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Oral Presentation

Spine

Identifying Risk Factors for Adverse Surgical Outcomes Following Lumbar Disc Arthroplasty: A Multi-Institutional Analysis of 473 Patients

Sunday, May 5, 2024
2:34 PM – 2:39 PM CT
Location:  N427bc
Disclosure(s):
Karim R. Nathani, MBBS: No financial relationships to disclose
Corey T. Walker, MD: Alphatec: Consultant (Ongoing); Globus: Speaker/Honoraria (Ongoing)
Introduction: Lumbar disc arthroplasty (LDA) is a potential alternative to fusion in select cases of lumbar spondylosis. It allows for the preservation of segmental motion and has a lower risk of fusion-related complications with a quicker recovery. This multicenter study aimed to assess for risk factors associated with poor surgical outcomes in patients undergoing LDA for lumbar spondylosis.

Methods: We conducted a retrospective analysis of electronic medical records from three participating institutions, focusing on patients who underwent LDA for lumbar spondylosis. Outcome variables examined included operative time, extended length of stay (LOS), and discharge disposition. Regressional models were developed for multivariate analyses of outcomes for independent factors.

Results: The study comprised of 473 patients with mean age 43.9 ± 11.5 years and 207 (43.4%) females. Analysis revealed revision surgery (23 (20.5%) vs. 29 (12.3%), p=0.04), current smoking (23 (16.9%) vs. 33 (9.9%), p=0.03), depression (31 (22.8%) vs. 48 (14.3%), p=0.03), preoperative motor weakness (46 (48.4%) vs. 36 (30.3%), p=0.01), and longer operative time (178.53 ± 90.07 vs. 136.23 ± 62.56 minutes, p< 0.01), among others, to be associated with an increased risk of extended LOS. Multivariate analysis found an independent association of operative time with extended LOS. Non-routine discharge correlated with older age (51.53 ± 12.77 vs. 43.08 ± 11.07 years, p< 0.01), higher BMI (28.43 ± 6.33 vs. 26.85 ± 4.59 kg/m2, p=0.03), current smoking, depression, higher estimated blood loss (EBL), and longer operative time (174.32 ±101.75 vs. 142.33 ± 66.99 minutes p< 0.01), among others. Older age, white race, employed status, and EBL>500ml were independently associated with non-routine discharge. Additionally, a separate multivariate model demonstrated that revision surgery, unemployed status, motor weakness, and EBL>250ml were independently associated with long operative time.

Conclusion : The current study represents one of the largest retrospective reviews across multiple centers investigating outcomes following LDA. It identifies several risk factors, including older age, BMI, current smoking, depression, and revision surgery, among other factors, that increase the risk of poor surgical outcomes following LDA.