title: National trends in revision spinal fusion in the USA: patient characteristics and complications.
abstract: Using the United States Nationwide Inpatient Sample, we identified national trends in revision spinal fusion along with a comprehensive comparison of comorbidities, inpatient complications and surgical factors of revision spinal fusion compared to primary spinal fusion. In 2009, there were 410 158 primary spinal fusion discharges and 22 128 revision spinal fusion discharges. Between 2002 and 2009, primary fusion increased at a higher rate compared with revision fusion (56.4% vs 51.0%; p < 0.001). In 2009, the mean length of stay and hospital charges were higher for revision fusion discharges than for primary fusion discharges (4.2 days vs 3.8 days, p < 0.001; USD $91 909 vs. $87 161, p < 0.001). In 2009, recombinant human bone morphogenetic protein (BMP) was used more in revision fusion than in primary fusion (39.6% vs 27.6%, p < 0.001), whereas interbody devices were used less in revision fusion (41.8% vs 56.6%, p < 0.001). In the multivariable logistic regression model for all spinal fusions, depression (odds ratio (OR) 1.53, p < 0.001), psychotic disorders (OR 1.49, p < 0.001), deficiency anaemias (OR 1.35, p < 0.001) and smoking (OR 1.10, p = 0.006) had a greater chance of occurrence in revision spinal fusion discharges than in primary fusion discharges, adjusting for other variables. In terms of complications, after adjusting for all significant comorbidities, this study found that dural tears (OR 1.41; p < 0.001) and surgical site infections (OR 3.40; p < 0.001) had a greater chance of occurrence in revision spinal fusion discharges than in primary fusion discharges (p < 0.001). A p-value < 0.01 was considered significant in all final analyses.
authors.affiliation: Spine Center and Orthopedic Center , Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Rajaee
authors.affiliation: Spine Center , Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: L E A
authors.initials: LE
authors.lastname: Kanim
authors.affiliation: Spine Center , Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Bae
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000191:economics / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
keywords: BMP; Bone graft; Bone morphogenetic protein; Cervical fusion; Interbody device; Lumbar fusion; Revision spine fusion; Spinal fusion; Spinal fusion rates