title: Degenerative Spondylolisthesis: An Analysis of the Nationwide Inpatient Sample Database.
abstract: METHODS
  Analysis of the Nationwide Inpatient Sample database.
  
  
  OBJECTIVE
  To investigate national trends, risks, and benefits of surgical interventions for degenerative spondylolisthesis (DS).
  
  
  BACKGROUND
  The surgical management of DS continues to evolve whereas the most clinically and cost-effective treatment is debated. With an aging US population and growing restraints on a financially burdened health care system, a clear understanding of national trends in the surgical management of DS is needed.
  
  
  METHODS
  The Nationwide Inpatient Sample database was queried for patients with DS undergoing lumbar fusions from 2001 to 2010, using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis and procedure codes. Analyses compared instrumented posterolateral fusion (PLF), posterolateral fusion with anterior lumbar interbody fusion (ALIF + PLF), PLF with posterior interbody fusion (P/TLIF + PLF), anterior instrumented interbody fusion (ALIF), and posterior interbody fusion with posterior instrumentation (P/TLIF). Clinical data were analyzed representing the initial acute phase care after surgery.
  
  
  RESULTS
  There were 48,911 DS surgical procedures identified, representing 237,383 procedures. The percentage of patients undergoing PLF, ALIF + PLF, or ALIF increased whereas the percentage of P/TLIF or P/TLIF + PLF decreased over time. Total charges were less (P < 0.001), average length of hospital stay was shorter (P < 0.01), and average age was older (P < 0.01) for patients who underwent PLF compared with any other procedure. Type of procedure varied on the basis of the geographic region of the hospital, teaching versus nonteaching hospital, and size of hospital (P < 0.01). Patients who had P/TLIF + PLF or ALIF had a higher risk of mortality than patients who had PLF (odds ratios: 5.02, 2.22, respectively). Patients were more likely to develop a complication if they had ALIF + PLF, P/TLIF + PLF, ALIF, and P/TLIF than if they had PLF (odds ratios: 1.45, 1.23, 1.49, 1.12, respectively).
  
  
  CONCLUSIONS
  Variation in the surgical management of DS related to patient demographics, hospital charges, length of hospital stay, insurance type, comorbidities, and complication rates was found within the Nationwide Inpatient Sample database. During the acute phase of care immediately after surgery, PLF procedures were found to reduce length of hospital stay, hospital charges, and postoperative complications.
  
  
  METHODS
  3.
authors.affiliation: From the Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Norton
authors.forename: Kristina
authors.initials: K
authors.lastname: Bianco
authors.forename: Christopher
authors.initials: C
authors.lastname: Klifto
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
authors.forename: John A
authors.initials: JA
authors.lastname: Bendo
mesh_terms: D016208:Databases, Factual; D029721:Drosophila Proteins; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods* / Q000401:mortality / Q000639:trends*; D013168:Spondylolisthesis / Q000601:surgery*; D014481:United States / Q000453:epidemiology
chemical_list: D029721:Drosophila Proteins; C569969:Inc protein, Drosophila