129. National trends in the utilization of lumbar disc replacement for lumbar degenerative disc disease over a 10-year period, 2010 to 2019

Abstract

<h3>BACKGROUND CONTEXT</h3> In the treatment of lumbar degenerative disc disease (DDD) that has failed conservative measures, lumbar fusion (LF) remains the gold standard. Approved in 2004, lumbar disc replacement (LDR) is designed to preserve motion. Initial studies showed LDR was used in 2.7% of surgeries for DDD and spondylosis. <h3>PURPOSE</h3> We aim to analyze the trends, complications and costs associated with LDR compared to LF using a large national database. <h3>STUDY DESIGN/SETTING</h3> Restrospective, administrative database. <h3>PATIENT SAMPLE</h3> National Inpatient Sample, 2010-2019. <h3>OUTCOME MEASURES</h3> Cost, length of stay, discharge destination, index hospitalization complications. <h3>METHODS</h3> The National Inpatient Sample (NIS) was queried from 2010 to 2019 to identify patients undergoing single and double- level LF and LDR with a diagnosis of lumbar DDD using ICD-9 and ICD-10 diagnostic and procedure codes. Revision procedures were excluded. Propensity score matching (PSM) with a ratio of 2:1 was performed to compare health care utilization metrics and index hospital complications for patients undergoing single-level LF or LDR. <h3>RESULTS</h3> A total of 1,129,121 LF cases (99.3%) and 8,049 LDR cases (0.7%) we identified during the study period, with 364,637 (32.3%) and 712 (8.8%) comprising two-level procedures, respectively. 1,712 LDRs were performed in 2010 (1.27% of all), decreasing to 565 in 2013 (0.52%), and increased slightly to 870 in 2019 (0.74%). For single-level procedures, the proportion of LDR cases decreases from 1.41% in 2010 to 0.66% in 2013 (p <0.001), but then increased gradually to 1.17% in 2019 (p <0.001 for trend). The proportion of two-level LF and LDR procedures increased significantly over the study period from 15.7% in 2010 to 45.5% in 2019 (p <0.001 for trend). LDR patients were significantly more likely to be younger (mean age 41.2 vs 57.1, p <0.001), healthier (mean ECI 0.88 vs 1.80, p <0.001) and male (57.5% vs 47.1%, p <0.001). LDR patients were also more likely to have procedures paid for by private insurance (55.8% vs 43.7%, p <0.001) and reside in higher income areas (top quartile 30.0% vs 23.2%, p <0.001). On PSM analysis, a total of 1,343 single-level LDR patient records were matched to 2,686 single-level LF patient records, and 141 two-level LDR patient records were matched to 282 two-level LF patient records. Single-level LDR patients had significantly shorter LOS (2.45 vs 3.10 days, p <0.001), lower likelihood of discharge to facility (1.7% vs 3.4%, p=0.003), and lower costs overall ($27,714 vs $32,242, p <0.001) compared to matched LF patients. Single-level LDR patients had significantly lower rates of any complication (7.0% vs 13.2%, p <0.001), blood transfusion (3.1% and 8.1%, p <0.001) and neurologic complication (3.0% vs 4.8%, p=0.006). There were no differences with regard to VTE, pneumonia, renal, would or pulmonary complications. With regard to two-level procedures, there were no differences with regard to LOS and discharge to facility (p=0.38 and 0.21, respectively), while overall costs were significantly higher for LDR patients compared to LF ($53,270 to $44,721, p=0.005). There were no differences in rates of index hospitalization complications for two-level procedures. <h3>CONCLUSIONS</h3> The utilization of LDR procedures decreased from 2010-2017 but began to increase again in 2018 and 2019. After adjusting for demographic, medical and hospital variables, single-level LDR was associated with reduced costs and LOS, and lower rates of blood transfusion compared to single-level fusion in patients with lumbar DDD. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.