TY - JOUR
T1 - Independent Predictors of Revision Lumbar Fusion Outcomes and the Impact of Spine Surgeon Variability
T2 - Does It Matter Whether the Primary Surgeon Revises?
AU - Montenegro, Thiago Scharth
AU - Singh, Akash
AU - Elia, Christopher
AU - Matias, Caio M.
AU - Gonzalez, Glenn A.
AU - Saiegh, Fadi Al
AU - Philipp, Lucas
AU - Hattar, Ellina
AU - Hines, Kevin
AU - Fatema, Umma
AU - Thalheimer, Sara
AU - Wu, Chengyuan
AU - Prasad, Srinivas K.
AU - Jallo, Jack
AU - Heller, Joshua E.
AU - Sharan, Ashwini
AU - Harrop, James
N1 - Publisher Copyright:
© 2021 Congress of Neurological Surgeons 2021.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - BACKGROUND: There is a paucity of information regarding treatment strategies and variables affecting outcomes of revision lumbar fusions. OBJECTIVE: To evaluate the influence of primary vs different surgeon on functional outcomes of revisions. METHODS: All elective lumbar fusion revisions, March 2018 to August 2019, were retrospectively categorized as performed by the same or different surgeon who performed the primary surgery. Oswestry Disability Index (ODI) and clinical variables were collected. Multiple logistic regression identified multivariable-adjusted odds ratio (OR) of independent variables analyzed. RESULTS: Of the 130 cases, 117 (90%) had complete data. There was a slight difference in age in the same (median: 59; interquartile range [IQR], 54-66) and different surgeon (median: 67; IQR, 56-72) groups (P =. 02); all other demographic variables were not significantly different (P >. 05). Revision surgery with a different surgeon had an ODI improvement (median: 8; IQR, 2-14) greater than revisions performed by the same surgeon (median: 1.5; IQR, -3 to 10) (P <. 01). Revisions who achieved minimum clinically important difference (MCID) performed by different surgeon (59.7%) were also significantly greater than the ones performed by the same surgeon (40%) (P =. 042). Multivariate analysis demonstrated that a different surgeon revising (OR, 2.37; [CI]: 1.007-5.575, P =. 04) was an independent predictor of MCID achievement, each additional 2 years beyond the last surgery conferred a 2.38 ([CI]: 1.36-4.14, P <. 01) times greater odds of MCID achievement, and the anterior lumbar interbody fusion approach decreased the chance of achieving MCID (OR, 0.19; [CI]: 0.04-0.861, P =. 03). CONCLUSION: All revision lumbar spinal fusion approaches may not achieve the same outcomes. This analysis suggests that revision surgeries may have better outcomes when performed by a different surgeon.
AB - BACKGROUND: There is a paucity of information regarding treatment strategies and variables affecting outcomes of revision lumbar fusions. OBJECTIVE: To evaluate the influence of primary vs different surgeon on functional outcomes of revisions. METHODS: All elective lumbar fusion revisions, March 2018 to August 2019, were retrospectively categorized as performed by the same or different surgeon who performed the primary surgery. Oswestry Disability Index (ODI) and clinical variables were collected. Multiple logistic regression identified multivariable-adjusted odds ratio (OR) of independent variables analyzed. RESULTS: Of the 130 cases, 117 (90%) had complete data. There was a slight difference in age in the same (median: 59; interquartile range [IQR], 54-66) and different surgeon (median: 67; IQR, 56-72) groups (P =. 02); all other demographic variables were not significantly different (P >. 05). Revision surgery with a different surgeon had an ODI improvement (median: 8; IQR, 2-14) greater than revisions performed by the same surgeon (median: 1.5; IQR, -3 to 10) (P <. 01). Revisions who achieved minimum clinically important difference (MCID) performed by different surgeon (59.7%) were also significantly greater than the ones performed by the same surgeon (40%) (P =. 042). Multivariate analysis demonstrated that a different surgeon revising (OR, 2.37; [CI]: 1.007-5.575, P =. 04) was an independent predictor of MCID achievement, each additional 2 years beyond the last surgery conferred a 2.38 ([CI]: 1.36-4.14, P <. 01) times greater odds of MCID achievement, and the anterior lumbar interbody fusion approach decreased the chance of achieving MCID (OR, 0.19; [CI]: 0.04-0.861, P =. 03). CONCLUSION: All revision lumbar spinal fusion approaches may not achieve the same outcomes. This analysis suggests that revision surgeries may have better outcomes when performed by a different surgeon.
KW - Different spine surgeon
KW - Functional outcomes
KW - Lumbar spine fusion
KW - Patient-reported outcome measure
KW - Revision spine surgery
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U2 - 10.1093/neuros/nyab300
DO - 10.1093/neuros/nyab300
M3 - Article
C2 - 34392365
AN - SCOPUS:85118598429
SN - 0148-396X
VL - 89
SP - 836
EP - 843
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -