Postoperative Outcomes Following Posterior Lumbar Fusion in Patients With Multiple Sclerosis

Abstract

of Background: Multiple sclerosis (MS) is a chronic inflammatory disease that can cause physical and neurological dysfunction. Patients with MS are living longer and undergoing more orthopedic procedures, but the risk of patients with MS undergoing posterior lumbar fusion (PLF) has not been studied in literature before.Objective: This study aims to (1) analyze the rates of postoperative complications of MS patients undergoing primary PLF and (2) analyze the economic burden associated with these surgeries in the MS population compared with patients without MS.Methods: A retrospective review of the Medicare database was conducted on all patients who underwent PLF and/or posterior lumbar interbody fusion between the years of 2006 and 2013. Cases involving same-day anterior or revision procedures and patients with a history of spine, infection, and trauma, or neoplasm were excluded from the study. Demographics, comorbidities, 90-day postoperative complications, cost, and length of stay were calculated. All outcomes of interest were analyzed using multivariate logistic regression, adjusting for age, sex, and comorbidity burden. Significance was defined as P-value < 0.05.Results: There were 2363 patients with MS and 23,569 matched controlled patients. We found a significant increase in the risk of sepsis [odds ratio (OR) = 1.85, P = 0.034], urinary tract infection (OR = 1.89, P < 0.001), deep vein thrombosis (OR = 1.4, P = 0.044), 90-day emergency room visit (OR = 1.14, P = 0.027), and 90-day readmissions (OR = 1.20, P = 0.011) compared with patients without a history of MS. Patients with MS also incurred $4379 extra in total hospital charge, a $1679 increase in the cost of hospitalization, and an increase in length of stay (4.05 vs. 3.61, P < 0.001).Conclusions: A diagnosis of MS is associated with a significant increase in postoperative complications and higher costs after hospitalization. It is imperative for physicians to understand the risk factors of patients undergoing PLF and/or posterior lumbar interbody fusion with MS to better counsel them about postoperative complications before surgery.

Psoriatic arthritis increases the risk of venous thromboembolism following degenerative lumbar spine surgery: An analysis of U.S. Nationwide Inpatient Sample 2005–2018

“…A few prior studies have focused on the effects of RA, multiple sclerosis (MS), and other autoimmune diseases on outcomes of spine surgery. Significant increases in the risks of sepsis, urinary tract infection, deep vein thrombosis, 90-day emergency room visits, and 90-day readmissions were found in MS patients who had undergone primary posterior lumbar fusion compared with lower risks in patients without MS [ 22 ]. Another study compared postoperative outcomes of lumbar spine surgery between RA and non-RA patients through retrospective propensity score-matched analysis, finding that RA had poorer postoperative outcomes for LDD surgery compared with P S-matched non-RA patients [ 23 ].…”