Thursday, September 27, 2018 1:05 PM–2:05 PM Lumbar Spine Surgery: What You Need to Know: 115. Matched cohort analysis of elective lumbar spinal fusion in patients with and without Parkinson disease

Abstract

BACKGROUND CONTEXT Parkinson disease is a common neurodegenerative condition associated with significant morbidity and mortality. Parkinson disease patients often develop spinal conditions, and are known to have high complication rates following surgery; however, a matched cohort analysis controlling for comorbidity and age has not previously been performed. PURPOSE The purpose of this study was to evaluate the outcomes of lumbar fusion surgery in patients with Parkinson disease utilizing a large, publicly available, national database. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was evaluated for the years 2000-2012. Lumbar spinal fusions were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes. ICD-9 CM procedure codes were used to identify patients with Parkinson's disease. Patients were excluded if they received surgical treatment for traumatic injury. OUTCOME MEASURES The matched cohort was analyzed to determine the association of Parkinson disease with in-hospital complication rate, length of stay, and cost of hospitalization. METHODS Parkinson patients were matched 1:3 with non-Parkinson control patients for age, sex, Charlson Comorbidity Index and year of admission using a propensity score matching procedure. Univariable and multivariable logistic regression were used to determine the relationship between Parkinson's disease and surgical outcomes in the matched cohort. Adjusted odds ratios and 95% confidence intervals were calculated for surgical outcomes. Statistical analyses were performed utilizing SAS statistical software v.9.4 (SAS Institute, Inc. Cary, NC). Statistical significance was set at p RESULTS The study examined 231,351 elective lumbar fusion patients of which 1,332 had comorbid Parkinson disease. Before matching, elective lumbar fusion patients with Parkinson disease were significantly older and more male (p CONCLUSIONS The prevalence of Parkinson disease in lumbar fusion patients increased over time from 2000 to 2012. This matched cohort analysis demonstrated significant increases in length and cost of hospitalization for lumbar spinal fusion in patients with Parkinson disease. However, the complication rate in Parkinson patients was not significantly increased when compared with matched controls. Although inpatient complication rates were not significantly higher in this study, performing elective spinal fusion in Parkinson disease patients should be approached with caution as instrumentation failure and spinal deformity may develop postoperatively. This is the first matched cohort analysis indicating that lumbar spinal fusion can be safely considered in patients with Parkinson's disease. This study uses a much larger sample size than previous case series. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.