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True Differences in Poor Outcome Risks Between Revision and Primary Lumbar Spine Surgeries
Chad E Cook1, Alessandra N Garcia2, Christine Park3
1Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC, USA.
Summary
Revision spine surgery carries higher risks than primary surgery, but the actual increase in poor outcomes is very small. Reporting absolute and relative risk increases alongside odds ratios clarifies significance.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Health Services Research
Background:
- Revision spine surgery generally has higher complication rates than primary surgery.
- Limited research quantifies the magnitude of risk differences for poor outcomes between primary and revision lumbar spine procedures.
Purpose of the Study:
- To compare the risks of poor outcomes for primary versus revision lumbar spine surgeries.
- To analyze various risk measures (OR, RR, RRI, ARI) to understand the true risk differences.
Main Methods:
- Retrospective observational study using the Quality Outcomes Database Lumbar Spine Surgical Registry (2012-2018).
- Included patients undergoing primary or revision surgery for degenerative lumbar disorders.
- Assessed 30-day complications, 30-day hospital readmission, 30-day return to OR, and 3-month re-revision surgery.
Main Results:
- Study included 31,843 primary and 7889 revision surgery patients.
- Revision surgery was associated with increased odds of 4 complications and all 3 destination variables after controlling for confounders.
- Risk ratios indicated smaller magnitudes of risk compared to odds ratios, but findings were consistent.
Conclusions:
- Revision spine surgery is linked to elevated overall risks compared to primary surgery.
- The actual magnitudes of these increased risks are minimal.
- Incorporating relative risk increase (RRI) and absolute risk increase (ARI) is crucial for accurately interpreting odds ratios (ORs).
