Trends in Short Construct Lumbar Fusions Over the Past Decade at a Single Institution

Author:

Lambrechts Mark J.ORCID,Siegel Nicholas,Issa Tariq Z.,Karamian Brian A.,Bodnar John G.,Canseco Jose A.,Woods Barrett I.,Kaye I. David,Hilibrand Alan S.,Schroeder Gregory D.,Vaccaro Alexander R.,Kepler Christopher K.

Abstract

Study Design. Retrospective cohort Objective. (1) To compare the rates of fusion techniques over the last decade; (2) to identify whether surgeon experience affects a surgeon’s preferred fusion technique; (3) to evaluate differences in complications, readmissions, mortality, and patient-reported outcomes measures (PROMs) based on fusion technique. Summary of Background Data. Database studies indicate the number of lumbar fusions have been steadily increasing over the last two decades; however, insufficient granularity exists to detect if surgeons’ preferences are altered based on additive surgical experience. Methods. A retrospective review of continuously collected patients undergoing lumbar fusion at a single urban academic center was performed. Rates of lumbar fusion technique: posterolateral decompression fusion (PLDF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion + PLDF (ALIF), and lateral lumbar interbody fusion + PLDF (LLIF) were recorded. Inpatient complications, 90-day readmission, and inpatient mortality were compared with χ2 test and Bonferroni correction. The Δ 1-year PROMs were compared with the analysis of variance. Results. Of 3938 lumbar fusions, 1647 (41.8%) were PLDFs, 1356 (34.4%) were TLIFs, 885 (21.7%) were ALIFs, and 80 (2.0%) were lateral lumbar interbody fusions. Lumbar fusion rates increased but interbody fusion rates (2012: 57.3%; 2019: 57.6%) were stable across the study period. Surgeons with <10 years of experience performed more PLDFs and less ALIFs, whereas surgeons with >10 years’ experience used ALIFs, TLIFs, and PLDFs at similar rates. Patients were more likely to be discharged home over the course of the decade (2012: 78.4%; 2019: 83.8%, P<0.001). No differences were observed between the techniques in regard to inpatient mortality (P=0.441) or Δ (postoperative minus preoperative) PROMs. Conclusions. Preferred lumbar fusion technique varies by surgeon preference, but typically remains stable over the course of a decade. The preferred fusion technique did not correlate with differences in PROMs, inpatient mortality, and patient complication rates. Levels of Evidence. 3—treatment.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine

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