P41. Reoperation, complications and patient reported outcomes in patients with Parkinson's disease undergoing elective spine surgery: a propensity matched analysis

Abstract

<h3>BACKGROUND CONTEXT</h3> Parkinson's Disease (PD) is a common neurodegenerative condition that has become increasingly prevalent in an aging population. While surgical treatment for degenerative spine pathology is often required in this population, previous literature has suggested that patients with PD have higher complication rates and inferior outcomes compared to the general population. <h3>PURPOSE</h3> To determine if patients with PD have worse PROs and higher reoperation, complication and readmission rates after elective spine surgery compared to the general population when adjusting for baseline covariates through propensity matching. <h3>STUDY DESIGN/SETTING</h3> A retrospective review of prospectively collected data from the Quality Outcomes Database (QOD), a national, longitudinal, multicenter spine outcomes registry was performed. <h3>PATIENT SAMPLE</h3> For the lumbar cohort, 343 patients with PD and 46,738 patients without PD were included. The cervical myelopathy cohort included 49 patients with PD and 6,426 patients without PD. The cervical radiculopathy cohort consisted of 37 patients with PD and 13,751 patients without PD. <h3>OUTCOME MEASURES</h3> Outcomes included: 1) reoperation, 2) complications, 3) readmission, and 4) PROs of NDI/ODI, NRS back/arm/leg pain, mJOA scores, patient satisfaction ratings at 3 and 12 months. In addition, Qaly scores were assessed at 12 months. <h3>METHODS</h3> Data from the QOD was queried between 04/2013-01/2019. Three surgical groups were identified: 1) Elective lumbar surgery, 2) Elective cervical surgery for myelopathy, 3) Elective cervical surgery for radiculopathy. Patients with any other neurodegenerative condition other than PD were excluded. Patients without PD were propensity matched against patients with PD in a 5 to 1 ratio without replacement based on ASA grade, arthrodesis, surgical approach, number of operated levels, age, and baseline ODI, NRS extremity pain, NRS back pain and EQ5D. Regressions with cluster-robust standard errors were used to estimate average effect of how the outcome would change if the PD patient didn't have the disease. The mean difference was used for continuous outcomes (ODI, NRS leg pain, NRS back pain, and EQ-5D at 3 and 12 months after surgery) and the risk difference was used for binary outcomes (patient satisfaction, complications, readmission, revision surgery and mortality). <h3>RESULTS</h3> For the lumbar analysis, PD patients had a higher rate of revision surgery at 12 months (risk difference=0.057, p=0.015) and lower mean Qaly score at 12 months (mean difference=-0.053, p=0.005) when compared to the control group. For the cervical myelopathy cohort, PD patients had lower NRS neck pain scores at 3 months (mean difference=-0.829, p=0.005) but also lower patient satisfaction at 3 months (risk difference=-0.262, p=0.041) compared to the control group. For the cervical radiculopathy cohort, PD patients demonstrated a lower readmission rate at 3 months (risk difference=-0.045, p=0.014) compared to the control group. <h3>CONCLUSIONS</h3> Patients with PD had similar PROs at 12 months following elective spine surgery when adjusting for baseline covariates through propensity matching. PD patients undergoing lumbar surgery had a higher reoperation rate than those without PD. These results demonstrate that a diagnosis of PD should not be a major contraindication to elective spine surgery, as PD patients had similar 12-month PROs compared to those without PD, though decreased PROs at 3-months and higher reoperation rates in lumbar surgery may be seen. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.