Introduction: Parkinson’s disease (PD) is increasingly recognized as an important cause of spinal disorders requiring surgical correction. Spinal decompression and/or fusion can be complicated due to poor bone quality and severe muscular dysfunction in this patient population.
The purpose of this study was to assess characteristics and outcomes of patients with PD undergoing lumbar spine surgery for degenerative conditions.
Methods: The National Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on ICD-9-CM procedural codes for lumbar spine surgery and further substratified to degenerative diagnoses. Incidence and baseline patient characteristics were determined. Multivariable analysis including patient characteristics (e.g. gender, age, race, insurance type), hospital characteristics and major comorbidities was done to determine independent risk factors increasing incidence of lumbar fusion revision in PD patients.
Results: PD patients account for 0.8% of all degenerative lumbar procedures. At baseline, PD patients are older (70.4 versus 58.9, p < .0001) and are more likely to be male (58.6% male, p < .0001). Mean length of stay (LOS) was increased in PD patients undergoing lumbar fusion (5.1 days versus 4.0 days, p < .0001) and lumbar fusion revision (6.2 days versus 4.7 days, p < .0001). Costs were nearly 8.0% (p < .0001) higher for lumbar fusion and approximately 25% (p < .0001) higher for lumbar fusion revision in PD patients when compared to those without PD. Multivariable analysis indicates that osteoporosis, psychiatric disorders, Medicare and, in particular, no insurance (odds ratio 8.8, p < .0001) are significant independent predictors of lumbar fusion revision in patients with PD.
Conclusions: PD patients undergoing lumbar surgery for degenerative conditions have increased LOS and costs when compared to patients without PD. Uninsured patients with PD, possibly due to advanced PD secondary to limited healthcare access, are nearly 9 times more likely to have a revision following the index surgery. Patients with PD undergoing lumbar spine surgery are a challenging population due to their poor bone quality and severe muscular dysfunction. PD patients with osteoporosis make these procedures increasingly difficult and should be managed with special attention to avoid revisions.
Patient Care: Increases awarness on outcomes of PD patients undergoing spine surgery
Learning Objectives: Importance of the diagnosis of PD in outcomes after spine surgery