Increasing Nonconcurrent Overlapping Surgery Is Not Associated With Outcome Changes in Lumbar Fusion

Abstract

Background: There remains a paucity of literature on the impact of overlap on neurosurgical patient outcomes. The purpose of the present study was to correlate increasing duration of surgical overlap with short-term patient outcomes following lumbar fusion.Methods: The present study retrospectively analyzed 1302 adult patients undergoing overlapping, single-level, posterioronly lumbar fusion within a single, multicenter, academic health system. Recorded outcomes included 30-day emergency department visits, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. The amount of overlap was calculated as a percentage of total overlap time. Comparison was made between patients with the most (top 10%) and least (bottom 40%) amount of overlap. Patients were then exact matched on key demographic factors but not by the attending surgeons. Subsequently, patients were exact matched by both demographic data and the attending surgeons. Univariate analysis was first carried out prior to matching and then on both the demographic-matched and surgeon-matched cohorts. Significance for all analyses was set at a P value of <0.05.Results: Within the whole population, increasing duration of overlap was not correlated with any short-term outcome (P = 0.41-0.91). After exact matching, patients with the most and least durations of overlap did not have significant differences with respect to any short-term outcomes (P = 0.34-1.00).Conclusion: Increased amount of overlap is not associated with adverse short-term outcomes for single-level, posterioronly lumbar fusions.Clinical Relevance: The present results suggest that increasing the duration of overlap during lumbar fusion surgery does not lead to inferior outcomes.

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

“…In the present study, we examine 30-day adverse events among patients who underwent posterior-only, single-level The duration of surgical overlap (as a percentage of total overlap time) was not associated with increased 90-d risk of intraoperative complication, readmission, ED visit, reoperation, or mortality among an exactly matched population of lumbar fusion patients Patients undergoing overlapping posterior single-level lumbar fusion are not at greater risk for adverse 90-day outcomes (Farooqi et al Clin Neurol Neurosurg 2021) 9 Overlapping surgery was not associated with increased 90-d risk of readmission, ED visit, reoperation, or mortality among an exactly matched population of lumbar fusion patients. Overlapping single-level lumbar fusion and adverse short-term outcomes (Farooqi et al J Neurosurg Spine 2021) 10 Overlapping surgery was not associated with increased 30-d risk of readmission, ED visit, reoperation, or mortality among an exactly matched population of lumbar fusion patients Postoperative outcomes and the association with overlap before or after the critical step of lumbar fusion (Farooqi et al J Neurosurg Spine 2021) 11 The duration of overlap either before or after the critical steps of surgery (as a percentage of total overlap time) was not associated with increased 90-d risk of intraoperative complication, readmission, ED visit, reoperation, or mortality among an exactly matched population of lumbar fusion patients Overlap before the critical step of lumbar fusion does not lead to increased short-term morbidity (Farooqi et al Neurosurgery 2021) 12 The duration of overlap before the critical steps of surgery (as a percentage of total overlap time) was not associated with increased 30-d risk of intraoperative complication, readmission, ED visit, reoperation, or mortality among an exactly matched population of lumbar fusion patients Increasing nonconcurrent overlapping surgery is not associated with outcome changes in lumbar fusion (Farooqi et al Int J Spine Surg 2022) 13 The duration of surgical overlap (as a percentage of total overlap time) was not associated with increased 30-d risk of readmission, ED visit, reoperation, or mortality among an exactly matched population of lumbar fusion patients Impact of the 2016 American College of Surgeons Guideline Revision on Overlapping…”