone new spinal fusion from 2009 to 2011. In accordance with the Healthcare Cost and Utilization Project methods series and analysis guidelines, generalized linear mixed effects models were used to estimate the odds of experiencing postoperative pseudoarthrosis as a function of multivariable patient characteristics, comorbidities, and surgical approach. Results: Of the 107,420 patients who had undergone cervical fusion, 1295 (1.2%) developed pseudoarthrosis requiring reoperation. On multivariable analysis, the risk factors included posterior (odds ratio [OR], 4.47; 95% confidence interval [CI], 3.92–5.10) and combined (OR, 1.77; 95% CI, 1.33–2.36) approaches, fusion of ≥9 vertebrae (OR, 2.54; 95% CI, 1.38–4.68), smoking (OR, 1.19; 95% CI, 1.05–1.34), and long-term steroid use (OR, 1.89; 95% CI, 1.18–3.00). Of the 148,081 patients who underwent thoracic or lumbar fusion, 2665 (1.8%) developed pseudoarthrosis. Posterior (OR, 0.58; 95% CI, 0.51–0.56) and combined (OR, 0.46; 95% CI, 0.40–0.54) approaches resulted in reduced rates. Fusion of 4–8 vertebrae (OR, 1.52; 95% CI, 1.39–1.67), ≥9 vertebrae (OR, 1.87; 95% CI, 1.49–2.34), hypertension (OR, 1.18; 95% CI, 1.09–1.28), sleep apnea (OR, 1.48; 95% CI, 1.26–1.72), smoking (OR, 1.22; 95% CI, 1.12–1.33), and long-term steroid use (OR, 1.53, 95% CI, 1.08–2.18) resulted in increased rates. Conclusions: These findings strongly associate several diagnoses with the development of pseudoarthrosis. However, further prospective studies are warranted to establish causation.
KW - Cervical fusion
KW - Epidemiology
KW - Healthcare Cost and Utilization Project
KW - Large database
KW - Long-term steroid use
KW - Pseudoarthrosis
KW - Reoperation
KW - Spinal fusion
KW - State Inpatient Database
KW - Thoracolumbar fusion
KW - Tobacco use
UR - http://www.scopus.com/inward/record.url?scp=85054600400&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054600400&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.08.026
DO - 10.1016/j.wneu.2018.08.026
M3 - Article
C2 - 30114540
AN - SCOPUS:85054600400
SN - 1878-8750
VL - 120
SP - e194-e202
JO - World Neurosurgery
JF - World Neurosurgery
ER -
