Abstract
BACKGROUND CONTEXT Surgical treatment for lumbar spondylolisthesis is often considered for those who have failed nonoperative care, especially with persistent or recurrent symptoms, progressive displacement, or worsening functional decline. Criteria for selecting surgical candidates are variable, and decisions about what type of operation to perform is discretionary. Wide heterogeneity in surgical procedure invasiveness reflects a lack of evidence on effectiveness and highlights the need to expand comparative effectiveness research that incorporates patient-reported outcomes. PURPOSE To examine the association of repeat spine operation (1-year), wound problem (90-day), and all-cause re-hospitalization (90-day) with surgical invasiveness in the treatment of lumbar spondylolisthesis. STUDY DESIGN/SETTING Retrospective analysis of spondylolisthesis data from the High Value Healthcare Collaborative, a network of diverse U.S. health systems. PATIENT SAMPLE We included patients (n=884) undergoing decompression or fusion for lumbar spondylolisthesis, excluding those with significant comorbidity or device removal/revision procedures. OUTCOME MEASURES The Surgical Invasiveness Index was calculated using a previously validated method based on Current Procedural Terminology codes. Safety outcomes reported in the High Value Healthcare Collaborative network including rate of repeat lumbar surgery, readmission, and wound problems were also analyzed. METHODS Logistic regression with site-specific robust standard errors were used to identify the association between the surgical invasiveness and safety outcomes, controlling for patient age, sex and Elixhauser (v3.7) comorbidity. RESULTS The adjusted mean adverse event rates were 2.0% for repeat surgery within 1 year, 1.3% for 90-day wound problems, and 4.2% for 90-day readmission. Surgical invasiveness was associated with wound problems (OR 1.10, p CONCLUSIONS Greater use of complex spine operations in treating spondylolisthesis might reflect surgeons’ intention to provide additional stability, even in cases of mild spondylolisthesis. However, we found that greater surgical invasiveness is associated with increased risk for wound problems and readmissions, even after controlling for patient characteristics and comorbidity. Therefore, in planning surgical interventions, surgeons must engage patients in shared decision making, balancing benefits of more complex procedures with these associated increased risks for harm. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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