Single vs Multistage Surgical Management of Single and Two-Level Lumbar Degenerative Disease
Journal Paper/Review - Jun 1, 2021
Varshneya Kunal, Wadhwa Harsh, Stienen Martin N., Ho Allen L, Medress Zachary A, Herrick Daniel B, Desai Atman, Ratliff John K, Veeravagu Anand
Retrospective cohort studying using a national, administrative database.
To determine the postoperative complications and quality outcomes of single and multi-stage surgical management for lumbar degenerative disease (LDD).
This study identified patients with who underwent surgery for LDD between 2007 - 2016. Patients were stratified based on whether their surgeon choose to correct their LDD in a single or multistage manner, and these cohorts were mutually exclusive. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between single and multi-stage patients. Patients who underwent three or more levels surgical correction, were under the age of 18 years, or those with any prior history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.
A total of 47,190 patients underwent primary surgery for LDD, of which 9,438 (20%) underwent multi-stage surgery. After propensity score matching, baseline covariates of the two cohorts were similar. The complication rate was 6.1% in the single stage cohort and 11.0% in the multistage cohort. Rates of post-hemorrhagic anemia, infection, wound complication, DVT, and hematoma were all higher in the multistage cohort. Lengths of stay, revision, and readmission rates were also significantly higher in the multi-stage cohort. Through 2-years of follow up, multi-stage surgery was associated with higher payments throughout the 2-year follow-up period ($57,036 vs $39,318, p < 0.05).
Single stage surgery for lumbar degenerative disc disease demonstrates improved outcomes and lower healthcare utilization. Spine surgeons should carefully consider single-stage surgery when treating patients with less than three-level LDD.