Predictors of 2-year reoperation in Medicare patients undergoing primary thoracolumbar deformity surgery

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  • 1 Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
  • 2 Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
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OBJECTIVE

This was a retrospective cohort study in which the authors used a nationally representative administrative database. Their goal was to identify the risk factors for reoperation in Medicare patients undergoing primary thoracolumbar adult spinal deformity (ASD) surgery. Previous literature reports estimate that 20% of patients undergoing thoracolumbar ASD correction undergo revision surgery within 2 years. Most published data discuss risk factors for revision surgery in the general population, but these have not been explored specifically in the Medicare population.

METHODS

Using the MarketScan Medicare Supplemental database, the authors identified patients who were diagnosed with a spinal deformity and underwent ASD surgery between 2007 and 2015. The interactions of patient demographics, surgical factors, and medical factors with revision surgery were investigated during the 2 years following primary ASD surgery. The authors excluded patients without Medicare insurance and those with any prior history of trauma or tumor.

RESULTS

Included in the data set were 2564 patients enrolled in Medicare who underwent ASD surgery between 2007 and 2015. The mean age at diagnosis with spinal deformity was 71.5 years. A majority of patients (68.5%) were female. Within 2 years of follow-up, 661 (25.8%) patients underwent reoperation. Preoperative osteoporosis (OR 1.58, p < 0.0001), congestive heart failure (OR 1.35, p = 0.0161), and paraplegia (OR 2.41, p < 0.0001) independently increased odds of revision surgery. The use of intraoperative bone morphogenetic protein was protective against reoperation (OR 0.71, p = 0.0371). Among 90-day postoperative complications, a wound complication was the strongest predictor of undergoing repeat surgery (OR 2.85, p = 0.0061). The development of a pulmonary embolism also increased the odds of repeat surgery (OR 1.84, p = 0.0435).

CONCLUSIONS

Approximately one-quarter of Medicare patients with ASD who underwent surgery required an additional spinal surgery within 2 years. Baseline comorbidities such as osteoporosis, congestive heart failure, and paraplegia, as well as short-term complications such as pulmonary embolism and wound complications significantly increased the odds of repeat surgery.

ABBREVIATIONS ASD = adult spinal deformity; BMP = bone morphogenetic protein; CHF = congestive heart failure; CPT = Current Procedural Terminology; ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification; PE = pulmonary embolism.

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Contributor Notes

Correspondence Anand Veeravagu: Stanford University, Stanford, CA. anandv2@stanford.edu.

INCLUDE WHEN CITING Published online July 24, 2020; DOI: 10.3171/2020.5.SPINE191425.

Disclosures Dr. Veeravagu is a consultant for NuVasive, Surgical Theater, and Johnson & Johnson.

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