Mahamid Assil, Jayyusi Fairoz, Hodruj Marah, Mansour Amr, Fishman Dan, Behrbalk Eyal
Department of Orthopedics, Hillel Yaffe Medical Center, Hadera 3820302, Israel.
Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa 3200003, Israel.
J Clin Med. 2025 Jan 23;14(3):723. doi: 10.3390/jcm14030723.
The etiology of lumbar spine revision surgery is multifactorial, involving mechanical, biological, and clinical factors that challenge sustained spinal stability. Comparative analysis reveals significantly higher complication rates, prolonged hospital stays, and increased costs for revision surgeries compared to primary fusions, despite low mortality rates. Leveraging a comprehensive dataset of 456,750 patients, this study identifies predictors of revision surgery and provides actionable insights to enhance patient outcomes and optimize healthcare resource allocation. A total of 456,750 patients registered in the National Inpatient Sample (NIS) database from 2016 to 2019 were identified as having undergone single-level lumbar fusion surgery (primary fusion: 99.5%; revision fusion: 0.5%). Multivariable logistic regression models adjusted for patient demographics, clinical comorbidities, and hospital characteristics were constructed to evaluate clinical outcomes and postoperative complications. Patients undergoing revision lumbar fusion surgery were significantly younger compared to those undergoing primary fusion procedures (53.92 ± 20.65 vs. 61.87 ± 12.32 years, < 0.001); among the entire cohort, 56.4% were women. Compared with patients undergoing primary lumbar fusion, those undergoing revision fusion surgery were significantly more likely to experience surgical site infections (odds ratio [OR] 27.10; 95% confidence interval [95% CI] 17.12-42.90; < 0.001), urinary tract infections (OR 2.15; 95% CI 1.39-3.33; < 0.001), and prolonged length of stay (OR 1.53; 95% CI 1.24-1.89; < 0.001). Revision surgery patients had significantly lower odds of incurring high-end hospital charges (OR 0.65; 95% CI 0.51-0.83; < 0.001). Other complications, including respiratory complications, dural tears, thromboembolic events, and acute renal failure, showed no statistically significant differences between the two groups. In-hospital mortality rates were low and did not differ significantly between groups (revision: 0.2% vs. primary: 0.1%, OR 3.29; 95% CI 0.45-23.84; = 0.23). Patients undergoing revision lumbar fusion surgeries face significantly higher risks of surgical site infections, urinary tract infections, and prolonged hospital stays compared to primary fusion procedures. These findings highlight the need for targeted interventions to improve perioperative management and reduce complications in revision lumbar fusion surgery.
腰椎翻修手术的病因是多因素的，涉及机械、生物和临床因素，这些因素对维持脊柱稳定性构成挑战。比较分析显示，与初次融合手术相比，翻修手术的并发症发生率显著更高、住院时间延长且费用增加，尽管死亡率较低。本研究利用一个包含456,750名患者的综合数据集，确定了翻修手术的预测因素，并提供了可行的见解，以改善患者预后并优化医疗资源分配。2016年至2019年在国家住院样本（NIS）数据库中登记的456,750名患者被确定为接受了单节段腰椎融合手术（初次融合：99.5%；翻修融合：0.5%）。构建了针对患者人口统计学、临床合并症和医院特征进行调整的多变量逻辑回归模型，以评估临床结局和术后并发症。接受腰椎翻修融合手术的患者比接受初次融合手术的患者明显更年轻（53.92±20.65岁对61.87±12.32岁，<0.001）；在整个队列中，56.4%为女性。与接受初次腰椎融合的患者相比，接受翻修融合手术的患者发生手术部位感染的可能性显著更高（优势比[OR]27.10；95%置信区间[95%CI]17.12 - 42.90；<0.001）、尿路感染（OR 2.15；95%CI 1.39 - 3.33；<0.001）以及住院时间延长（OR 1.53；95%CI 1.24 - 1.89；<0.001）。翻修手术患者产生高端医院费用的几率显著更低（OR 0.65；95%CI 0.51 - 0.83；<0.001）。其他并发症，包括呼吸并发症、硬膜撕裂、血栓栓塞事件和急性肾衰竭，两组之间无统计学显著差异。住院死亡率较低，两组之间无显著差异（翻修：0.2%对初次：0.1%，OR 3.29；95%CI 0.45 - 23.84；P = 0.23）。与初次融合手术相比，接受腰椎翻修融合手术的患者面临手术部位感染、尿路感染和住院时间延长的风险显著更高。这些发现凸显了采取针对性干预措施以改善围手术期管理并减少腰椎翻修融合手术并发症的必要性。
