Introduction: The complexity of patients undergoing spine surgery at tertiary centers is increasing despite external demands to minimize complications and improve patient outcomes. The present study evaluated the impact of comorbidities on short-term outcomes after lumbar diskectomy.
Methods: A retrospective review of 252 patients undergoing lumbar diskectomy was performed. Patients undergoing minimally invasive approach, repeat diskectomy, or multilevel surgery were excluded. Baseline characteristics including age, gender, preoperative symptoms, prior surgery, level of diskectomy, and far lateral discs were compared across multiple preoperative comorbidities. Charlson index was calculated. Outcomes included length of stay (LOS), durotomy, urinary retention (UR), morbidity, infection, re-admissions and emergency visits within 30 days, and pain relief by discharge and 30 days. Multivariate regression was used to evaluate for predictors of outcomes controlling for age and baseline differences.
Results: Mean age was 59 +/-11 years. Baseline differences were found with respect to age, obesity, hypertension, coronary artery disease (CAD), and hypothyroidism. Far lateral discs were more prevalent among obese patients, as was female gender in hypothyroid patients. LOS was longer in diabetic patients independent of age (1.9 vs 1.3 days, p=0.01). Controlling for age and gender, hypothyroidism was a significant predictor of durotomy (p=0.03, OR=8.8) and emergency visits (p=0.02, OR=5.5). Predictors of UR included diabetes (p < 0.0001, OR=8.9), hypertension (p=0.01, OR=2.5), and Charlson index (p=0.01, OR=26.3). CAD was predictive of pain relief at 30 days (p=0.02, OR=0.2) and emergency visits (p= 0.04, OR=3.2, CI 1.05-8.9). Predictors of morbidity included diabetes (p=0.01, OR=3.3), liver disease (p=0.0004, OR=25), and Charlson comorbidity index (p=0.002, OR=1.8) independent of age. Patients with higher Charlson scores (p=0.02, OR=1.6) and liver disease (p=0.001, OR=19.6) were more likely to develop post-operative infections. Liver disease was associated with higher readmission rates (p= 0.003, OR=18.4).
Conclusions: Short-term outcomes after diskectomy are adversely effected by patient comorbidities.
Patient Care: It will improve allocation of resources and perhaps effect reimbursement of patients undergoing elective surgery
Learning Objectives: By the conclusion of this session, participants should understand: 1) which comorbidities effect short term outcomes after diskectomy 2) the components of a Charlson index 3) a perspective of the need to account for comorbidities when developing reimbursement models