P132. Lumbar fusion during the COVID-19 pandemic: greater rates of morbidity and longer procedures

Abstract

BACKGROUND CONTEXTThe coronavirus-19 (COVID-19) pandemic has altered the standard of care for spine surgery in many ways. However, there is a lack of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic. In particular, no large database study evaluating the impact of the COVID-19 pandemic on spine surgery outcomes has been published.PURPOSETo evaluate the impact of the COVID-19 pandemic on perioperative factors and postoperative outcomes of lumbar fusion procedures.STUDY DESIGN/SETTINGRetrospective cohort study.PATIENT SAMPLEPatients who underwent primary, elective lumbar fusionbetween 2019 and 2020.OUTCOME MEASURESThirty-day readmission, reoperation, morbidity, complications, operative time, non-home discharge disposition, length of hospital stay, total RVUs and RVUs per minute.METHODSThe ACS-NSQIP database was queried for all patients who underwent primary lumbar fusion in 2019 and 2020. Exclusion criteria included cervical or thoracic fusion, arthroplasty, non-elective, emergency cases, deformity procedures, malignancy, preoperative sepsis, wound infection and missing perioperative variables. Patients were grouped into cohorts based on 2019 or 2020 operation year. Multivariate logistic and Poisson regression models were utilized to evaluate the impact of 2020 operative year on postoperative outcomes.RESULTSA total of 27,446 patients were included in the analysis (12,473 cases in 2020). For the 2020 cohort, non-white race (24.9% vs 23.4%, p=0.004), functional dependence (1.8% vs 1.4%, p=0.022), congestive heart failure (0.5% vs 0.3%, p=0.015), and ASA class =3 (53.5% vs 52.2%, p=0.037) were more common. Lumbar fusions performed in 2020 were also associated with longer mean operative time (209.3±99.3 vs. 205.9±98.6 minutes, p=0.005) and higher mean fusion levels (1.45±0.69 vs 1.41±0.65, p 0.05). However, operation year 2020 independently predicted morbidity (OR 1.087 [95% CI 1.007-1.172], p=0.032), pneumonia (1.407 [1.039-1.906], p=0.027), DVT (1.508 [1.106-2.056], p=0.009) and sepsis (1.537 [1.101-2.146], p=0.012). In terms of perioperative variables, operation year 2020 predicted greater operative time (1.012 [1.001-1.013], p=0.046), non-home discharge (0.690 [0.642-0.743], p<0.001), and total RVUs (1.044 [1.004-1.083], p=0.033).CONCLUSIONSLumbar fusion procedures performed amidst the COVID-19 pandemic were associated with poorer outcomes, including higher rates of morbidity, pneumonia, DVT and sepsis. In addition, surgeries performed in 2020 were associated with longer operative times and less frequent non-home discharge disposition.FDA DEVICE/DRUG STATUSThis abstract does not discuss or include any applicable devices or drugs.