General Session: Value and Outcomes in Spine Surgery - Hall F

Presented by: B. Khechen

Author(s):

B. Haws(1), B. Khechen(1), A. Narain(1), F. Hijji(1), K. Cardinal(1), J. Guntin(1), K. Singh(1)

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

Abstract

Introduction: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is becoming an increasingly popular technique for the treatment of lumbar degenerative pathologies. As with all surgical procedures, the prevention of perioperative and postoperative complications is necessary in order to avoid poor postoperative outcomes and increased healthcare costs. As such, the objective of this study is to determine patient risk factors for the development of perioperative and postoperative complications up to 2 years after a primary, single-level MIS TLIF.

Methods: Patients were retrospectively reviewed to identify those who underwent primary, single-level MIS TLIF. The incidence of both medical and surgical complications up to 2 years postoperatively was determined for each patient. Patients were categorized according to demographic, comorbidity, and procedural characteristics. Bivariate Poisson regression with robust error variance was used to determine if an association existed between demographic, comorbidity, or procedural characteristics and complication incidence. A final multivariate model including all demographic, comorbidity, and procedural characteristics as controls was created using backwards, stepwise regression.

Results: 390 patients were included in this study. The most common medical complication was urinary retention requiring re-catheterization (10.3%). The most common surgical complication was symptomatic pseudarthrosis requiring index-level reoperation (8.7%), as identified via CT scan. Upon bivariate analysis, age > 50 years (p=0.025), diabetes mellitus (p=0.001), and operative duration > 105 minutes (p=0.016) were associated with increased medical complication rates after MIS TLIF. Regarding surgical complications, age ≤ 50 years (p< 0.001), obesity (p=0.012), and diabetes mellitus (p=0.028) were identified as risk factors on bivariate analysis. Upon final multivariate analysis, operative time > 105 minutes (p=0.009) and diabetes mellitus (p=0.001) were independent risk factors for medical complications. Independent risk factors for surgical complications on multivariate analysis included age ≤ 50 years (p< 0.001) and hypertension (p=0.002).

Conclusions: Older patients and those with diabetes were at increased risk of medical complications, while younger patients and those with hypertension were at increased risk of surgical complications up to 2-years after MIS TLIF. Practitioners can use this information to identify patients who require preventative care before their procedure or increased postoperative vigilance and clinical monitoring after single-level MIS TLIF.

Table 1

Table 2