Lumbar Spinal Fusion Outcomes in Patients With Cancer Compared to Matched Peers Without Cancer.

STUDY DESIGN

Retrospective Matched Cohort Study.

OBJECTIVES

Optimization of medical comorbidities is an essential part of preoperative management. However, the isolated effects of individual comorbidities have not been evaluated within a homogenous spine surgery population. This exact matching study aims to assess the independent effects of cancer on outcomes following single-level lumbar fusions for non-cancer surgery.

METHODS

4680 consecutive patients undergoing single-level posterior-only lumbar fusion were retrospectively enrolled. Univariate statistics and coarsened exact matching (CEM) were computed to evaluate outcomes between cancer patients and those without comorbidities.

RESULTS

By logistic regression, malignancy conferred a higher risk of surgical complication ( = 0.016, OR = 2.64, CI = [1.200,5.790]), 30- and 90- day readmission ( = 0.012, OR = 2.025, CI = [1.170-3.510]; < 0.001, OR = 2.34, CI = [1.430, 3.830], respectively), 90-day reoperation ( < 0.001, OR = 2.16, [1.110, 4.200]), and death at 90-days ( = 0.032, OR = 8.27, CI = [1.200, 56.850]). After matching, malignancy was associated with increased odds of incidental durotomy (6 vs 0 cases, = 0.048) and death at both 30 and 90 days (both: OR = 8.0, = 0.020, CI = [1.00, 63.960]). No cases of durotomy occurred in cases with mortality in the matched sample, suggesting independent relationships. There were no differences in length of stay, non-home discharge, ED evaluation, readmission, or reoperations.

CONCLUSION

Among otherwise exact-matched patients undergoing single level lumbar fusion, history of malignancy conferred a higher risk of short-term mortality, but not other outcomes suggestive of surgical failure. Increased mortality after lumbar fusion should be studied further and may play a role in surgical decision-making and patient discussions.