Does the Addition of Either a Lateral or Posterior Interbody Device to Posterior Instrumented Lumbar Fusion Decrease Cost Over a 6-Year Period?
Schadler, Paul; Derman, Peter; Lee, Lily; Do, Huong; Girardi, Federico P; Cammisa, Frank P; Sama, Andrew A; Shue, Jennifer; Koutsoumbelis, Stelios; Hughes, Alexander P
Study Design/UNASSIGNED:Retrospective case-control study. Objectives/UNASSIGNED:Few studies have compared the costs of single-level (1) posterior instrumented fusion alone (PSF), (2) posterior interbody fusion with PSF (PLIF), and (3) lateral interbody fusion with PSF (circumferential LLIF). The purpose of this study was to compare costs associated with these procedures. Methods/UNASSIGNED:Charts were reviewed and patients followed-up with a telephone questionnaire. Medicare reimbursement data was used for cost estimation from the payer's perspective. Multivariate survival analysis was performed to assess time to elevated resource use (greater than 90% of study patients or $68â€‰672). Results/UNASSIGNED:= .017). Conclusions/UNASSIGNED:Circumferential LLIF and PSF patients were more likely to have higher resource use than PLIF patients and thus incur greater costs at 6-year follow-up.
Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis
Koutsoumbelis, Stelios; Hughes, Alexander P; Girardi, Federico P; Cammisa, Frank P; Finerty, Eileen A; Nguyen, Joseph T; Gausden, Elizabeth; Sama, Andrew A
BACKGROUND:Surgical site infection in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment, and estimated blood loss are well established in the literature to affect the risk of infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among spine patients undergoing posterior lumbar instrumented arthrodesis. METHODS:The medical records of 3218 patients who underwent posterior lumbar instrumented arthrodesis from January 2000 to December 2006 were reviewed to identify those who developed a postoperative infection (eighty-four patients; 2.6%). The size of this single-institution patient group allowed construction of a multivariate logistic regression model to evaluate the independent associations of potential risk factors for surgical site infection in the spine. RESULTS:In the final regression model, obesity, estimated intraoperative blood loss, ten or more people in the operating room, a dural tear, history of diabetes, chronic obstructive pulmonary disease, coronary heart disease, and osteoporosis were critical risk factors for the onset of spinal surgical site infection. Obesity and a history of chronic obstructive pulmonary disease were the strongest risk factors for postoperative spinal infection after adjusting for all other variables. The most common pathogen was methicillin-resistant Staphylococcus aureus with a prevalence of 34.5%. This study established a single institution infection rate for posterior lumbar instrumented arthrodesis at 2.6%. CONCLUSIONS:This analysis confirms previously demonstrated risk factors for postoperative infection while reporting on new potential independent risk factors of osteoporosis, chronic obstructive pulmonary disease, and dural tears in the setting of posterior lumbar instrumented arthrodesis. Areas of new research can focus on the roles these novel factors may play in the pathogenesis of surgical site infections in the spine.