Disparities in Rates of Fusions in Single-Level Lumbar Disc Pathologies

Abstract

Abstract INTRODUCTION Single-level lumbar disc pathologies are managed surgically through decompression (lumbar discectomy or laminectomy) and a potential fusion. However, there is a lack of evidence for or against fusion after decompression in specific patient populations. This study seeks to observe disparities in the rates of fusion after decompression. METHODS Patients requiring surgical treatment for single-level disc herniation or degeneration were queried from the National Inpatient Sample datasets spanning 2012 to 2015. Multivariate logistic regression (with a Holm-Bonferroni correction) was performed to assess effects of patient demographics, temporality of admission, and hospital characteristics on rates of lumbar fusion while controlling for patient-level medical comorbidities. RESULTS A total of 84 336 patients were included in the analysis of indicators for fusion after elective and nonelective surgical intervention for lumbar disc pathologies. Patients in private for-profit and not-for-profit hospitals were more likely to receive a fusion compared to those in public hospitals for elective cases (OR 1.20, P < .001; OR 1.21, P < .001, respectively). Nonelective patients in urban teaching and nonteaching hospitals were less likely to receive a fusion compared to those in rural hospitals (OR 0.49, P < .001; OR 0.54, P < .001, respectively). In both elective and nonelective cases, weekend admissions were less likely to receive fusions than weekday admissions (OR 0.35, P < .001; OR 0.46, P < .001, respectively). Compared to hospitals in New England, hospitals in East North Central, South Atlantic, and East South Central regions had higher rates of elective fusion (OR 1.29, 1.50, and 2.09, respectively; P < .001 for all), while hospitals in the Pacific and West South Central regions had lower rates of fusion (OR 0.56, P < .001; OR 0.50, P < .001, respectively). CONCLUSION The results of this study illustrate disparities that exist in fusion after the surgical intervention of lumbar disc pathologies in terms of patient demographics and hospital characteristics.