TY - JOUR
T1 - Complications and operative spine fusion construct length in Parkinson's disease
T2 - A nationwide population-based analysis
AU - McClelland, Shearwood
AU - Baker, Joseph F.
AU - Smith, Justin S.
AU - Line, Breton G.
AU - Hart, Robert
AU - Ames, Christopher P.
AU - Bess, R. Shay
PY - 2016/12/30
Y1 - 2016/12/30
N2 - There remains a dearth of information regarding the surgical complications following multilevel spine surgery in Parkinson's disease (PD) patients. This retrospective cohort study was performed to address this issue on a nationwide level using the Nationwide Inpatient Sample from 2001 to 2012. More than 25 postoperative variables were analyzed to assess the impact of fusion construct length on each variable. Subsequently, the same analysis was performed on admissions without PD. 4301 PD patients with spine fusion were identified, of whom 934 (21.7%) underwent fusion of at least three levels; the remaining 3367 underwent fusion of 1-2 levels. Patients with 3+ level fusions were more likely to suffer paraplegia (P = .001; OR = 3.0; 95%CI = 1.5-6.1), hematoma/seroma (P = .009; OR = 1.9; 95%CI = 1.2-3.2), IVC filter placement (P = .018; OR = 2.1; 95%CI = 1.1-3.9), RBC transfusion (P <. .001; OR = 3.2; 95%CI = 2.7-3.8), PE (P = .027; OR = 4.5; 95%CI = 1.2-16.9), postoperative shock (P = .023; OR = 7.3; 95%CI = 1.3-39.6), ARDS (P <. .001; OR = 4.1; 95%CI = 2.7-6.3), VTE (P = .006; OR = 2.6; 95%CI = 1.3-5.4), acute posthemorrhagic anemia (P <. .001; OR = 2.0; 95%CI = 1.7-2.4), device-related complications (P <. .001; OR = 3.1; 95%CI = 2.3-4.2), and in-hospital mortality (P = .005; OR = 3.4; 95%CI = 1.5-7.4). 3+ level fusions were also more likely to have LOS. >. 1. week (P <. .001; OR = 2.1; 95%CI = 1.8-2.5), and a nonroutine discharge (P = .005; OR = 1.9; 95%CI = 1.4-2.4). 692,173 non-PD patients with spine fusion were identified; 123,964 (17.9%) underwent 3+ level fusion. Differences between 3+ versus 1-2 level fusions were similar to those in PD patient, but unlike PD patients, postoperative infection was significant while in-hospital mortality, PE and VTE were not. Fusion of at least three levels increased morbidity, mortality, and adverse discharge disposition compared with 1-2 level fusions. Nearly 80% of all spine fusions performed in the United States are fewer than three levels. These findings are worth considering during operative decision-making in both PD and non-PD patients.
AB - There remains a dearth of information regarding the surgical complications following multilevel spine surgery in Parkinson's disease (PD) patients. This retrospective cohort study was performed to address this issue on a nationwide level using the Nationwide Inpatient Sample from 2001 to 2012. More than 25 postoperative variables were analyzed to assess the impact of fusion construct length on each variable. Subsequently, the same analysis was performed on admissions without PD. 4301 PD patients with spine fusion were identified, of whom 934 (21.7%) underwent fusion of at least three levels; the remaining 3367 underwent fusion of 1-2 levels. Patients with 3+ level fusions were more likely to suffer paraplegia (P = .001; OR = 3.0; 95%CI = 1.5-6.1), hematoma/seroma (P = .009; OR = 1.9; 95%CI = 1.2-3.2), IVC filter placement (P = .018; OR = 2.1; 95%CI = 1.1-3.9), RBC transfusion (P <. .001; OR = 3.2; 95%CI = 2.7-3.8), PE (P = .027; OR = 4.5; 95%CI = 1.2-16.9), postoperative shock (P = .023; OR = 7.3; 95%CI = 1.3-39.6), ARDS (P <. .001; OR = 4.1; 95%CI = 2.7-6.3), VTE (P = .006; OR = 2.6; 95%CI = 1.3-5.4), acute posthemorrhagic anemia (P <. .001; OR = 2.0; 95%CI = 1.7-2.4), device-related complications (P <. .001; OR = 3.1; 95%CI = 2.3-4.2), and in-hospital mortality (P = .005; OR = 3.4; 95%CI = 1.5-7.4). 3+ level fusions were also more likely to have LOS. >. 1. week (P <. .001; OR = 2.1; 95%CI = 1.8-2.5), and a nonroutine discharge (P = .005; OR = 1.9; 95%CI = 1.4-2.4). 692,173 non-PD patients with spine fusion were identified; 123,964 (17.9%) underwent 3+ level fusion. Differences between 3+ versus 1-2 level fusions were similar to those in PD patient, but unlike PD patients, postoperative infection was significant while in-hospital mortality, PE and VTE were not. Fusion of at least three levels increased morbidity, mortality, and adverse discharge disposition compared with 1-2 level fusions. Nearly 80% of all spine fusions performed in the United States are fewer than three levels. These findings are worth considering during operative decision-making in both PD and non-PD patients.
KW - In-hospital mortality
KW - Morbidity
KW - Multilevel spine fusion
KW - Nationwide analysis
KW - Parkinson's disease
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U2 - 10.1016/j.jocn.2017.05.006
DO - 10.1016/j.jocn.2017.05.006
M3 - Article
C2 - 28599840
AN - SCOPUS:85020206681
SN - 0967-5868
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -