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Trends in Comorbidities and Complications Among Patients Undergoing Inpatient Spine Surgery.

STUDY DESIGN
Retrospective database study.


OBJECTIVE
We sought to identify trends in demographics, comorbidities, and postoperative complications among patients undergoing ACDF and PLF.


SUMMARY OF BACKGROUND DATA
As demand for anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF) surgery continues to increase, it is important to understand changes in the healthcare system and patient populations undergoing these procedures.


METHODS
We identified 220,520 ACDF and 151,547 PLF surgeries (2006-2016; Premier Healthcare database). Annual proportions or medians were calculated for patient and hospital characteristics, and (Elixhauser) comorbidities. Postoperative complications, including blood transfusions, cardiovascular, pulmonary, renal, or wound complications, hemorrhage, stroke, sepsis, thromboembolism, delirium, inpatient falls, and mortality, were reported per 1,000 inpatient days. Trends were assessed by Cochran-Armitage tests and linear regression for binary and continuous variables, respectively.


RESULTS
The median age of patients undergoing ACDF and PLF increased significantly from 2006 to 2016 (50 to 57 years and 58 to 61 years, respectively; p < 0.001) coinciding with an increasing comorbidity burden (30.2% to 47.9% and 44.9% to 55.7%, respectively representing the share of patients with ≥2 Elixhauser comorbidities; p < 0.001). Overall rate of any complication experienced a significant decline after both ACDF (24.5 to 20.8 per 1,000 inpatient days; p = 0.002) and PLF (30.5 to 23.1 per 1,000 inpatient days; p < 0.001).


CONCLUSIONS
The comorbidity burden of patients undergoing ACDF and PLF increased substantially from 2006 to 2016, however without a corresponding increase in overall complication rate. Understanding these changes can help guide future practice, advise in the allocation of resources, and inform future areas of research.


LEVEL OF EVIDENCE
3.