Introduction: Recently, there has been an excessive use of post-operative imaging after spine surgery and has been a target for hospitals to reduce unnecessary costs. However, there is a paucity of data identifying the rate of instrumentation stability changes after complex spinal surgery involving =5 level fusions.
Methods: The medical records of 136 adult (=18 years-old) spine deformity patients undergoing elective, primary complex spinal fusion (=5 levels) for deformity correction a major academic institution from 2005 to 2015 were reviewed. Patient demographics, comorbidities, intra- and post-operative complication rates were collected for each patient. We reviewed the first five subsequent post-operative and follow-up images, and whether revision of surgery was performed within five years after surgery. The primary outcome investigated in this study was the rate of instability on follow-up imaging.
Results: The majority of patients were female, with the mean ± SD age of 53.8±20.0 years and BMI of 27.3±6.2 kg/m2. The median [IQR] fusion levels operated was 9 [7-13], with a mean ± SD length of surgery of 327.8±124.7 mins and estimated blood loss of 1312.1±1269.2 mL. The mean±SD length of hospital stay was 6.6±3.9 days with a 30-day readmission rate of 14.0%. Post-Operative and follow-up change in stability on imaging (days from operation) included: Image 1 (4.6±9.3 days) 0.0%; Image 2 (51.7±49.9 days) 3.0%; Image 3 (142.1±179.8 days) 5.6%; Image 4 (277.3±272.5 days); and Image 5 (463.1±525.9 days) 15.7%. The third-year after surgery had the highest rate of hardware revision (5.55%), followed by the second-year (4.68%), and first-year (4.54).
Conclusions: Our study suggests that the rate of instrumentation stability changes on imaging increases overtime, with no changes occurring at the first post-operative image. In an era of cost-conscious healthcare, reduction of early imaging after complex spinal fusions (=5 levels) may not impact patient care and can reduce overall healthcare resources.
Patient Care: Will allow providers to reduce unnecessary imaging and reduce healthcare costs by optimizing timing for post-operative images.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of post-operative images after complex spine surgery, 2) Discuss, in small groups, the clinical necessity of multiple post-operative images, 3) Identify an effective time length between discharge and follow up that best demonstrates stability of instrumentation.