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Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample

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Abstract

Purpose

Anterior thoracolumbar (TL) surgical approaches provide more direct trajectories compared to posterior approaches. Proper patient selection is key in identifying populations that may benefit from anterior TL fusion. Here, we utilize predictive analytics to identify risk factors in anterior TL fusion in patients with trauma and deformity.

Methods

In this retrospective cohort study of patients receiving anterior TL fusion (between and including T12/L1), population-based regression models were developed to identify risk factors using the National Readmission Database 2016–2017. Readmissions were analyzed at 30- and 90-day intervals. Risk factors included hypertension, obesity, malnutrition, smoking, alcohol use, long-term opioid use, and frailty. Multivariate regression models were developed to determine the influence of each risk factor on complication rates.

Results

A total of 265 and 375 patients were identified for the scoliosis and burst fracture cohorts, respectively. In patients with scoliosis, alcohol use was found to increase the length of stay (LOS) (p = 0.00061) and all-payer inpatient cost following surgery (p = 0.014), and frailty was found to increase the inpatient LOS (p = 0.0045). In patients with burst fractures, malnutrition was found to increase the LOS (p < 0.0001) and all-payer cost (p < 0.0001), obesity was found to increase the all-payer cost (p = 0.012), and frailty was found to increase the all-payer cost (p = 0.031) and LOS (p < 0.0001).

Discussion

Patient-specific risk factors in anterior TL fusion surgery significantly influence complication rates. An understanding of relevant risk factors before surgery may facilitate preoperative patient selection and postoperative patient triage and risk categorization.

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Data availability

No patient identifiers were collected, as we used a publicly available nationally representative database purchased through the Healthcare Cost and Utilization Project website. No unique code was developed, and standard statistical software (RStudio) and tests were used.

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Funding

No sources of funding were used for this study.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Shane Shahrestani, Alexander M. Ballatori, Xiao T. Chen, Andy Ton, Zorica Buser & Jeffrey C. Wang

  2. Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA

    Shane Shahrestani

  3. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Shane Shahrestani & Zorica Buser

Authors
  1. Shane Shahrestani
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  2. Alexander M. Ballatori
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  3. Xiao T. Chen
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  4. Andy Ton
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  5. Zorica Buser
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  6. Jeffrey C. Wang
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Corresponding authors

Correspondence to Shane Shahrestani or Zorica Buser.

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Conflict of interest

Disclosures outside of submitted work: ZB-consultancy: Cerapedics, The Scripps Research Institute, Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrics (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Research committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee—committee member; JCW Royalties—Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options—Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors—North American Spine Society, AO Foundation (20,000 honorariums for board position, plus travel for board meetings), Cervical Spine Research Society; Editorial Boards—Spine, The Spine Journal, Clinical Spine Surgery, Global Spine Journal; Fellowship Funding (paid directly to institution): AO Foundation.

Disclsoures

JCW- Royalties – Biomet, Seaspine, Amedica, Synthes; Investments/Options – Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors - AO Foundation, Society for Brain Mapping and Therapeutics, Fellowship Funding (paid to institution): AO Foundation ZB- consultancy: Cerapedics (past), The Scripps Research Institute (past), Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrics (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Educational Committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee member.

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Shahrestani, S., Ballatori, A.M., Chen, X.T. et al. Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample. Eur Spine J 31, 669–677 (2022). https://doi.org/10.1007/s00586-021-06857-6

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  • DOI: https://doi.org/10.1007/s00586-021-06857-6

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