title: Elective Thoracolumbar Spine Fusion Surgery in Patients with Parkinson Disease.
abstract: OBJECTIVE
  Few data are available concerning clinical outcomes in patients with Parkinson disease who undergo elective thoracolumbar spine fusion surgery. The goal of this study is to elucidate complication and revision rates after posterior thoracolumbar fusion surgery in patients with Parkinson disease, with a focus on how Parkinson disease modifies these rates.
  
  
  METHODS
  The PearlDiver database (2005-2012) was queried for patients who underwent posterior approach thoracolumbar fusion from 2006 to 2011. Cohorts of patients with a previous diagnosis of Parkinson disease (n = 4816) and without (n = 280,702) were compared. Multivariate analysis that included various comorbidities and demographics was used to calculate effects of Parkinson disease on development of postoperative infection and major medical complications within 90 days and revision surgery within 1 year. For analyses, significance was set at P < 0.001.
  
  
  RESULTS
  Major medical complications were observed in 545 patients (11.3%) for 90 days after the index procedure. Postoperative infection was noted in 91 patients (1.9%) within 90 days, and revision surgeries were performed in 250 patients (5.2%) within 1 year. Multivariate analysis showed that Parkinson disease was significantly associated with an increased risk for medical complications (adjusted odds ratio, 1.22; 95% confidence interval, 1.11-1.34; P < 0.001) and revision surgery (adjusted odds ratio, 1.70; 95% confidence interval, 1.49-1.93; P < 0.001), but not postoperative infection (P = 0.02).
  
  
  CONCLUSIONS
  Patients with Parkinson disease are more likely to require revision surgery and have higher rates of adverse medical events postoperatively. Patients with Parkinson disease should be appropriately selected to ensure favorable clinical outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Puvanesarajah
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Rabia
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: S Evan
authors.initials: SE
authors.lastname: Carstensen
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Tyger
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: hh4xd@hscmail.mcc.virginia.edu.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*
keywords: Complication; Lumbar; Outcomes; Parkinson; Revision; Spine; Thoracolumbar