Oral Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Is spinal osteotomy associated with decreased life expectancy? - A nationwide population-based study (#MP-4b)

Jae-Won Shin 1 2 , Ju-Hyoung Park 3 , Si-Young Park 1 , Sang-Ho Kim 1 , Hak-Sun Kim 1 , Kyung-Soo Suk 1 , Seong-Hwan Moon 1 , Byung-Ho Lee 1 , Ji-Won Kwon 1 , Joong-Won Ha 2 , Yung Park 2 , Woo-Seok Jung 1
  1. Orthopedic Department, College of Medicine, Yonsei University, Seoul, Republic of Korea
  2. Orthopedic Department, National Health Insurance Service Ilsan Hospital, Goyang, Gyeongi-do, Republic of Korea
  3. College of business, Hallym University, Chuncheon, Kangwon-do, Korea

Introduction

Spine osteotomy(SO) is an effective yet invasive procedure for patients with spinal imbalances, associated with substantial intraoperative and postoperative complications. Paradoxically, it may increase the risk of life-threatening systemic issues, potentially impacting patient life expectancy. We aim to investigate whether there is a difference in postoperative life expectancy between patients who underwent spine osteotomy, which has advantages and disadvantages, and those who underwent spine fusion(SF).

Methods

This retrospective nationwide cohort study reviewed the Korean National Health Insurance database from 2002 to 2018. Patients who underwent SF or SO for spinal disease were selected as study subjects and followed for a period of 6 months using their unique resident registration number. The objective of this study is to compare the death rates between the SO and SF groups during the follow-up period, while also considering other potential risk factors such as socioeconomic factors.

Results

Among the total of 199,593  , 912 (0.46%) underwent SO (Mean age, 65.66±8.84; Male, N = 310, 33.99%), while 198,681 (99.54%) underwent SF (Mean age, 65.10±8.36; Male, N = 73,063, 36.77%). The rate of mortality within 1 year after surgery was 6.36% for SO and 2.12% for SF. (p<0.001) The 5 years mortality rate was 13.52% for SO and 7.83% for SF. (P<0.001) The 10 years mortality rate was 26.69% for SO and 15.36% for SF.(P<0.001) The total risk of death was higher for patients with SO than for patients with SF (adjusted hazard ratio (HR) 1.335) (95% CI 1.155 to 1.544)

Discussion

While various studies have indicated a higher mortality rate within a few years after undergoing spine osteotomy, there is currently a lack of reports comparing the actual lifespan of patients who underwent spine osteotomy to those who underwent only spine fusion. Through the results of this study, it is evident that patients who underwent spine osteotomy not only showed a significantly higher postoperative mortality rate within one year but also over the entire ten-year period compared to those who had undergone spine fusion. Compared to spine fusion, patients who underwent spine osteotomy exhibited a substantially higher total death risk with a hazard ratio (HR) of 1.752 (adjusted HR 1.335). Additionally, it is noteworthy that female patients had a significantly lower HR compared to males (0.533), and patients with medical aid insurance type had a notably higher HR compared to those with national health insurance type (2.142). One particularly remarkable finding is that as the age at the time of surgery increased by one year, the HR also increased to 1.093. In summary, it can be stated formally that being male, having medical aid insurance, and advancing age are significant risk factors for postoperative survival following spine osteotomy. Spine surgeons need to be attentive to these risk factors. 

 

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