Degenerative Spondylolisthesis: An analysis of the Nationwide Inpatient Sample Database.
Spine (Phila Pa 1976). 2015 May 27;
Authors: Norton R, Bianco K, Klifto C, Errico T, Bendo J
STUDY DESIGN: Analysis of the Nationwide Inpatient Sample (NIS) database.
OBJECTIVE: To investigate national trends, risks, and benefits of surgical interventions for degenerative spondylolisthesis (DS).
SUMMARY OF BACKGROUND DATA: The surgical management of DS continues to evolve while the most clinically and cost-effective treatment is debated. With an aging US population and growing restraints on a financially burdened healthcare system, a clear understanding of national trends in the surgical management of DS is needed.
METHODS: The NIS database was queried for patients with DS undergoing lumbar fusions from 2001-2010 using ICD-9 diagnosis and procedure codes. Analyses compared instrumented posterolateral fusion (PLF), posterolateral fusion with anterior lumbar interbody fusion (ALIF+PLF), posterolateral fusion with posterior interbody fusion (P/TLIF+PLF), anterior instrumented interbody fusion (ALIF), and posterior interbody fusion with posterior instrumentation (P/TLIF). Clinical data was analyzed representing the initial acute phase care after surgery.
RESULTS: There were 48,911 DS surgeries identified, representing 237,383 procedures. The percentage of patients undergoing PLF, ALIF+PLF, or ALIF increased while the percentage of P/TLIF or P/TLIF+PLF decreased over time. Total charges were less (p<0.001), average length of hospital stay (LOS) was shorter (p<0.01), and average age was older (p<0.01) for patients who underwent PLF compared to any other procedure. Type of procedure varied based on the geographic region of the hospital, teaching versus non-teaching hospital, and size of hospital (p<0.01). Patients who had P/TLIF+PLF or ALIF had a higher risk of mortality than patients who had PLF (OR: 5.02, 2.22, respectively). Patients were more likely to develop a complication if they had ALIF+PLF, P/TLIF+PLF, ALIF, and P/TLIF than if they had PLF (OR: 1.45, 1.23, 1.49, 1.12, respectively).
CONCLUSIONS: Variation in the surgical management of DS related to patient demographics, hospital charges, LOS, insurance type, comorbidities, and complication rates were found within the NIS database. During the acute phase of care immediately after surgery, PLF procedures were found to reduce LOS, hospital charges, and post operative complications.
PMID: 26020842 [PubMed – as supplied by publisher]