Article Figures & Data
Figures
- Figure 1
Histogram showing the distribution of estimated blood loss (EBL) in patients with 1-level open posterior lumbar fusion, with and without interbody fusion. *33 patients had EBL >1000, **17 patients had EBL >1000.
- Figure 2
Regression graphs demonstrating the linear relationship between estimated blood loss (EBL) and length of stay: 1-level posterior lumbar fusion with interbody fusion (A), 1-level posterior lumbar fusion without interbody fusion (B).
- Figure 3
Receiver-operating characteristic curves (ROC) of estimated blood loss (EBL) vs length of stay of 1 d or more. Patients undergoing 1-level posterior lumbar fusion with interbody fusion (A) and patients undergoing 1-level posterior lumbar fusion without interbody fusion (B). AUC, area under the curve; Se, sensitivity; Sp, specificity.
Tables
- Table 1
Demographic characteristics of patients receiving 1-level posterior lumbar fusion.
Variables With Interbody Without Interbody Total (N = 763) Total (N = 420) Age, y, mean ± SD 59.2 ± 11.6 61.6 ± 13.2 Gender: men, n (%) 334 (43.8%) 195 (46.4%) Race: White, n (%) 676 (88.6%) 372 (88.6%) Body mass index, mean ± SD 31.3 ± 6.6 30.5 ± 6.2 Comorbidities, n (%) 1 or 2 468 (61.3%) 267 (63.6%) >2 150 (19.7%) 95 (22.6%) Coronary artery disease, n (%) 108 (14.2%) 72 (17.1%) Hypertension, n (%) 453 (59.4%) 280 (66.7%) Congestive heart failure, n (%) 21 (2.8%) 8 (1.9%) Chronic obstructive pulmonary disease, n (%) 26 (3.4%) 21 (5.0%) Osteoporosis, n (%) 14 (1.8%) 10 (2.4%) Diabetes, n (%) 157 (20.6%) 95 (22.6%) Active smoker, n (%) 122 (16.0%) 58 (13.8%) Preoperative anticoagulation/antiplatelet usage, n (%) 15 (2.0%) 9 (2.1%) Insurance, n (%) Private 381 (49.8%) 169 (40.2%) Medicare/Medicaid/Tenncare 301 (39.5%) 216 (51.4%) VA/Government (including Tricare) 74 (9.7%) 34 (8.1%) Uninsured/not applicable 7 (1.0%) 1 (0.3%) Currently employed, n (%) 328 (43.0%) 139 (33.1%) Intend to return to work, n (%) 311 (94.8%) 133 (95.6%) Preoperative ambulation, n (%) With assistance 200 (26.2%) 139 (33.1%) Independent 556 (72.9%) 275 (65.5%) Wheelchair bound 3 (0.4%) 5 (1.2%) Duration of symptoms, n (%) <3 mo 39 (5.1%) 17 (4.0%) 3–12 mo 168 (22.0%) 94 (22.4%) >12 mo 408 (53.5%) 223 (53.1%) Diagnosis, n (%) Stenosis 156 (20.4%) 88 (21.0%) Herniated disc 65 (8.5%) 26 (6.2%) Fracture 4 (0.5%) 3 (0.7%) Deformity/scoliosis 34 (4.5%) 18 (4.3%) Spondylolisthesis 478 (62.6%) 230 (54.8%) Pseudarthrosis 17 (2.2%) 29 (6.9%) Others 9 (1.3%) 26 (6.1%) Revision, n (%) 227 (29.8%) 160 (38.1%) Reason for revision, n (%) Adjacent segment disease 56 (7.3%) 47 (11.2%) Pseudarthrosis/instrumentation failure 23 (3.0%) 28 (6.7%) Same level recurrent stenosis 50 (6.6%) 42 (10.0%) Same level recurrent disc herniation 43 (5.6%) 14 (3.3%) Others 55 (7.2%) 29 (6.9%) - Table 2
Operative and perioperative variables of patients receiving 1-level posterior lumbar fusion.
Variables With Interbody Without Interbody Total (N = 763) Total (N = 420) Estimated blood loss (mL), mean ± SD, median (IQR) 439.3 ± 352.7, 350 (200–600) 390.2 ± 350.5, 300 (150–500) Operative time (min), mean ± SD, median (IQR) 213.8 ± 74.5, 204 (166–246) 208.0 ± 72.9, 202 (160–248) Length of stay (d), mean ± SD, median (IQR) 2.8 ± 2.4, 2 (2–3) 3.0 ± 1.7, 3 (2–4) Discharged, n (%) Home 640 (83.9%) 343 (81.7%) In-patient rehabilitation facility 46 (6.0%) 37 (8.6%) Skilled nursing facility 22 (2.9%) 20 (4.8%) Unknown 55 (7.2%) 20 (4.8%) Abbreviation: IQR, interquartile range.
- Table 3
Univariate/multivariate logistic and linear regression showing the association between estimated blood loss and outcomes, controlling for age, body mass index, and revision.
Outcomes Univariate Multivariate OR/β (95% CI) P Value OR/β (95% CI) P Value 1-Level With Interbody Length of stay 0.002 (0.001–0.002) <0.001* 0.001 (0.001–0.002) <0.001* Complications 1.00 (0.99, 1.00) 0.633 1.00 (0.99–1.00) 0.789 MCID NRS back 1.00 (0.99–1.00) 0.225 1.00 (1.00–1.00) 0.512 MCID NRS leg 1.00 (0.99–1.00) 0.551 1.00 (1.00–1.00) 0.210 MCID ODI 1.00 (1.00–1.00) 0.848 1.00 (1.00–1.00) 0.983 1-Level Without Interbody Length of stay 0.001 (0.001–0.002) <0.001* 0.001 (0.001–0.002) <0.001* Complications 1.00 (0.99–1.00) 0.856 1.00 (0.99–1.00) 0.989 MCID NRS back 1.00 (0.99–1.00) 0.244 1.00 (1.00–1.00) 0.333 MCID NRS leg 1.00 (0.99–1.00) 0.182 0.99 (0.99–1.00) 0.190 MCID ODI 1.00 (1.00–1.00) 0.229 1.00 (1.00–1.00) 0.252 Abbreviations: MCID, minimum clinically important difference; NRS, Numeric Rating Scale; ODI, Oswestry Disability Index.
- Table 4
Medical/surgical complications of diabetic patients within 30 d after lumbar spine surgery.
With Interbody Without Interbody Variable Total (N = 763) Total (N = 420) Complication, n (%) 41 (5.4%) 27 (6.4%) Urinary tract infection, n (%) 13 (1.7%) 17 (4.0%) Hematoma, n (%) 1 (0.1%) 1 (0.2%) Neurological deficit, n (%) 7 (0.9%) 2 (0.5%) Pneumonia, n (%) 2 (0.3%) 1 (0.2%) Deep vein thrombosis, n (%) 2 (0.3%) 1 (0.2%) SSI, n (%) 18 (2.4%) 7 (1.7%) SSI treatment, n (%) Oral antibiotics 12 (1.6%) 4 (1.0%) IV antibiotics 2 (0.3%) 2 (0.5%) Surgical incision and drainage with IV antibiotics 4 (0.5%) 1 (0.2%) Readmission, n (%) 34 (4.5%) 25 (6.0%) Reoperation, n (%) 18 (2.4%) 12 (2.9%) Reason for reoperation, n (%) Revised implants 0 1 (0.2%) SSI/wound dehiscence 4 (0.5%) 1 (0.2%) Others 14 (1.5%) 10 (2.4%) Abbreviations: IV, intravenous; SSI, surgical site infection.
- Table 5
Receiver-operating characteristic curve analysis of 1-level posterior lumbar fusion with patient-reported outcomes.
Patient-Reported Outcome Area Under the Curve (95% CI) P Value With interbody Length of stay POD1 0.73 (0.68–0.78) <0.001 Complications 0.47 (0.37–0.57) 0.624 MCID NRS back 0.43 (0.38–0.48) 0.016 MCID NRS leg 0.48 (0.42–0.53) 0.551 MCID ODI 0.48 (0.43–0.53) 0.625 Without Interbody Length of stay POD1 0.78 (0.71–0.85) <0.001 Complications 0.55 (0.43–0.66) 0.389 MCID NRS back 0.44 (0.36–0.51) 0.122 MCID NRS leg 0.53 (0.46–0.61) 0.328 MCID ODI 0.44 (0.37–0.51) 0.101 Abbreviations: MCID, minimum clinically important difference; NRS, Numeric Rating Scale; ODI, Oswestry Disability Index; POD1, postoperative day 1.
- Table 6
Preoperative and 3-mo PROs in patients undergoing elective 1-level open posterior lumbar fusion.
PROs Preoperative 3 mo Minimum Clinically Important Difference 30% Reduction at 3 mo P Value 3 mo to Preoperative With interbody NRS back 6.8 ± 2.3 3.4 ± 2.7 432 (56.6%) <0.001 NRS leg 6.8 ± 2.4 2.5 ± 3.0 470 (75.3%) <0.001 ODI 46.2 ± 13.9 27.5 ± 17.4 400 (52.4%) <0.001 Without interbody NRS back 6.7 ± 2.7 3.3 ± 2.7 258 (61.4%) <0.001 NRS leg 6.6 ± 2.8 2.8 ± 3.0 241 (57.4%) <0.001 ODI 47.1 ± 15.1 28.9 ± 18.5 375 (53.3%) <0.001 Abbreviations: NRS, Numeric Rating Scale; ODI, Oswestry Disability Index; PROs, patient-reported outcomes.
Note: Mean ± SD for continuous variables and n (%) for categorical variables.
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