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

Montenegro, Thiago S.; Singh, Akash Ranjan; Elia, Christopher; Matias, Caio; Gonzalez, Glenn A.; Saiegh, Fadi Al; Philipp, Lucas; Hattar, Ellina; Hines, Kevin; Fatema, Umma; Thalheimer, Sara; Wu, Chengyuan; Prasad, Srinivas; Jallo, Jack; Heller, Joshua; Sharan, Ashwini

doi:10.1093/neuros/nyab300

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…15 A recent retrospective study evaluated the impact of a different surgeon on outcomes after revision spine fusion identifying a greater 6month ODI improvement among patients operated on by a different surgeon. 26 In contrast, our study found no significant differences across any PROM regardless of whether the index surgeon or a different surgeon performed the revision. However, we did identify that patient's operated on at a different hospital than their index fusion did not report improvement in baseline physical or mental health.…”

Section: Discussioncontrasting

confidence: 82%

“…Patients undergoing revision surgery are more likely to experience only modest improvement in disability and physical function postoperatively 15 . A recent retrospective study evaluated the impact of a different surgeon on outcomes after revision spine fusion identifying a greater 6-month ODI improvement among patients operated on by a different surgeon 26 . In contrast, our study found no significant differences across any PROM regardless of whether the index surgeon or a different surgeon performed the revision.…”

Section: Discussioncontrasting

confidence: 68%

“…Only one study evaluated this phenomenon, identifying improved outcomes among a very small cohort of 117 patients who underwent revision surgery with a different surgeon. 26 However, the effects of length of time between index and revision fusion and the effects of hospital change have not been evaluated. Therefore, the primary objective our study was to evaluate the impact of a different surgeon performing the revision procedure on surgical outcomes including complications, readmissions, length of stay, and subsequent revisions.…”

mentioning

confidence: 99%

“…Only one study evaluated this phenomenon, identifying improved outcomes among a very small cohort of 117 patients who underwent revision surgery with a different surgeon 26 . However, the effects of length of time between index and revision fusion and the effects of hospital change have not been evaluated.…”

mentioning

confidence: 99%

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Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision?

Issa

Toci²,

Lambrechts³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective cohort study. Objective: To determine the effects of discontinuity in care by changing surgeons, health systems, or increased time to revision surgery on revision spine fusion surgical outcomes and patient-reported outcomes. Summary of Background Information: Patients undergoing revision spine fusion experience worse outcomes than those undergoing primary lumbar surgery. Those requiring complex revisions are often transferred to tertiary or quaternary referral centers under the assumption that those institutions may be more accustomed at performing those procedures. However, there remains a paucity of literature assessing the impact of discontinuity of care in revision spinal fusions. Methods: Patients who underwent revision 1–3 level lumbar spine fusion 2011–2021 were grouped based on (1) revision performed by the index surgeon versus a different surgeon, (2) revision performed within the same versus different hospital system as the index procedure, and (3) length of time from index procedure. Multivariate regression for outcomes controlled for confounding differences. Results: A total of 776 revision surgeries were included. An increased time interval between the index procedure and the revision surgery was predictive of a lower risk for subsequent revision procedure (odds ratio: 0.57, P=0.022). Revision surgeries performed by the same surgeon predicted a reduced length of hospital stay (β: −0.14, P=0.001). Neither time to revision nor undergoing by the same surgeon or same practice predicted 90-day readmission rates. Patients are less likely to report meaningful improvement in Mental Component Score-12 or Physical Component Score-12 if revision surgery was performed at a different hospital system. Conclusions: Patients who have revision lumbar fusions have similar clinical outcomes regardless of whether their surgeon performed the index procedure. However, continuity of care with the same surgeon may reduce hospital length of stay and associated health care costs. The length of time between primary and revision surgery does not significantly impact patient-reported outcomes. Level of Evidence: Level III.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussioncontrasting

confidence: 68%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision?

Issa

Toci²,

Lambrechts³

et al. 2023

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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“…Yet, it is important to highlight that the average ΔODI improvement across our cohort at three months and one year post-revision was 13.36 and 18.66, respectively. In comparison, previous reports have documented mean ODI improvements of 6.58, and 5.0 at 6 months following revision lumbar fusion [24,25]. Similarly, Djurasovic et al highlighted a modest improvement in ODI by 11.4 points in comparison to significantly greater improvements in patients undergoing primary lumbar fusion [7].…”

Section: Resultsmentioning

confidence: 74%

The attainment of a patient acceptable symptom state in patients undergoing revision spine fusion

Issa,

Tarawneh,

Ezeonu

et al. 2024

Eur Spine J

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Introduction Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision. Methods We retrospectively identified all 1–3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a distribution-based method at each postoperative time point. PASS was set at the threshold of ≤ 22. Results We identified 197 patients: 56% with ASD, 28% with recurrent stenosis, and 15% with pseudarthrosis. The MCID for ODI was 10.05 and 10.23 at three months and one year, respectively. In total, 61% of patients with ASD, 52% of patients with nonunion, and 65% of patients with recurrent stenosis achieved our cohort-specific MCID at one year postoperatively with ASD (p = 0.78). At one year postoperatively, 33.8% of ASD patients, 47.8% of nonunion patients, and 37% of patients with recurrent stenosis achieved PASS without any difference between indication (p = 0.47). Conclusions The majority of patients undergoing revision spine fusion experience significant postoperative improvements regardless of the indication for revision. However, a large proportion of these patients do not achieve the patient acceptable symptom state. While revision spine surgery may offer substantial benefits, these results underscore the need to manage patient expectations.

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Effect of revision sacroiliac joint fusion on unresolved pain and disability: a retrospective cohort study

Brown,

Swiontkowski,

Odland

et al. 2024

Eur Spine J

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

Cited by 4 publications

References 27 publications

Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision?

Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision?

The attainment of a patient acceptable symptom state in patients undergoing revision spine fusion

Effect of revision sacroiliac joint fusion on unresolved pain and disability: a retrospective cohort study

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