162 - Outcomes of Multi-level versus Single Level Lumbar Spine Surgery...

#162 Outcomes of Multi-level versus Single Level Lumbar Spine Surgery

Epidemiology-Natural History

Poster Presented by: K. Singh


K. Singh (1)
M. Pelton (1)
S.J. Fineberg (1)
M. Oglesby (1)
A. Patel (2)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, USA
(2) Northwestern University Feinberg School of Medicine, Orthopaedic Surgery, Chicago, IL, USA


Introduction: Lumbar fusions are commonly performed for both single level and multi-level degenerative pathologies. Complications and costs differences based upon increasing levels of degenerative pathology are not well known. To characterize these differences on a national level, a population-based database was analyzed with regards to patient demographics, complications, mortality and costs.

Methods: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was obtained for each year between 2002-2009. Patients undergoing lumbar fusion (LF) for the diagnosis of lumbar radiculopathy, herniated nucleus pulposus, degenerative disc disorder, and spinal stenosis were identified and separated into three cohorts (1-2 levels, 3-7 levels, and 8 or greater levels). Patient demographics and co-morbidities were compared. Major complications, hospitalization days, and costs were assessed. χ2 was used to assess for significant differences between categorical data and Pearson´s Correlation was used to identify trends. Regression analysis was performed to assess independent predictors of in-hospital mortality. A p-value of ≤ 0.0005 was used to denote significance.

Results: A total of 222,672 lumbar fusions were identified in the NIS from 2002-2009. Patients treated with multi-level fusions (3+ levels) trended towards increasing ages, co-morbidity scores, hospitalization days, and costs over 1-2 level fusions. (P< 0.0005) (Table 1). All procedure-related complications (per 1,000 cases) and in-hospital mortality rates were higher as the number of levels increased. The most prevalent complications in three or more level cases were cardiac complications and infection. Regression analysis revealed predictors of mortality were age >65 years, congestive heart failure, coagulopathy, electrolyte disorders, neurologic disorders, peripheral vascular disease, pulmonary disorders, renal failure, and weight loss.

Discussion: Patients undergoing multi-level (3 or more) lumbar fusion demonstrate increased hospitalizations, costs, complications, and mortality. Possible explanations for these increases are a greater complexity and co-morbidity of patients treated with multi-level fusions. Elderly patients with the presence of certain risk factors (e.g. heart failure, coagulopathy) should be identified and treated prophylactically to decrease complications and mortality. We suggest that more vigilant post-operative monitoring is indicated to decrease the incidence of common complications after multi-level procedures and decrease overall mortality. Lastly, these significant risk factors and differences in complication rates should be accounted for in the surgical decision making process and used to aid patient decision making.

Table 1