Clinical outcomes in revision lumbar spine fusions: an observational cohort study

Montenegro, Thiago S.; Gonzalez, Glenn A.; Saiegh, Fadi Al; Philipp, Lucas; Hines, Kevin; Hattar, Ellina; Franco, Daniel; Mahtabfar, Aria; Keppetipola, Kavantissa M.; Leibold, Adam; Atallah, Elias; Fatema, Umma; Thalheimer, Sara; Wu, Chengyuan; Prasad, Srinivas; Jallo, Jack; Heller, Joshua; Sharan, Ashwini

doi:10.3171/2020.12.spine201908

Cited by 19 publications

(16 citation statements)

References 44 publications

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“…We found that the VAS scores of these patients remained higher than those who did not undergo the second procedure at the final follow-up, which was consistent with the results of previous studies [7,18]. In a retrospective study of 309 patients, Montenegro et al [19] found that up to 23% of patients had a declined functional status 6 months after reoperation. The underlying reason for this is unclear; however, more extended hospital stays and higher costs may lead to lower satisfaction and confidence in the operation [20,21].…”

Section: Discussionsupporting

confidence: 91%

Incidence and risk factors for early and late reoperation following lumbar fusion surgery

Wang

Wang²,

Li³

et al. 2022

J Orthop Surg Res

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Study design Retrospective cohort study. Purpose The aim of our study was to determine the rates and indications of reoperations following primary lumbar fusion, as well as the independent risk factors for early and late reoperation. Methods We retrospectively reviewed patients who underwent lumbar fusion surgery between January 2017 and March 2020. All patients were followed up for more than 2 years. Characteristics, laboratory tests, primary diagnosis and surgery-related variables were compared among the early reoperation (< 3 months), the late reoperation (> 3 months) and the non-reoperation groups. Multivariable logistic regression analysis was used to identify independent risk factors for early and late reoperations. Results Of 821 patients included in our studies, 34 patients underwent early reoperation, and 36 patients underwent late reoperation. The cumulative reoperation rate was about 4.1% (95% CI 3.8–4.5%) at 3 months, 6.2% (95% CI 5.9–6.5%) at 1 year and 8.2% (95% CI 8.0–8.5%) at 3 years. Multivariable analysis indicated that osteoporosis (odds ratio [OR] 3.6, 95% CI 1.2–10.5, p = 0.02) and diabetes (OR 2.1, 95% CI 1.1–4.5, p = 0.04) were independently associated with early reoperation and multilevel fusion (OR 2.4, 95% CI 1.1–5.4, p = 0.03) was independently associated with late reoperation. Conclusions The most common reasons for early reoperation and late operation were surgical site infection and adjacent segment diseases, respectively. Osteoporosis and diabetes were independent risk factors for early reoperation, and multilevel fusion was independent risk factor for late reoperation. Surgeons should pay more attention to these patients, and future studies should consider the effects of follow-up periods on results.

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Section: Discussionsupporting

confidence: 91%

Incidence and risk factors for early and late reoperation following lumbar fusion surgery

Wang

Wang²,

Li³

et al. 2022

J Orthop Surg Res

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“…A subset analysis was also conducted to evaluate exclusively patients who had just 2 surgeries (the primary procedure and the revision) (n = 65) to evaluate whether the addition of multiple procedures might have influenced the results, but the findings were analogous to what was demonstrated with the full dataset. The median ODI improvement of the group of patients who had a revision with a different surgeon (median: 10; IQR, [3][4][5][6][7][8][9][10][11][12][13][14] was significantly greater than the group who had a revision with the same spine surgeon (median: 4; IQR, -2 to 11) (P = .031). Moreover, the percentage of patients from the different group who achieved ODI MCID (68.5%) was also significantly higher than the same group (43.3%) (P = .041) in this subset analysis.…”

Section: Resultsmentioning

confidence: 99%

Independent Predictors of Revision Lumbar Fusion Outcomes and the Impact of Spine Surgeon Variability: Does It Matter Whether the Primary Surgeon Revises?

Montenegro¹,

Singh²,

Elia³

et al. 2021

Neurosurg.

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BACKGROUND There is a paucity of information regarding treatment strategies and variables affecting outcomes of revision lumbar fusions. OBJECTIVE To evaluate the influence of primary vs different surgeon on functional outcomes of revisions. METHODS All elective lumbar fusion revisions, March 2018 to August 2019, were retrospectively categorized as performed by the same or different surgeon who performed the primary surgery. Oswestry Disability Index (ODI) and clinical variables were collected. Multiple logistic regression identified multivariable-adjusted odds ratio (OR) of independent variables analyzed. RESULTS Of the 130 cases, 117 (90%) had complete data. There was a slight difference in age in the same (median: 59; interquartile range [IQR], 54-66) and different surgeon (median: 67; IQR, 56-72) groups (P = .02); all other demographic variables were not significantly different (P > .05). Revision surgery with a different surgeon had an ODI improvement (median: 8; IQR, 2-14) greater than revisions performed by the same surgeon (median: 1.5; IQR, −3 to 10) (P < .01). Revisions who achieved minimum clinically important difference (MCID) performed by different surgeon (59.7%) were also significantly greater than the ones performed by the same surgeon (40%) (P = .042). Multivariate analysis demonstrated that a different surgeon revising (OR, 2.37; [CI]: 1.007-5.575, P = .04) was an independent predictor of MCID achievement, each additional 2 years beyond the last surgery conferred a 2.38 ([CI]: 1.36-4.14, P < .01) times greater odds of MCID achievement, and the anterior lumbar interbody fusion approach decreased the chance of achieving MCID (OR, 0.19; [CI]: 0.04-0.861, P = .03). CONCLUSION All revision lumbar spinal fusion approaches may not achieve the same outcomes. This analysis suggests that revision surgeries may have better outcomes when performed by a different surgeon.

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“…As seen in previous literature, patient specific factors such as preoperative ODI, ASA class, and classification of revision surgery demonstrated statistical correlations with PRO in the form of MCID at 6 months postoperatively. 29,34 Of note, patient factors traditionally predictive of increased morbidity such as age, 35 BMI, 36 and smoking status 37 did not improve outcome modeling as they did not significantly contribute to differences in PRO in this cohort. This is likely When examining surgeon experience, this study confirmed that MCID in ODI improvements postoperatively were statistically correlated with the surgeon's years in practice.…”

Section: Discussionmentioning

confidence: 78%

Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients

Hines¹,

Philipp²,

Thalheimer³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: The present study design was that of a single center, retrospective cohort study to evaluate the influence of surgeon-specific factors on patient functional outcomes at 6 months following lumbar fusion. Retrospective review of a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis identified the present study population. Objective: This study seeks to evaluate surgeon-specific variable effects on patient-reported outcomes such as Oswestry Disability Index (ODI) and the effect of North American Spine Society (NASS) concordance on outcomes in the setting of variable surgeon characteristics. Summary of Background Data: Lumbar fusion is one of the fastest growing procedures performed in the United States. Although the impact of surgeon-specific factors on patient-reported outcomes has been contested, studies examining these effects are limited. Methods: This is a single center, retrospective cohort study analyzing a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis by 1 of 5 neurosurgery fellowship trained spine surgeons. The primary outcome was improvement of ODI at 6 months postoperative follow-up compared with preoperative ODI. Results: A total of 307 patients were identified for analysis. Overall, 62% of the study population achieved minimum clinically important difference (MCID) in ODI score at 6 months. Years in practice and volume of lumbar fusions were statistically significant independent predictors of MCID ODI on multivariable logistic regression (P=0.0340 and P=0.0343, respectively). Concordance with evidence-based criteria conferred a 3.16 (95% CI: 1.03, 9.65) times greater odds of achieving MCID. Conclusion: This study demonstrates that traditional surgeon-specific variables predicting surgical morbidity such as experience and procedural volume are also predictors of achieving MCID 6 months postoperatively from lumbar fusion. Independent of surgeon factors, however, adhering to evidence-based guidelines can lead to improved outcomes.

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Clinical outcomes in revision lumbar spine fusions: an observational cohort study

Cited by 19 publications

References 44 publications

Incidence and risk factors for early and late reoperation following lumbar fusion surgery

Incidence and risk factors for early and late reoperation following lumbar fusion surgery

Independent Predictors of Revision Lumbar Fusion Outcomes and the Impact of Spine Surgeon Variability: Does It Matter Whether the Primary Surgeon Revises?

Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients

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