347 - Outcomes of Multi-level Anterior Lumbar Fusion from 2002-2011...

#347 Outcomes of Multi-level Anterior Lumbar Fusion from 2002-2011

Epidemiology/Natural History

Poster Presented by: K. Singh


A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States


Introduction: Anterior lumbar fusion is performed for both single and multi-level degenerative pathology. To characterize the differences based upon the number of fusion levels, a population-based database was analyzed with regards to patient demographics, complications, mortality and costs.

Methods: Data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project was queried from 2002-2011. Patients undergoing an anterior lumbar fusion (ALF) for the diagnosis of lumbar radiculopathy, herniated nucleus pulposus, degenerative disc disorder, and spinal stenosis were identified and separated into three cohorts depending upon the number of levels fused (1-2, 3-7, and 8 or more fusion levels). Patient demographics, comorbidities (CCI), postoperative complications, hospital length of stay (LOS) and total costs were compared between the cohorts. Statistical analysis was performed with χ2 and one-way ANOVA for categorical and continuous data respectively. A p-value of < 0.001 denoted statistical significance.

Results: A total of 25,829 patients underwent an ALF between 2002-2011 of which 23,785 (92.1%) involved 1-2 levels, 1,720 (6.7%) involved 3-7 levels, and 324 (1.2%) involved 8+ levels. Patients in the 8+ level cohort were significantly older and demonstrated a greater comorbidity burden than the 1-2 and 3-7 level cohorts (p< 0.001). In addition, the 8+ level cohort demonstrated the greatest LOS and total hospital costs when compared to the other cohorts (p< 0.001). Patients who underwent a 3-7 level fusion demonstrated the highest incidence of postoperative pulmonary embolism (PE) and surgical site infections (SSI). In contrast, patients who underwent an 8+ level fusion demonstrated the greatest incidence of deep vein thrombosis (DVT), cardiac complications, hematoma, hemorrhagic anemia, ileus, urinary tract infection (UTI) and neurological complications. However, the number of fusion levels did not significantly increase the postoperative mortality rate.

Conclusions: The patients who underwent an 8+ level ALF were older, demonstrated a greater comorbidity burden, and incurred a greater LOS and total hospital costs. In addition, patients with 3+ fusion levels demonstrated a greater incidence of postoperative complications when compared to the 1-2 level cohort. However, mortality did not significantly differ based upon the number of fusion levels. Further studies are warranted to characterize the impact of multilevel ALF procedures on the incidence of postoperative complications.

Table 1