Introduction: Incidental durotomies during spine surgeries are well known complications. The incidence of this complication has been shown to increase with increasing surgical complexity. The aim of this study was to study the medical cost of incidental durotomies in complex lumbar surgeries, such as fusion procedures, from a large database.
Methods: We acquired the Nationwide Inpatient Sample (NIS), and extracted all the admissions with procedures coding for lumbar fusion surgeries (ICD-9 codes 81.04-81.08) and refusion surgeries (ICD-9 codes 81.34-81.38) from 2005 to 2009. We analyzed the patients with inadvertent dural tears (ICD-9 code 349.31). Only patients with a primary diagnosis of spine pathology and a primary procedure of spinal fusion were included in the study. We excluded patients less than 18 years of age.
Results: A total of 214,547 admissions were recorded in NIS from 2005-2009. The average age at the time of admission was 55.8 years (range: 19-110 years). Females were a majority, accounting for 56.0% of all admissions. Incidental durotomies were coded in 2201 admissions (1.0% of all admissions). Posterior approach was associated with a higher incidence of incidental durotomies compared to the anterior approach (1.0% vs. 0.3%, p<0.001). In posterior lumbar fusion, the presence of an inadvertent durotomy was associated with a significant increase of medical costs (mean difference of $29,125.92, p<0.001) and length of stay (5.64 vs. 4.55 days, p<0.001). In patients undergoing anterior lumbar fusion procedures, a similar trend was found, with a significant increase in medical costs (mean difference of $28,833.75, p<0.001) and length of stay (5.63 vs. 4.56 days, p<0.001).
Conclusions: Although most unintended durotmies in lumbar spine fusion surgeries do not have any long-term sequelae, they do lead to significantly increased medical costs. This increase in cost may be due to increased length of stays and/or additional procedures.
Patient Care: Becoming aware of the added cost of incidental durotomies in lumbar fusion surgeries can help in surgical decision making and counseling patients on the risk and complications of such procedures.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of incidental durotomies during lumbar spine fusion surgeries and the cost associated with it, 2) Discuss, in small groups, ways to prevent the complication and identify cost-effective treatment strategies.