The True Effect of a Lumbar Dural Tear on Complications and Cost

Abstract

Study Design. Retrospective database analysis. Objective. The aim of this study was to match risk factors for complications in patients who did and did not sustain a dural tear while undergoing posterior lumbar spine surgery and compare local and systemic complications. Summary of Background Data. Current data do not adequately define whether the event of sustaining an isolated dural tear increases the risk for postoperative complications while controlling for other confounding risk factors. Methods. The PearlDiver Database was queried for patients who underwent posterior lumbar spine decompression and/or fusion for degenerative pathology. Patients with and without dural tears were 1:2 matched based on demographic variables and comorbidities. Complications, cost, length of stay (LOS), and readmission rates were analyzed. Results. The 1:2 matched cohort included 9038 patients with a dural tear and 17,340 patients without a dural tear. All complications assessed were significantly higher in the dural tear group (P < 0.03). Venothromboembolic (VTE) events occurred in 1.3% of patients with a dural tear and 0.9% of patients without a dural tear (odds ratio [OR] 1.46, P < 0.0001). Meningitis occurred in 25 patients (0.3%) with a dural tear and eight patients (<0.1%) without a dural tear (OR 6.0, P < 0.0001). Patients with a dural tear had 120% higher medical costs, 200% greater LOS, and were two times more likely to be readmitted (P < 0.0001). Conclusion. Sustaining a dural tear while undergoing posterior lumbar spinal decompression and/or fusion for degenerative pathology significantly increased the risk of complications and increased length of stay, risk of readmission, and overall 90-day hospital cost. Dural tears specifically increased the risk of a VTE complication by 1.46 times and meningitis by six times; these are important complications to have a high degree of suspicion for in the setting of durotomy, as they can lead to significant morbidity for the patient. Level of Evidence: 3

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

“…Patients in the dural tear cohort had median 90-day total costs that were more than $10,000 higher (120% higher) than costs in the control cohort. Although neither study provided a breakdown in these cost differences, it is likely that the increased costs stem from higher rates of readmission (up to 2-fold higher) 3 and longer hospitalizations (1.5-2 days longer, on average). 5,6 Furthermore, the current article found that the occurrence of an incidental durotomy led to an extra day spent in the hospital.…”

“…Using a cohort of more than 40,000 patients from the Medicare insurance database, Puvanesarajah and Hassanzadeh 5 found that expenditures for patients with incidental durotomies were more than $4000 higher per patient, a nearly 67% increase. More recently, Alluri et al 3 reported on a 1:2 matched cohort of 26,378 patients in the PearlDiver database (a multipayer data set). Patients in the dural tear cohort had median 90-day total costs that were more than $10,000 higher (120% higher) than costs in the control cohort.…”

“…2 Consequences of dural tears include postoperative headache, meningitis, new-onset neurological deficit, pseudomeningocele, need for surgical revision, and significant financial costs to the patient and health system. [3][4][5][6] Previous ABBREVIATIONS ASA = American Society of Anesthesiologists; ASD-S = adult spinal deformity-surgical; AUC = area under the curve; CCI = Charlson Comorbidity Index; LOS = length of stay; NLP = natural language processing; PRC = precision-recall curve; ROC = receiver operating characteristic.…”

Cranial fat dissemination following fat grafting for lumbar dural tear: First case report in the literature

“…A large retrospective database analysis by Ram Alluri et al demonstrated 1.46 times increased risk of venousthromboembolsim and six times increased risk of meningitis with CSF leak [ 5 ]. Compressive radiculopathy and subdural hematoma have been also reported with dural tear and CSF leak [ 6 , 7 ].…”

Economic Analysis of Transforaminal Lumbar Interbody Fusion Surgery Utilizing a Curved Bone Removal Device

“…Table 1 presents the cost per unit of different components affecting the overall cost, extracted from the literature [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], available online resources [5,27], and the financial department of the hospital. The conversion rates used were the conversion rates on January 15th, 2020: US$1 (US dollar) = €0.9, US$1 = £0.77, and US$1 = 3.46 Israeli new shekels (ILS).…”