Single-Stage Versus Multistage Surgical Management of Single- and Two-Level Lumbar Degenerative Disease
| Autor: | Zachary A Medress, Kunal Varshneya, Daniel B. Herrick, Anand Veeravagu, Harsh Wadhwa, Martin N. Stienen, Atman Desai, John K. Ratliff, Allen L Ho |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Anemia Deep vein Intervertebral Disc Degeneration Neurosurgical Procedures Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine Hematoma Lumbar medicine Humans Propensity Score Aged Retrospective Studies Lumbar Vertebrae business.industry Retrospective cohort study Length of Stay Middle Aged medicine.disease Thrombosis Surgery Spinal Fusion Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis Propensity score matching Cohort Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 152:e449-e454 |
| ISSN: | 1878-8750 |
| Popis: | To determine postoperative complications and quality outcomes of single-stage and multistage surgical management for lumbar degenerative disease (LDD).This retrospective cohort study using a national administrative database identified patients who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether their surgeon chose to perform single-stage or multistage LDD surgery, and these cohorts were mutually exclusive. Propensity score matching was used to mitigate intergroup differences between single-stage and multistage patients. Patients who underwent ≥3 levels of surgical correction, who were18 years old, or who had any prior history of trauma or tumor were excluded from the study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.Primary surgery for LDD was performed in 47,190 patients; 9438 (20%) of these patients underwent multistage surgery. After propensity score matching, baseline covariates of the 2 cohorts were similar. The complication rate was 6.1% in the single-stage cohort and 11.0% in the multistage cohort. Rates of posthemorrhagic anemia, infection, wound complication, deep vein thrombosis, and hematoma all were higher in the multistage cohort. Length of stay, revisions, and readmissions were also significantly higher in the multistage cohort. Through 2 years of follow-up, multistage surgery was associated with higher payments throughout the 2-year follow-up period ($57,036 vs. $39,318, P0.05).Single-stage surgery for LDD demonstrated improved outcomes and lower health care utilization. Spine surgeons should carefully consider single-stage surgery when treating patients with LDD requiring3 levels of correction. |
| Databáze: | OpenAIRE |
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