title: Impact of Parkinson's disease on perioperative complications and hospital cost in multilevel spine fusion: A population-based analysis.
abstract: Parkinson's disease (PD) is a neurodegenerative disorder manifesting over time to result in reduced mobility. The impact of PD on spinal fusion has yet to be addressed on a nationwide level. The Nationwide Inpatient Sample (NIS) from 2001 to 2012 was used for analysis. Admissions with spinal fusion of two or more vertebrae (ICD-9 codes=81.62, 81.63 and 81.64) were included and then stratified based on the presence or absence of PD (ICD-9 code=332.0); patients with cancer (ICD-9 codes=140-239) or trauma (ICD-9 codes=805.0-806.9) were excluded. Propensity score matching adjusted for potential confounding effects introduced by patient age, race, sex, and primary payer for care. 570,858 patients receiving spinal fusion of two or three vertebrae (1-2 levels) were identified, 2648 (0.5%) of whom had PD. Analysis revealed that PD was independently predictive for increased in-hospital mortality, durotomy, paraplegia, postoperative infection, venous thrombotic events, inferior vena cava filter placement, red blood cell transfusion, pulmonary embolism, total hospital charge >$200,000, length of stay >1week, non-routine discharge disposition, acute respiratory distress syndrome, acute posthemorrhagic anemia, multisystem complications (nervous system, cardiac, respiratory, urinary), and device-related complications (all P<0.001). In conclusion, these findings from a nationwide analysis comprising a 12-year period indicate that PD is significantly associated with increased in-hospital morbidity, mortality, and cost following spine fusion of 1-2 levels when compared with the general population. These findings point to the need for risk stratification and adjustment of quality metrics for this growing patient population, and should be integrated into operative decision-making and patient counseling.
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, United States. Electronic address: drwood@post.harvard.edu.
authors.forename: Shearwood
authors.initials: S
authors.lastname: McClelland
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, United States.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Baker
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, United States.
authors.forename: Breton G
authors.initials: BG
authors.lastname: Line
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, United States.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
authors.affiliation: Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, United States.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, United States.
authors.forename: R Shay
authors.initials: RS
authors.lastname: Bess
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D007431:Intraoperative Complications / Q000191:economics* / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010300:Parkinson Disease / Q000150:complications* / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D013123:Spinal Fusion / Q000191:economics*; D014947:Wounds and Injuries / Q000150:complications
keywords: In-hospital mortality; Morbidity; Multilevel spine fusion; Nationwide analysis; Parkinson’s disease