Relationship Between Comorbidity Burden and Short-Term Outcomes Across 4680 Consecutive Spinal Fusions

Connor A Wathen; Ryan S Gallagher; Austin J Borja; Emelia G Malhotra; Tara Collier; Jianbo Na; Scott D McClintock; Jang W Yoon; Ali K Ozturk; James M Schuster; William C Welch; Paul J Marcotte; Neil R Malhotra

doi:10.1016/j.wneu.2023.08.044

Relationship Between Comorbidity Burden and Short-Term Outcomes Across 4680 Consecutive Spinal Fusions

World Neurosurg. 2023 Dec:180:e84-e90. doi: 10.1016/j.wneu.2023.08.044. Epub 2023 Aug 18.

Affiliations

¹ Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
² McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, USA.
³ West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania, USA.
⁴ Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA. Electronic address: neil.malhotra@pennmedicine.upenn.edu.

PMID: 37597658
DOI: 10.1016/j.wneu.2023.08.044

Abstract

Objective: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI)-an easily derived measure of aggregate medical comorbidity-to predict outcomes from spinal fusion surgery. Coarsened exact matching is employed to control for key patient characteristics and isolate CCI.

Methods: We retrospectively assessed 4680 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single academic center. Logistic regression evaluated the univariate relationship between CCI and patient outcomes. Coarsened exact matching generated exact demographic matches between patients with high comorbid status (CCI >6) or no medical comorbidities (matched n = 524). Patients were matched 1:1 on factors associated with surgical outcomes, and outcomes were compared between matched cohorts. Primary outcomes included surgical complications, discharge status, 30- and 90-day risk of readmission, emergency department (ED) visits, reoperation, and mortality.

Results: Univariate regression of increasing CCI was significantly associated with non-home discharge, as well as 30- and 90-day readmission, ED visits, and mortality (all P < 0.05). Subsequent isolation of comorbidity between otherwise exact-matched cohorts found comorbid status did not affect readmissions, reoperations, or mortality; high CCI score was significantly associated with non-home discharge (OR = 2.50, P < 0.001) and 30-day (OR = 2.44, P = 0.02) and 90-day (OR = 2.29, P = 0.008) ED evaluation.

Conclusions: Comorbidity, measured by CCI, did not increase the risk of readmission, reoperation, or mortality. Single-level, posterior lumbar fusions may be safe in appropriately selected patients regardless of comorbid status. Future studies should determine whether CCI can guide discharge planning and postoperative optimization.

Keywords: Coarsened exact matching; Lumbar fusion; Medical comorbidity; Spine surgery.

MeSH terms

Comorbidity
Humans
Length of Stay
Patient Readmission
Postoperative Complications / epidemiology
Retrospective Studies
Spinal Fusion*