Using the United States Nationwide Inpatient Sample, we identified national trends in revision spinal fusion along with a comprehensive comparison of comorbidities, inpatient complications and surgical factors of revision spinal fusion compared to primary spinal fusion.
In 2009, there were 410 158 primary spinal fusion discharges and 22 128 revision spinal fusion discharges. Between 2002 and 2009, primary fusion increased at a higher rate compared with revision fusion (56.4% vs 51.0%; p < 0.001). In 2009, the mean length of stay and hospital charges were higher for revision fusion discharges than for primary fusion discharges (4.2 days vs 3.8 days, p < 0.001; USD $91 909 vs. $87 161, p < 0.001). In 2009, recombinant human bone morphogenetic protein (BMP) was used more in revision fusion than in primary fusion (39.6% vs 27.6%, p < 0.001), whereas interbody devices were used less in revision fusion (41.8% vs 56.6%, p < 0.001).
In the multivariable logistic regression model for all spinal fusions, depression (odds ratio (OR) 1.53, p < 0.001), psychotic disorders (OR 1.49, p < 0.001), deficiency anaemias (OR 1.35, p < 0.001) and smoking (OR 1.10, p = 0.006) had a greater chance of occurrence in revision spinal fusion discharges than in primary fusion discharges, adjusting for other variables. In terms of complications, after adjusting for all significant comorbidities, this study found that dural tears (OR 1.41; p < 0.001) and surgical site infections (OR 3.40; p < 0.001) had a greater chance of occurrence in revision spinal fusion discharges than in primary fusion discharges (p < 0.001). A p-value < 0.01 was considered significant in all final analyses.
Cite this article: Bone Joint J 2014;96-B:807–16.
- Spinal fusion
- Revision spine fusion
- Lumbar fusion
- Bone graft
- Interbody device
- Spinal fusion rates
- Cervical fusion
- Bone morphogenetic protein
S. Rajaee is the first author, H. Bae is the corresponding and last author.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by S Hughes and first proof edited by A. C Ross
Supplementary material. One table providing information about ICD-9-CM diagnosis and three tables which present univariable patient characteristics for cervical, thoracic and lumbar fusion separately, are available alongside the electronic version of this article on our website www.bjj.boneandjoint.org.uk
- Received December 18, 2012.
- Accepted February 21, 2014.
- ©2014 The British Editorial Society of Bone & Joint Surgery