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

Introduction: For patients with lumbar radiculopathy or neurogenic claudication, surgical treatment is typically pursued after a trial of non-operative management supervised in the outpatient setting. Yet, there exists a group of patients who present to the acute care setting with intractable pain or progressive neurologic deficits who may be indicated for early operative intervention. Given the differences in initial management and pre-operative optimization, it is unclear if surgical and post-operative outcomes differ between these populations.  

Methods: This was a retrospective cohort study from an academic medical center. Surgical case logs from the institution’s electronic medical record were used to identify patients who underwent lumbar laminectomy, discectomy, or laminectomy with posterior spinal fusion (excluding all interbody fusion procedures) from T10 and lower with 4 fellowship trained orthopaedic spine surgeons from 1/1/2017 to 12/30/2021. Analysis was grouped by admission status to the hospital; those presenting for scheduled outpatient surgery (“Outpatient” group) versus those who underwent surgery after presentation to the emergency department due to acute symptoms (“ED” group). The medical record was reviewed for patient demographic information, post-procedure length of stay (LOS), readmission, subsequent returns to the ED without readmission, and reoperations. Statistical comparisons were performed with Chi-square and Student’s T-tests.

Results: Outcomes are listed in Table 1, dichotomized by use of instrumentation (laminectomy and discectomy vs. posterior spinal fusion). A total of 1717 patients underwent decompressive procedures without instrumentation and 1229 patients underwent posterior spinal fusion. Patients undergoing procedures without fusion were significantly younger than the cohort undergoing fusion (56.5 years vs 65.8 years; p <.001), regardless of presentation. Though post-procedure length of stay was similar for non-instrumented procedures in the ED and Outpatient groups, those admitted for lumbar fusion from the ED had a substantially longer LOS compared to the Outpatient cohort (9.24 days vs 3.41 days). Additionally, there were a substantially higher number of re-admissions in the ED group undergoing lumbar fusion (33% vs 13.8%).

Discussion: For patients indicated for posterior spinal fusion after presenting to the acute care setting, there were higher rates of readmission and longer lengths of stay compared to those undergoing planned elective surgery. Further investigation is required to identify modifiable perioperative risk factors associated with prolonged length of stay and readmission in this population.