Lumbar Spine Fusion Surgery in Solid Organ Transplant Recipients Is Associated with Increased Medical Complications and Mortality

Raj Amin, Varun Puvanesarajah, Rabia Qureshi, Amit Jain, Khaled M Kebaish, Frank H. Shen, Hamid Hassanzadeh

Research output: Contribution to journalReview article

Abstract

Study Design. Retrospective database review. Objective. To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery. Summary of Background Data. Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined. Methods. Data from the full 100% Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality. Results. There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P-<-0.001), and a higher 30-day readmission rate compared to non-SOT patients (P-=-<-0.001). In addition, SOT patients experienced a 23.8% rate of 90-day postoperative major medical complications and 3.0%, 1-year mortality, significantly larger than respective rates in the control population (P-<-0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts. Conclusion. Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance.

Original languageEnglish (US)
Pages (from-to)617-621
Number of pages5
JournalSpine
Volume43
Issue number9
DOIs
StatePublished - May 1 2018

Fingerprint

Spine
Transplants
Mortality
Population
Transplant Recipients
Reoperation
Kidney
Graft Survival
Medicare
Patient Selection
Length of Stay
Quality of Life
Databases
Lung
Liver

Keywords

  • complications
  • lumbar fusion
  • lumbar spine
  • solid organ transplant
  • spine surgery
  • transplant

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Lumbar Spine Fusion Surgery in Solid Organ Transplant Recipients Is Associated with Increased Medical Complications and Mortality. / Amin, Raj; Puvanesarajah, Varun; Qureshi, Rabia; Jain, Amit; Kebaish, Khaled M; Shen, Frank H.; Hassanzadeh, Hamid.

In: Spine, Vol. 43, No. 9, 01.05.2018, p. 617-621.

Research output: Contribution to journalReview article

Amin, Raj ; Puvanesarajah, Varun ; Qureshi, Rabia ; Jain, Amit ; Kebaish, Khaled M ; Shen, Frank H. ; Hassanzadeh, Hamid. / Lumbar Spine Fusion Surgery in Solid Organ Transplant Recipients Is Associated with Increased Medical Complications and Mortality. In: Spine. 2018 ; Vol. 43, No. 9. pp. 617-621.
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abstract = "Study Design. Retrospective database review. Objective. To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery. Summary of Background Data. Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined. Methods. Data from the full 100{\%} Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality. Results. There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P-<-0.001), and a higher 30-day readmission rate compared to non-SOT patients (P-=-<-0.001). In addition, SOT patients experienced a 23.8{\%} rate of 90-day postoperative major medical complications and 3.0{\%}, 1-year mortality, significantly larger than respective rates in the control population (P-<-0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts. Conclusion. Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance.",
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AU - Amin, Raj

AU - Puvanesarajah, Varun

AU - Qureshi, Rabia

AU - Jain, Amit

AU - Kebaish, Khaled M

AU - Shen, Frank H.

AU - Hassanzadeh, Hamid

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N2 - Study Design. Retrospective database review. Objective. To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery. Summary of Background Data. Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined. Methods. Data from the full 100% Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality. Results. There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P-<-0.001), and a higher 30-day readmission rate compared to non-SOT patients (P-=-<-0.001). In addition, SOT patients experienced a 23.8% rate of 90-day postoperative major medical complications and 3.0%, 1-year mortality, significantly larger than respective rates in the control population (P-<-0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts. Conclusion. Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance.

AB - Study Design. Retrospective database review. Objective. To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery. Summary of Background Data. Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined. Methods. Data from the full 100% Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality. Results. There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P-<-0.001), and a higher 30-day readmission rate compared to non-SOT patients (P-=-<-0.001). In addition, SOT patients experienced a 23.8% rate of 90-day postoperative major medical complications and 3.0%, 1-year mortality, significantly larger than respective rates in the control population (P-<-0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts. Conclusion. Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance.

KW - complications

KW - lumbar fusion

KW - lumbar spine

KW - solid organ transplant

KW - spine surgery

KW - transplant

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