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

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.