Introduction: Clinical practice in post-operative bracing after posterior lumbar spine fusion (PLF) is inconsistent between providers. Direct evidence for its efficacy is limited. We sought to elucidate the effect of bracing on short-term outcomes related to safety, quality of care and direct costs.
Methods: Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing (2013-2017) was undertaken (n=906). Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher’s exact test, Cochran-Mantel-Haenszel) Mann-Whitney-Wilcoxon tests and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition/need for post-acute care, quality-adjusted life year (QALY), surgical-site-infection (SSI), hospital cost, total cost, readmission within 30 days, and ER visits within 30 days.
Results: Amongst the study population, 863 patients were braced and 43 were not braced. There was no difference in graft type (P=0.145) or comorbidities (P=0.20-1.00) such as obesity (P=1.000), smoking (P=1.000), chronic obstructive pulmonary disease (P=1.000), hypertension (P=0.805), coronary artery disease (P=1.000), congestive heart failure (P=1.000), and problem list number (P=0.228). The braced group incurred a significantly higher direct cost (median increase of 41.43%, P<0.001) compared to the unbraced cohort (bracing cost excluded). No difference was seen between the two groups in LOS (P=0.836), discharge disposition (P=0.226), readmission (P=1.000), ER visits (P=0.281), SSI (P=1.000), and QALY gain (P=0.319).
Conclusions: Bracing following single-level posterior lumbar fixation does not alter short-term post-operative course or reduce the risk for early adverse events. Furthermore, patients braced subsequent to PLF incurred higher direct costs. Short term data suggest that removal of bracing from the post-operative regimen for PLF will not result in increased adverse outcomes but will reduce cost. Long-term analysis of risk and fusion rates is necessary prior to elimination of post-operative bracing from care algorithms.
Patient Care: By the conclusion of this session, participants should be able to: 1) Describe the equivalency of bracing after PLF, 2) Understand the cost benefit and clinical benefit of utilizing a brace vs. no brace.
Learning Objectives: Utilization of post-operative bracing after PLF is not associated with mitigation of short-term risk. Elimination of bracing from clinical practice could help lower costs, but long-term risk assessment is needed.