Ninety day adverse events following single level posterior lumbar interbody fusion in patients with sickle cell disease

Dec 11, 2023The spine journal : official journal of the North American Spine Society

Complications within 90 days after lower back fusion surgery in people with sickle cell disease

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Abstract

Patients with sickle cell disease (SCD) undergoing single-level posterior lumbar interbody fusion (PLIF) had significantly increased odds of adverse postoperative events.

Patients with SCD had an odds ratio (OR) of 17.69 for requiring blood transfusions post-surgery.
The likelihood of developing pneumonia was 6.30 times greater in patients with SCD.
An increased odds ratio of 4.86 for sepsis was observed in SCD patients compared to those without the condition.
SCD patients had 4.65 times greater odds of experiencing aggregated minor adverse events.
Overall adverse events were 3.87 times more likely in SCD patients, with ED visits occurring at a 3.53 times higher rate.
The odds of experiencing aggregated severe adverse events were 2.80 times greater for patients with SCD.

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BACKGROUND CONTEXT: Sickle cell disease (SCD) is an inherited disorder of red blood cells caused by mutation in the hemoglobin beta chain and is the most common inherited genetic disorder in the United States. Postoperative outcomes following single-level posterior lumbar interbody fusion (PLIF) in patients with SCD are not well characterized.

PURPOSE: To examine 90-day postoperative outcomes among a matched cohort of patients with and without SCD who underwent single level PLIF utilizing a national administrative database.

STUDY DESIGN/SETTING: Retrospective database study.

PATIENT SAMPLE: Adult patients without and with SCD who underwent single level PLIF from 2010 to 2021 Q1 were identified and matched 10:1 based on age, sex and ECI. Exclusion criteria included: age <18 years old, recent history of infection, neoplasm, or trauma, as well as not being active in the database for 90 days following their procedure.

OUTCOME MEASURES: Ninety-day postoperative adverse events and emergency department (ED) visits.

METHODS: The matched cohorts were defined, and 90-day adverse event and ED visit rates were compared with univariable analyses and multivariable logistic regression, controlling for age, sex, and Elixhauser comorbidity index (ECI).

RESULTS: Overall, 191,765 PLIF patients were identified, of which SCD was noted for 76 (0.04%). On multivariable analysis of the matched populations, patients with SCD were at increased odds ratio (OR) of the following (in decreasing OR order): transfusion (OR 17.69), pneumonia (OR 6.30), sepsis (OR 4.86), aggregated minor adverse events (OR 4.65), aggregated all adverse events (OR 3.87), ED visits (OR 3.53), and aggregated severe adverse events (OR 2.80) (p<.05 for all).

CONCLUSIONS: The current study examined a relatively small, but largest to date, cohort of SCD patients undergoing PLIF. Patients with this condition were at greater odds of several perioperative adverse events, and these findings may be helpful for patient counselling and surgical planning.

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Ninety day adverse events following single level posterior lumbar interbody fusion in patients with sickle cell disease

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