Varying Degree of Overlap Following the Critical Steps of Lumbar Fusion and Short-term Outcomes

Author:

Borja Austin J.1,Farooqi Ali S.1,Gallagher Ryan S.1,Detchou Donald K.E.1,Glauser Gregory1,Shultz Kaitlyn23,McClintock Scott D.3,Malhotra Neil R.12

Affiliation:

1. Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania

2. McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia

3. West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA

Abstract

Study Design: Retrospective cohort. Objective: The present study analyzes the impact of end-overlap on short-term outcomes after single-level, posterior lumbar fusions. Summary of Background Data: Few studies have evaluated how “end-overlap” (i.e., surgical overlap after the critical elements of spinal procedures, such as during wound closure) influences surgical outcomes. Methods: Retrospective analysis was performed on 3563 consecutive adult patients undergoing single-level, posterior-only lumbar fusion over a 6-year period at a multi-hospital university health system. Exclusion criteria included revision surgery, missing key health information, significantly elevated body mass index (>70), non-elective operations, non-general anesthesia, and unclean wounds. Outcomes included 30-day emergency department visit, readmission, reoperation, morbidity, and mortality. Univariate analysis was carried out on the sample population, then limited to patients with end-overlap. Subsequently, patients with the least end-overlap were exact-matched to patients with the most. Matching was performed based on key demographic variables—including sex and comorbid status—and attending surgeon, and then outcomes were compared between exact-matched cohorts. Results: Among the entire sample population, no significant associations were found between the degree of end-overlap and short-term adverse events. Limited to cases with any end-overlap, increasing overlap was associated with increased 30-day emergency department visits (P=0.049) but no other adverse outcomes. After controlling for confounding variables in the demographic-matched and demographic/surgeon-matched analyses, no differences in outcomes were observed between exact-matched cohorts. Conclusions: The degree of overlap after the critical steps of single-level lumbar fusion did not predict adverse short-term outcomes. This suggests that end-overlap is a safe practice within this surgical population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine,Surgery

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