Complications and operative spine fusion construct length in Parkinson's disease: A nationwide population-based analysis

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.