Article Figures & Data
Figures
- Figure 1
Histogram showing the distribution of estimated blood loss (EBL) in milliliters in patients with 2-level (A) and 3-level (B) posterolateral lumbar fusion, with and without interbody fusion.
- Figure 2
Receiver operating characteristic curves of estimated blood loss (EBL) vs length of stay in 2-level (A) and 3-level (B) posterolateral lumbar fusion. AUC, area under the curve; Se, sensitivity; Sp, specificity.
- Figure 3
Comparison of 25th centile and Youden’s Index of patients with prolonged length of stay (LOS) in 2-level (A) and 3-level (B) posterolateral lumbar fusion. The red vertical lines indicate the calculated Youden’s Index. The purple lines show the 25th centile of patients with prolonged LOS. Estimated blood loss is given in milliliters. ROC, receiver operating characteristic curve.
Tables
- Table 1
Demographic characteristics of patients receiving 2- and 3-level posterolateral lumbar fusion.
Variables 2-Level Fusion (N = 557) 3-Level Fusion (N = 287) Age, mean ± SD 61.74 ± 12.05 63.71 ± 11.57 Gender: men, n (%) 277 (50.0%) 128 (44.9%) Race: White, n (%) 482 (87.2%) 264 (93.0%) Body mass index, mean ± SD 31.23 ± 6.68 30.67 ± 6.44 Comorbidities, n (%) 1 or 2 Comorbidities 319 (57.3%) 165 (57.5%) >2 Comorbidities 153 (27.5%) 87 (30.3%) Coronary artery disease 99 (23.6%) 53 (22.9%) Hypertension 350 (62.8%) 193 (67.2%) Congestive heart failure 17 (3.1%) 10 (3.5%) Chronic obstructive pulmonary disease 31 (5.6%) 10 (3.5%) Osteoporosis 17 (4.1%) 14 (6.1%) Diabetes 142 (25.5%) 72 (25.1%) Active smoker, n (%) 88 (15.8%) 51 (17.8%) Preoperative anticoagulation/antiplatelet usage, n (%) 13 (3.1%) 8 (3.5%) Insurance, n (%) Private 237 (42.5%) 95 (33.1%) Medicare/Medicaid/Tenncare 265 (47.6%) 171 (59.6%) Veterans Affairs/Government (includes Tricare) 38 (6.8%) 15 (5.2%) Uninsured/not available 7 (1.3%) 3 (1.0%) Currently employed, n (%) 191 (34.4%) 67 (23.3%) Intend to return to work, n (%) 183 (95.8%) 59 (89.4%) Preoperative ambulation, n (%) With assistance 179 (32.3%) 96 (33.4%) Independent 371 (66.8%) 189 (65.9%) Wheelchair bound 5 (0.9%) 2 (0.7%) Duration of symptoms, n (%) <3 mo 33 (7.6%) 15 (6.5%) 3–12 mo 141 (32.4%) 67 (29.1%) >12 mo 261 (60.0%) 148 (64.3%) Diagnosis, n (%) Stenosis 132 (24.0%) 66 (23.6%) Herniated disc 11 (2.0%) 10 (3.6%) Fracture 29 (5.3%) 14 (5.0%) Deformity/scoliosis 43 (7.8%) 60 (21.4%) Spondylolisthesis 280 (51.0%) 97 (34.6%) Pseudarthrosis 30 (5.5%) 22 (7.9%) Other 22 (4.0%) 11 (4.0%) Revision, n (%) 214 (38.4%) 135 (47.0%) Reason for revision, n (%) Adjacent segment disease 68 (38.4%) 43 (38.4%) Pseudarthrosis/instrumentation failure 34 (19.2%) 30 (26.8%) Same level recurrent stenosis 53 (29.9%) 26 (23.2%) Same level recurrent disc herniation 16 (9.0%) 6 (5.4%) Other 6 (3.4%) 7 (6.3%) - Table 2
Operative and perioperative variables of patients receiving 2- and 3-level posterolateral lumbar fusion.
Variables 2-Level Fusion (N = 557) 3-Level Fusion (N = 287) Estimated blood loss (mL), mean ± SD 583.09 ± 447.54 790.32 ± 682.26 Operative time (min), mean ± SD 240.82 ± 68.47 272.82 ± 75.74 Interbody placement, n (%) 178 (32.0%) 70 (24.4%) Length of stay (d), mean ± SD 3.44 ± 1.82 4.46 ± 2.67 Discharged, n (%) Home 443 (85.0%) 202 (74.5%) In-patient rehabilitation facility 48 (9.2%) 46 (17.0%) Skilled nursing facility 30 (5.8%) 23 (8.5%) Variables, n (%) 2-Level Fusion (N = 557) 3-Level Fusion (N = 287) Complication 43 (7.7%) 33 (11.5%) Urinary tract infection 26 (4.7%) 15 (5.2%) Hematoma 0 (0.0%) 2 (0.7%) Neurological deficit 5 (0.9%) 4 (1.4%) Pneumonia 2 (0.4%) 1 (0.3%) Deep vein thrombosis 2 (0.4%) 2 (0.7%) SSI 14 (2.5%) 12 (4.2%) SSI treatment Oral antibiotics 6 (42.9%) 3 (25.0%) IV antibiotics 2 (14.3%) 2 (16.7%) Surgical incision and drainage with IV antibiotics 5 (35.7%) 6 (50.0%) Readmission 38 (8.9%) 22 (9.4%) Reoperation 12 (2.9%) 14 (6.1%) Reason for reoperation Revised implants 2 (16.7%) 2 (14.3%) SSI/wound dehiscence 5 (41.7%) 6 (42.9%) Other 5 (41.7%) 6 (42.9%) Abbreviations: IV, intravenous; SSI, surgical site infection.
- Table 4
Receiver operating characteristic curve analysis of 2- and 3-level posterolateral lumbar fusion with patient-reported outcomes.
Outcomes Estimated Blood Loss, mL Area Under the Curve (95% CI) P Value 2-Level Fusion (N = 557) Length of stay POD2 375 0.64 (0.58–0.7) <0.001 Complication (30 d) 637.5 0.5 (0.38–0.61) <0.001 MCID ODI 287.5 0.54 (0.48–0.6) <0.001 MCID NRS back 975 0.53 (0.46–0.59) <0.001 MCID NRS leg 975 0.51 (0.44–0.57) <0.001 3-Level Fusion (N = 287) Length of stay POD2 675 0.63 (0.54–0.73) 0.012 Complication (30 d) 538 0.63 (0.51–0.76) <0.001 MCID ODI 675 0.52 (0.44–0.6) <0.001 MCID NRS back 512.5 0.57 (0.49–0.65) <0.001 MCID NRS leg 375 0.46 (0.37–0.56) <0.001 Abbreviations: MCID, minimal clinically important difference; NRS, Numerical Rating Scale; ODI, Oswestry Disability Index; POD2, postoperative day 2.
Outcomes Preoperative 3 mo Minimal Clinically Important Difference 30% Reduction at 3 mo P Value,
3 mo to Preoperative2-Level Fusion (N = 557) NRS back 6.97 ± 2.30 3.94 ± 2.72 303 (62.3%) <0.001 NRS leg 6.34 ± 2.86 3.06 ± 3.21 294 (64.8%) <0.001 ODI 48.48 ± 14.21 32.27 ± 17.83 269 (54.0%) <0.001 3-Level Fusion (N = 287) NRS back 7.14 ± 2.19 3.81 ± 2.58 172 (66.7%) <0.001 NRS leg 6.60 ± 2.97 2.58 ± 2.98 181 (74.2%) <0.001 ODI 48.63 ± 13.90 34.18 ± 16.44 131 (50.0%) <0.001 Abbreviations: NRS, Numerical Rating Scale; ODI, Oswestry Disability Index.
Note: Data presented as mean ± SD for continuous variables and n (%) for categorical variables.
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.