Oral Posters: Thoraco-lumbar Degenerative

Presented by: P. Maloney - View Audio/Video Presentation (Members Only)

Author(s):

P. Maloney(1), D. Shepherd(1), M. Murphy(1), B. Mccutcheon(1), E. Habermann(2), D. Ubl(2), P. Kerezoudis(1), M. Bydon(1)

(1) Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
(2) Mayo Clinic, Rochester, MN, United States

Abstract

Background: Decompressive laminectomy without fusion is one of the most common surgical spine procedure for treating lumbar spondylosis. In the absence of instability, decompressive laminectomies provide symptom relief with restoration of functional movement in most patients. The extent of the decompression, by number of vertebral levels, and its effects on postoperative morbidity were assessed using a national surgical database.

Methods: This study is a retrospective cohort analysis utilizing the 2011-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Patients admitted from home with degenerative spine disease for lumbar decompression without fusion were included. Thirty-day outcomes and operative characteristics were compared with regard to the number of vertebral levels decompressed using chi-square and Kruskal-Wallis tests. Multivariable logistic regression analysis was used to interrogate whether the extent of lumbar decompression was significantly associated with adverse discharge disposition, 30-day readmission, or any minor complication.

Results: A total of 8744 patients were identified and stratified into the following cohorts by the number vertebral levels of decompression: one, two, and three or more (3+) levels. Univariate analysis showed that 3+ levels was significantly associated with increased age, increased BMI, non-smoking status, functional dependency , hypertension requiring medications, steroid use for chronic conditions, decreased glomerular filtration rate, and higher ASA score (all p< 0.05). Operative and outcome measures associated with 3+ levels included operative time, perioperative blood transfusions, any major morbidity, length of hospital stay, readmissions within 30 days, return to the operating room, and non-home discharge(all p< 0.05). On multivariable analysis with single level surgery as the reference, increased levels of surgery were significantly associated with discharge location other than home (two levels OR 1.5, 95% CI 1.29-1.85) (3+ levels OR 1.75, 95% CI 1.40-2.20) but not 30 day readmission or any minor complication (both p>0.05).

Conclusions: In patients undergoing lumbar decompression, increasing the number of vertebral levels was significantly associated with postoperative morbidity. Increased number of levels was associated with a significantly higher odds of discharge to a location other than home. Postoperative morbidity risk stratification and disposition merit discussion during preoperative counseling, especially when multilevel decompressions are being considered.