Increased Emergency Department Utilization After Revision Compared With Primary Lumbar Fusion

Area of Science:

• Spine Surgery
• Health Services Research
• Patient Outcomes

Background:

• Emergency department (ED) utilization after lumbar fusion presents a significant financial burden.
• Understanding ED visit patterns post-lumbar fusion can identify cost-saving opportunities.

Purpose of the Study:

• To compare the incidence, timing, and reasons for ED visits following primary versus revision lumbar fusion.
• To identify predictors of postoperative ED visits.

Main Methods:

• Retrospective cohort study of 2360 patients undergoing primary or revision lumbar fusion.
• Analysis of ED visit incidence and characteristics at 2 weeks, 30 days, and 90 days.
• Logistic regression to determine independent predictors of ED visits.

Main Results:

• Revision lumbar fusion patients had a higher 90-day ED visit rate (10.2% vs. 6.86%).
• The difference was significant between 14-30 days postoperatively (3.35% vs. 1.30%).
• Revision surgery, cut-to-close time, and length of stay (LOS) independently predicted ED visits.

Conclusions:

• Revision lumbar fusion is an independent predictor of ED visits, with a mild absolute risk increase.
• ED visits post-revision surgery were less likely to require readmission than post-primary surgery.
• Counseling patients on pain expectations and acute care is crucial, especially after revision lumbar fusion.