The Impact of Osteoporosis on Adverse Outcomes After Short Fusion for Degenerative Lumbar Disease.

Autor:	Wolfert AJ; From the Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY (Wolfert, Rompala, Beyer, N. V. Shah, Ikwuazom, Kim, S. T. Shah, Paulino, and Diebo), the Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY (Passias), the Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY (Lafage and Schwab), the Department of Orthopaedic Surgery, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY (Paulino), and the Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI (Diebo)., Rompala A, Beyer GA, Shah NV, Ikwuazom CP, Kim D, Shah ST, Passias PG, Lafage V, Schwab FJ, Paulino CB, Diebo BG
Jazyk:	angličtina
Zdroj:	The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2022 Jun 15; Vol. 30 (12), pp. 573-579. Date of Electronic Publication: 2022 Mar 15.
DOI:	10.5435/JAAOS-D-21-01258
Abstrakt:	Introduction: Osteoporosis affects nearly 200 million individuals worldwide. There are little available data regarding outcomes in patients with osteoporosis who undergo short-segment lumbar fusion for degenerative disk disease (DDD). We sought to identify a relationship between osteoporosis and risk of adverse outcomes in patients with DDD undergoing short-segment lumbar fusion. Methods: Using the New York State Statewide Planning and Research Cooperative System, all patients with DDD who underwent 2- to 3-level lumbar fusion from 2009 through 2011 were identified. Patients with bone mineralization disorders and other systemic and endocrine disorders and surgical indications of trauma, systemic disease(s), and infection were excluded. Patients were stratified by the presence or absence of osteoporosis and compared for demographics, hospital-related parameters, and 2-year complications and revision surgeries. Multivariate binary logistic regression models were used to identify notable predictors of complications. Results: A total of 29,028 patients (osteoporosis = 1,353 [4.7%], nonosteoporosis = 27,675 [95.3%]) were included. Patients with osteoporosis were older (66.9 vs 52.6 years), more often female (85.1% vs 48.4%), and White (82.8% vs 73.5%) (all P < 0.001). The Charlson/Deyo comorbidity index did not significantly differ between groups. Hospital lengths of stay and total charges were higher for patients with osteoporosis (4.9 vs 4.1 days; $74,484 vs $73,724; both P < 0.001). Medical complication rates were higher in patients with osteoporosis, including acute renal failure and deep-vein thrombosis (both P < 0.01). This cohort also had higher rates of implant-related (3.4% vs 1.9%) and wound (9.8% vs 5.9%) complications (both P < 0.01). Preoperative osteoporosis was strongly associated with 2-year medical and surgical complications (odds ratios, 1.6 and 1.7) as well as greater odds of revision surgeries (odds ratio, 1.3) (all P < 0.001). Conclusion: Patients with osteoporosis undergoing 2- to 3-level lumbar fusion for DDD were at higher risk of 2-year medical and surgical complications, especially implant-related and wound complications. These findings highlight the importance of rigorous preoperative metabolic workup and patients' optimization before spinal surgery. (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)
Databáze:	MEDLINE
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