Demographic predictors of treatment and complications for adult spinal deformity: An analysis of the national inpatient sample

Nolan J Brown; Omar Al Jammal; Alexander Himstead; Shane Shahrestani; Chenyi Yang; Neal A Patel; Julian L Gendreau; Ronald Sahyouni; Luis Daniel Diaz-Aguilar; Martin H Pham

doi:10.1016/j.clineuro.2022.107423

Demographic predictors of treatment and complications for adult spinal deformity: An analysis of the national inpatient sample

Clin Neurol Neurosurg. 2022 Nov:222:107423. doi: 10.1016/j.clineuro.2022.107423. Epub 2022 Aug 24.

Affiliations

¹ Department of Neurosurgery, University of California Irvine School of Medicine, Orange, CA, United States. Electronic address: nolanb@hs.uci.edu.
² Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, United States.
³ Department of Neurosurgery, University of California Irvine School of Medicine, Orange, CA, United States.
⁴ Department of Neurosurgery, USC Keck School of Medicine, Los Angeles, CA, United States; Medical Scientist Training Program, California Institute of Technology, Pasadena, CA, United States.
⁵ Department of Neurosurgery, Mercer University School of Medicine, GA, United States.
⁶ Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, MD, United States.

PMID: 36063642
DOI: 10.1016/j.clineuro.2022.107423

Abstract

Purpose: To examine the role of demographics on surgical management and inpatient complications in patients with spinal deformity between 2010 and 2014 via retrospective analysis.

Methods: Data were obtained from the National Inpatient Sample (NIS). International Classification of Diseases 9th revision codes were used to identify patients with a primary diagnosis of adult spinal deformity (ASD). Multivariable Poisson regression analyses were used to determine whether any individual demographic variables were predictive of surgical management, surgical complexity, postoperative complications and revision operations.

Results: 17,433 patients were identified for analysis. Surgical intervention was performed for 94.5% of patients with a primary diagnosis of ASD. Patients at urban teaching hospitals were the most likely to receive surgery (OR= 2.13; 95% CI 1.51-2.95; p < 0.001) relative to rural patients. Female patients were the majority undergoing surgery and were more likely to receive a complication or require a revision when controlling for surgical complexity. Medicare patients were the least likely to undergo surgery and the most likely to receive complex fusion when undergoing an operation. Medicare patients were the least likely to experience complications (OR=0.89; 95% CI 0.80-0.98; p = 0.022) after adjusting for surgical complexity. With regards to race and ethnicity, Hispanics had a decreased likelihood of receiving a revision surgery.

Conclusion: There were substantial differences in rates of surgical management, postoperative complications, and revisions among individuals of different demographics including sex, insurance status, ethnicity and hospital teaching status. Further research evaluating the effect of demographics in spine surgery is warranted to fully understand their influence on patient outcomes.

Keywords: Adult spinal deformity; Complications; IV; Lumbar spine surgery; National Inpatient Sample; Retrospective Level of Evidence.

MeSH terms

Adult
Aged
Demography
Female
Humans
Inpatients
Medicare
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Spinal Fusion* / adverse effects
United States / epidemiology