ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic has altered the standard of care for spine surgery in many ways. However, there is a lack of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic. In particular, no large database study evaluating the impact of the COVID-19 pandemic on spine surgery outcomes has yet been published. Therefore, the aim of this study was to evaluate the impact of the COVID-19 pandemic on perioperative factors and postoperative outcomes of lumbar fusion procedures. Methods: This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which was queried for all adult patients who underwent primary lumbar fusion in 2019 and 2020. Patients were grouped into cohorts based on 2019 (pre-pandemic) or 2020 (intra-pandemic) operation year. Differences in 30-day readmission, reoperation, and morbidity rates were evaluated using multivariate logistic regression. Differences in total relative value units (RVUs), RVUs per minute, and total operation time were evaluated using quantile (median) regression. Odds ratios (OR) for length of stay were estimated via negative binomial regression. Results: A total of 27,446 patients were included in the analysis (12,473 cases in 2020). Unadjusted comparisons of outcomes revealed that lumbar fusions performed in 2020 were associated with higher rates of morbidity, pneumonia, bleeding transfusions, deep venous thrombosis (DVT), and sepsis. 2020 operation year was also associated with longer length of hospital stay, less frequent non-home discharge, higher total RVUs, and higher RVUs per minute. After adjusting for baseline differences in regression analyses, the differences in bleeding transfusions, length of stay, and RVUs per minute were no longer statistically significant. However, operation year 2020 independently predicted morbidity, pneumonia, DVT, and sepsis. In terms of perioperative variables, operation year 2020 predicted greater operative time, non-home discharge, and total RVUs. Conclusions: Lumbar fusion procedures performed amidst the COVID-19 pandemic were associated with poorer outcomes, including higher rates of morbidity, pneumonia, DVT, and sepsis. In addition, surgeries performed in 2020 were associated with longer operative times and less frequent non-home discharge disposition.
ABSTRACT
STUDY DESIGN: A retrospective cohort study. PURPOSE: To compare 30-day readmission, reoperation, and morbidity for patients undergoing posterior cervical decompression and fusion (PCDF) in inpatient vs. outpatient settings. OVERVIEW OF LITERATURE: PCDF has recently been increasingly performed in outpatient settings, often utilizing minimally invasive techniques. However, literature evaluating short-term outcomes for PCDF is scarce. Moreover, no currently large-scale database studies have compared short-term outcomes between PCDF performed in the inpatient and outpatient settings. METHODS: Patients who underwent PCDF from 2005 to 2018 were identified using the National Surgical Quality Improvement Program database. Regression analysis was utilized to compare primary outcomes between surgical settings and evaluate for predictors thereof. RESULTS: We identified 8,912 patients. Unadjusted analysis revealed that outpatients had lower readmission (4.7% vs. 8.8%, p =0.020), reoperation (1.7% vs. 3.8%, p =0.038), and morbidity (4.5% vs. 11.2%, p <0.001) rates. After adjusting for baseline differences, readmission, reoperation, and morbidity no longer statistically differed between surgical settings. Outpatients had lower operative time (126 minutes vs. 179 minutes) and levels fused (1.8 vs. 2.2) (p <0.001). Multivariate analysis revealed that age (p =0.008; odds ratio [OR], 1.012), weight loss (p =0.045; OR, 2.444), and increased creatinine (p <0.001; OR, 2.233) independently predicted readmission. The American Society of Anesthesiologists (ASA) classification of ≥3 predicted reoperation (p =0.028; OR, 1.406). Rehabilitation discharge (p <0.001; OR, 1.412), ASA-class of ≥3 (p =0.008; OR, 1.296), decreased hematocrit (p <0.001; OR, 1.700), and operative time (p <0.001; OR, 1.005) predicted morbidity. CONCLUSIONS: The 30-day outcomes were statistically similar between surgical settings, indicating that PCDF can be safely performed as an outpatient procedure. Surrogates for poor health predicted negative outcomes. These results are particularly important as we continue to shift spinal surgery to outpatient centers. This importance has been highlighted by the need to unburden inpatient sites, particularly during public health emergencies, such as the coronavirus disease 2019 pandemic.