Predictors of Operative Duration and Complications in Single-Level Posterior Interbody Fusions for Degenerative Spondylolisthesis

Nicholas M Rabah; Hammad A Khan; Michael Shost; Joel Beckett; Thomas E Mroz; Michael P Steinmetz

doi:10.1016/j.wneu.2021.04.034

Predictors of Operative Duration and Complications in Single-Level Posterior Interbody Fusions for Degenerative Spondylolisthesis

World Neurosurg. 2021 Jul:151:e317-e323. doi: 10.1016/j.wneu.2021.04.034. Epub 2021 Apr 18.

Authors

Nicholas M Rabah¹, Hammad A Khan², Michael Shost², Joel Beckett³, Thomas E Mroz⁴, Michael P Steinmetz⁵

Affiliations

¹ Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: nmr68@case.edu.
² Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³ Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁴ Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Orthopaedic Surgery, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
⁵ Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 33878465
DOI: 10.1016/j.wneu.2021.04.034

Abstract

Background: The goal of this study was to identify predictors of prolonged operative time (OT) in patients receiving posterior/transforaminal lumbar interbody fusion (P/TLIF) and examine the relationship between prolonged OT and perioperative outcomes in this population.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing single-level P/TLIF (Common Procedural Terminology code) between 2012 and 2018. Multivariable linear regression models were constructed to identify factors independently associated with changes in OT and examine the relationship between prolonged OT and perioperative outcomes (overall complications, surgical complications, medical complications, 30-day readmission, 30-day reoperation, and length of stay). All models were adjusted for sociodemographic variables, comorbidities, and procedure-specific variables.

Results: Our cohort included 6260 patients. After adjusting for baseline covariates, age between 19 and 39 years increased OT by 15.14 minutes, male sex increased OT by 12.91 minutes, African American race increased OT by 17.82 minutes, other race increased OT by 18.13 minutes, obesity class III increased OT by 27.80 minutes, and the use of navigation increased OT by 10.83 minutes. Our multivariate logistic regression also found that after 2 hours, each additional hour of OT was associated with an increased risk of any complication (3-3.99 hours, odds ratio [OR], 1.68; 4-4.99 hours, OR, 2.33; and >5 hours, OR, 4.65). Incremental increases in OT were also associated with an increased risk of extended length of stay, readmission, and return to the operating room.

Conclusions: The results of this study highlight several factors associated with prolonged OT and underscore its association with poorer perioperative outcomes. These data can be used to risk stratify patients before single-level P/TLIF.

Keywords: Degenerative spondylolisthesis; Interbody fusion; Operative time.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Humans
Male
Middle Aged
Operative Time*
Patient Readmission
Postoperative Complications / etiology*
Risk Factors
Spinal Fusion / adverse effects
Spinal Fusion / methods*
Spondylolisthesis / surgery*
Young Adult