Trends in Short Construct Lumbar Fusions Over the Past Decade at a Single Institution.
Publication/Presentation Date
3-15-2023
Abstract
STUDY DESIGN: Retrospective cohort.
OBJECTIVE: (1) To compare the rates of fusion techniques over the last decade; (2) to identify whether surgeon experience affects a surgeon's preferred fusion technique; (3) to evaluate differences in complications, readmissions, mortality, and patient-reported outcomes measures (PROMs) based on fusion technique.
SUMMARY OF BACKGROUND DATA: Database studies indicate the number of lumbar fusions have been steadily increasing over the last two decades; however, insufficient granularity exists to detect if surgeons' preferences are altered based on additive surgical experience.
METHODS: A retrospective review of continuously collected patients undergoing lumbar fusion at a single urban academic center was performed. Rates of lumbar fusion technique: posterolateral decompression fusion (PLDF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion + PLDF (ALIF), and lateral lumbar interbody fusion + PLDF (LLIF) were recorded. Inpatient complications, 90-day readmission, and inpatient mortality were compared with χ 2 test and Bonferroni correction. The Δ 1-year PROMs were compared with the analysis of variance.
RESULTS: Of 3938 lumbar fusions, 1647 (41.8%) were PLDFs, 1356 (34.4%) were TLIFs, 885 (21.7%) were ALIFs, and 80 (2.0%) were lateral lumbar interbody fusions. Lumbar fusion rates increased but interbody fusion rates (2012: 57.3%; 2019: 57.6%) were stable across the study period. Surgeons with < 10 years of experience performed more PLDFs and less ALIFs, whereas surgeons with >10 years' experience used ALIFs, TLIFs, and PLDFs at similar rates. Patients were more likely to be discharged home over the course of the decade (2012: 78.4%; 2019: 83.8%, P < 0.001). No differences were observed between the techniques in regard to inpatient mortality ( P =0.441) or Δ (postoperative minus preoperative) PROMs.
CONCLUSIONS: Preferred lumbar fusion technique varies by surgeon preference, but typically remains stable over the course of a decade. The preferred fusion technique did not correlate with differences in PROMs, inpatient mortality, and patient complication rates.
LEVELS OF EVIDENCE: 3-treatment.
Volume
48
Issue
6
First Page
391
Last Page
399
ISSN
1528-1159
Published In/Presented At
Lambrechts, M. J., Siegel, N., Issa, T. Z., Karamian, B. A., Bodnar, J. G., Canseco, J. A., Woods, B. I., Kaye, I. D., Hilibrand, A. S., Schroeder, G. D., Vaccaro, A. R., & Kepler, C. K. (2023). Trends in Short Construct Lumbar Fusions Over the Past Decade at a Single Institution. Spine, 48(6), 391–399. https://doi.org/10.1097/BRS.0000000000004548
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
36730237
Department(s)
Administration and Leadership
Document Type
Article