Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodongro, Gurogu, Seoul 08308, Republic of Korea.
Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA.
Spine J. 2024 Aug;24(8):1378-1387. doi: 10.1016/j.spinee.2024.03.003. Epub 2024 Mar 16.
Fusions for lumbar spine diseases are widely performed and have a growing incidence, especially in elderly population.
The goal of this study was to assess national trends of lumbar spinal fusions and examine the risk for reoperations after a lumbar fusion with a focus on 'epidemiologic transition' relating to age.
STUDY DESIGN/SETTING: The prospectively collected Korean Health Insurance Review and Assessment Service (HIRA) nationwide cohort database was retrospectively reviewed.
The total 278,815 patients who underwent lumbar spinal fusions for degenerative spine diseases between 2010 and 2018 were reviewed and used to assess trends in operative incidence. The 37,050 patients who underwent lumbar fusions between 1/2010 and 12/2011 were enrolled to determine 8-year reoperation rates.
The overall number of lumbar spinal fusions were analyzed for the national annual trend. Demographic data, reoperation rates, and confounding clinical factors were evaluated.
The overall number of lumbar spinal fusions was analyzed to determine the national annual trend of operative incidence. For the reoperation rate analysis, the primary outcome measured was the cumulative incidence of revision operations within a minimum 8-year follow-up period. Additional outcomes included comparative analyses of the reoperation rate with respect to age, sex, or other underlying comorbidities.
Over time, elderly patients comprised a larger portion of the cohort (2010:24.2%; 2018:37.6%), while operations in younger patients decreased over time (2010:40.3%; 2018:27.0%). In the cohort of patients with a minimum 8-year follow-up (n=37,050), rates of reoperation peaked in patients aged 60-69 years (17.6 per 1000 person-years [HR 2.20 compared to <40years]) and decreased for more elderly patients (14.3 per 1000 person-years [HR 1.80 compared to <40years]). Age was the most significant risk factor for reoperation. Osteoporosis was also a risk factor for reoperation in postmenopausal females.
Increasing incidence of lumbar fusions in elderly patients was seen however the risk of reoperation decreased in patients aged 70 or more. Lumbar fusion for elderly patients should not be hesitated in the decision-making process because of concerns about reoperation.
腰椎疾病融合术广泛开展，发病率不断上升，尤其是在老年人群中。
本研究旨在评估全国范围内腰椎融合术的趋势，并研究腰椎融合术后再次手术的风险，重点关注与年龄相关的“流行病学转变”。
研究设计/设置：回顾性分析前瞻性收集的韩国健康保险审查与评估服务（HIRA）全国队列数据库。
回顾性分析了 2010 年至 2018 年间因退行性脊柱疾病行腰椎脊柱融合术的 278815 例患者，评估手术发病率的趋势。纳入了 2010 年 1 月至 2011 年 12 月期间接受腰椎融合术的 37050 例患者，以确定 8 年的再次手术率。
分析全国每年腰椎融合术的总数，以评估手术发病率的年度趋势。评估人口统计学数据、再手术率和混杂的临床因素。
分析全国每年腰椎融合术总数，以确定手术发病率的年度趋势。对于再手术率分析，主要观察指标是在至少 8 年的随访期内，行翻修手术的累积发生率。其他结果包括根据年龄、性别或其他基础合并症对再手术率进行比较分析。
随着时间的推移，老年患者在队列中的比例越来越大（2010 年：24.2%；2018 年：37.6%），而年轻患者的手术数量则随时间减少（2010 年：40.3%；2018 年：27.0%）。在至少有 8 年随访的患者队列（n=37050）中，60-69 岁患者的再手术率最高（17.6/1000 人年[HR 2.20，与<40 岁相比]），而年龄更大的患者再手术率则降低（14.3/1000 人年[HR 1.80，与<40 岁相比]）。年龄是再手术的最显著危险因素。绝经后女性骨质疏松症也是再手术的危险因素。
腰椎融合术在老年患者中的发病率不断上升，但 70 岁及以上患者的再手术风险降低。在决策过程中，不应因担心再手术而犹豫对老年患者进行腰椎融合术。
