title: Increased 30-Day Complication Rates Associated with Laminectomy in 874 Adult Patients with Spinal Deformity Undergoing Elective Spinal Fusion: A Single Institutional Study.
abstract: OBJECTIVE
  Recent studies have reported that decompression with fusion leads to superior outcomes in correction of spinal deformity. The aim of this study was to determine if there is a difference in intraoperative and 30-day postoperative complication rates in patients undergoing spinal fusion with and without decompression.
  
  
  METHODS
  Medical records of 874 adult (≥18 years old) patients with spinal deformity undergoing elective spinal fusion at a major academic institution from 2005 to 2015 were reviewed; 374 (42.8%) patients underwent laminectomy in addition to spinal fusion. The primary outcome investigated was the rate of intraoperative and 30-day complications.
  
  
  RESULTS
  Patient demographics and comorbidities were similar between groups. The laminectomy cohort had significantly higher estimated blood loss (P < 0.0001), incidence of allogeneic blood transfusions (P = 0.0001), and rate of intraoperative durotomies (laminectomy cohort 10.4% vs. no-laminectomy cohort 3.1%; P < 0.0001). The laminectomy cohort had a significantly higher proportion of patients in the intensive care unit (28.6% vs. 17.7%; P < 0.001). There was no significant difference in 30-day readmission rate between cohorts (laminectomy cohort 13.0% vs. no-laminectomy cohort 9.8%; P = 0.13). Within 30 days after initial discharge, the laminectomy cohort had significantly higher rates of altered mental status (3.2% vs. 1.2%; P = 0.05), urinary tract infection (4.3% vs. 1.4%; P = 0.009), wound drainage (7.2% vs. 3.1%; P = 0.007), and instrumentation failure (1.1% vs. 0.0%; P = 0.03).
  
  
  CONCLUSIONS
  Patients undergoing spinal fusion with laminectomy may have higher complication rates than patients undergoing spinal fusion alone.
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Aladine A
authors.initials: AA
authors.lastname: Elsamadicy
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: owoicho.adogwa@gmail.com.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Warwick
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sergesketter
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Lydon
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Ronnie L
authors.initials: RL
authors.lastname: Shammas
authors.affiliation: Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Ankit I
authors.initials: AI
authors.lastname: Mehta
authors.affiliation: Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Raul A
authors.initials: RA
authors.lastname: Vasquez
authors.affiliation: Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery*
keywords: 30-Day readmission; Laminectomy; Spine surgery; Surgical outcomes