title: Primary and Revision Posterior Lumbar Fusion Have Similar Short-Term Complication Rates.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To compare short-term morbidity for primary and revision posterior lumbar fusions.
  
  
  BACKGROUND
  Revision lumbar fusions are unfortunately relatively common. Previous studies have described an increased risk of postoperative complications after revision lumbar fusion; however, these studies have been limited by small sample sizes, poor data quality, and/or narrow outcome measures. There is a need to validate these findings using a high-quality, national cohort of patients to have an accurate assessment of the relative risk of revision posterior lumbar fusions compared with primary lumbar fusion.
  
  
  METHODS
  The prospectively-collected American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients that underwent undergoing primary and revision posterior lumbar fusion from 2005 to 2013. The occurrence of individual and aggregated postoperative complications within 30 days, along with rates of blood transfusion and readmission, were compared between primary and revision procedures using bivariate and multivariate Poisson regression with robust error variance to control for patient and operative characteristics. Operative time and postoperative length of stay were compared between groups using bivariate and multivariate linear regression.
  
  
  RESULTS
  Of the 14,873 posterior lumbar fusion procedures that met inclusion criteria, 1287 (8.7%) were revision cases. There were no differences in the rates of 30-day postoperative complications or readmission between primary and revision posterior lumbar fusion using multivariate analysis to control for patient and operative characteristics. Similarly, no significant differences were found for operative time or postoperative length of stay. There was an increased rate of blood transfusion for revision surgery compared with primary surgery (relative risk 1.4, P < 0.001).
  
  
  CONCLUSIONS
  This study suggests that revision posterior lumbar fusion does not carry significantly increased risk of complications or readmission compared with a primary posterior lumbar fusion. Patients undergoing revision surgery were more likely to receive a blood transfusion. This information suggests that general health risk stratification for revision procedures can be similar to that considered for primary cases.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL†Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Diaz-Collado
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Geddes
authors.forename: Andre M
authors.initials: AM
authors.lastname: Samuel
authors.forename: Adam M
authors.initials: AM
authors.lastname: Lukasiewicz
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Webb
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult