P27. Chronic hyperlipidemia increases the risk of complications following lumbar spinal fusion: a nationwide database study with propensity score matching analysis

BACKGROUND CONTEXT

Lumbar spinal fusion is widely used in treating degenerative and traumatic conditions of the lumbar spine. The impact of chronic hyperlipidemia on perioperative complications has not been yet investigated.

PURPOSE

This study compared the perioperative complications of single- and multi-level lumbar fusions in patients with and without chronic hyperlipidemia.

STUDY DESIGN/SETTING

Retrospective database study.

PATIENT SAMPLE

Patients with or without chronic hyperlipidemia who underwent single- or multilevel lumbar fusions between 2010 and 2019.

OUTCOME MEASURES

Perioperative surgical and medical complications.

METHODS

A nationwide claims database, PearlDiver, was utilized for this study. International Classification of Diseases (ICD-9 and ICD-10) codes were used to identify patients with chronic hyperlipidemia. Current Procedural Terminology (CPT) codes were used to identify lumbar spinal fusion surgeries. Utilizing the appropriate ICD-9, ICD-10 and CPT codes, we retrieved the perioperative surgical and medical complications. Propensity score matching was implemented to control for the confounding factors, including age, gender and Elixhauser Comorbidity Index (ECI). Chi-square test was used to compare the incidence of complications among groups.

RESULTS

Single-level lumbar fusions included a total of 65,674 patients: with hyperlipidemia (n=18,395) and without hyperlipidemia (n=47,279). Propensity score matching resulted in 16,930 patients in each group. Patients with hyperlipidemia had a higher incidence of wound complications (481 [2.8%] vs 357 [2.1%], P < 0.001), surgical site infection (370 [2.2%] vs 231 [1.4%], P < 0.001), failed back syndrome (1914 [11.3%] vs 1605 [9.5%], P < 0.001), hardware removal (1,006 [5.9%] vs 761 [4.5%], P < 0.001), deep venous thrombosis/pulmonary embolism (264 [1.6%] vs 216 [1.3%], P=0.031), myocardial infarction (81 [0.5%] vs 23 [0.1%], P < 0.001), cerebrovascular accident (86 [0.5%] vs 39 [0.2%], P < 0.001), renal failure (305 [1.8%] vs 197 [1.2%], P < 0.001), sepsis (103 [0.6%] vs 51 [0.3%], P < 0.001), urinary tract infection/incontinence (697 [4.1%] vs 436 [2.6%], P < 0.001). Multilevel lumbar fusions included a total of 48,928 patients: with hyperlipidemia (n=15,527) and without hyperlipidemia (n=33,401). Propensity score matching resulted in 14,218 patients in each group. Patients with hyperlipidemia had a higher incidence of nerve root injury (33 [0.2%] vs 17 [0.1%], P=0.034), wound complications (624 [4.4%] vs 508 [3.6%], p < 0.001), surgical site infection (438 [3.1%] vs 307 [2.2%], p < 0.001), failed back syndrome (2,024 [14.2%] vs 1,642 [11.5%], p < 0.001), hardware removal (1,146 [8.1%] vs 885 [6.2%], p < 0.001), revision (922 [6.5%] vs 1,055 [7.4%], P=0.002), myocardial infarction (120 [0.8%] vs 41 [0.3%], p < 0.001), renal failure (472 [3.3%] vs 313 [2.2%], p < 0.001), urinary tract infection (810 [5.7%] vs 618 [4.3%], p < 0.001).

CONCLUSIONS

Following single- or multilevel lumbar fusions, patients with chronic hyperlipidemia have an increased risk of perioperative complications, including wound complications, surgical site infection, failed back syndrome, hardware removal, myocardial infarction, renal failure and urinary tract infection. In multilevel lumbar fusions, chronic hyperlipidemia is associated with a higher incidence of nerve root injury and revision rates.

FDA DEVICE/DRUG STATUS

This abstract does not discuss or include any applicable devices or drugs.