Student University of Pennsylvania Philadelphia, Pennsylvania, United States
Introduction: Readmission, reoperation and prolonged hospital length of stay (LOS) all contribute to rising healthcare costs and are surrogate markers for quality of care. This retrospective study aims to define and predict a good outcome after multilevel posterior spinal fusions (PSF) for adult deformity.
Methods: Using CPT codes, patients undergoing multi-level PSF between 2013 and 2021 were identified at a single tertiary academic center. Charts were reviewed for demographic, preoperative, surgical, and postoperative information. PSFs with less than 6 vertebrae fused, a cervical component, and patients undergoing non-deformity surgeries, such as trauma and tumor, were excluded. To further study predictors of successful surgery, a composite for good outcomes was defined, with a good outcome defined as discharge to home, no reoperation, and LOS less than the mean. T-tests and 2-testing was performed for continuous characteristics and categorical characteristics, respectively. Additionally, regression analysis was performed to further examine the relationship between variables while controlling for confounders.
Results: 646 patients were included in the analysis, 181 met criteria for good outcome, while 465 did not. Patients with good outcomes were significantly younger (50.7 vs 63.47 years old, p< 0.001), had a shorter LOS (4.88 vs 9.12, p< 0.001), shorter length of ICU stay (1.45 vs 3.08, p< 0.001), lower BMI (26.55 vs 28.22, p=0.005), higher preoperative hemoglobin (13.36 vs 12.84, p< 0.001), shorter OR time (439.73 vs 527.3, p< 0.001), less average number of levels fused (10.27 vs 11.06, p< 0.001, less intraoperative RBC transfusions in mL (437.73 vs 785.28, p< 0.001), and less postoperative RBC transfusion in mL (142.54 vs 251.94, p< 0.001). Regression analysis showed intraoperative blood transfusion (p=0.005), increasing age (p < 0.001), three-column osteotomy (3CO) (p=0.018), and increasing OR time (p < 0.001) inversely associated with good outcomes.
Conclusion : Factors associated with a good outcome after multi-level spinal fusion were younger age, higher preoperative hemoglobin, less transfusion, shorter operative time, and fewer levels included in the fusion construct. After regression modeling, 3CO, increased OR time, higher age and intraoperative blood transfusions were strongly inversely correlated with good outcomes.
