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Published on: March 23, 2019
Postoperative Outcomes Following Posterior Lumbar Fusion in Patients With Multiple Sclerosis
Pramod N Kamalapathy1, Joshua Bell1, Varun Puvanesarajah2
1Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Summary 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.
Level Of Evidence:
Level III.
Insights
Patients with multiple sclerosis (MS) face higher risks of complications and increased costs after posterior lumbar fusion (PLF) surgery. Understanding these risks is crucial for better patient counseling and surgical planning.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Health Economics
Background:
- Multiple sclerosis (MS) is a chronic inflammatory neurological disease.
- Patients with MS are living longer and undergoing more orthopedic procedures.
- The risks associated with posterior lumbar fusion (PLF) in MS patients are not well-documented.
Purpose of the Study:
- To analyze postoperative complication rates in MS patients undergoing primary PLF.
- To assess the economic burden of PLF in MS patients compared to those without MS.
Main Methods:
- Retrospective review of Medicare database (2006-2013).
- Included patients undergoing PLF and/or posterior lumbar interbody fusion.
- Excluded cases with same-day anterior/revision procedures, or history of spine issues, infection, trauma, or neoplasm.
- Analyzed demographics, comorbidities, 90-day complications, costs, and length of stay using multivariate logistic regression.
Main Results:
- Significant increase in sepsis, urinary tract infection, deep vein thrombosis, ER visits, and readmissions for MS patients.
- MS patients incurred higher total hospital charges ($4379 extra) and hospitalization costs ($1679 increase).
- Increased length of stay observed for MS patients (4.05 vs. 3.61 days).
Conclusions:
- MS diagnosis is linked to significantly higher postoperative complications and costs after PLF.
- Physicians must understand MS-related risks to counsel patients effectively before spinal fusion surgery.
- Informed consent regarding potential complications is imperative for MS patients undergoing PLF.
