Higher readmission rates seen with decompression alone vs decompression with fusion

DALLAS — A population-based study of data from three states indicates higher rates of readmission and secondary surgery, but lower rates of reoperation for patients with lumbar degenerative spondylolisthesis treated with decompression alone compared with decompression with fusion.

“Similar to what was on the SPORT trial of degenerative spondylolisthesis, 90% of these patients underwent fusion,” Todd F. Alamin, MD, said during his presentation. “Of the patients who undergo a primary decompression, 9% had a secondary fusion surgery and 7% had a secondary decompression surgery. Of patients who had a primary fusion, 11% of patients had a secondary fusion surgery and 5% had a secondary decompression surgery. In the end, with a primary diagnosis of degenerative spondylolisthesis and again without stratifying severity, the reoperation rate was slightly lower for decompression than for fusion patients.”

Alamin used ICD-9 codes to identify 57,951 patients with primary or secondary lumbar degenerative spondylolisthesis who were included in the State Inpatient Database and State Ambulatory Surgery Database for California, Florida and New York State between 2005 and 2009. He analyzed and compared the 30-day, 90-day and 4-year readmission and secondary spinal surgery rates between the groups.

Patients who underwent decompression alone were more likely to be older, have Medicare insurance, fewer comorbidities and a Charlson score of 0, Almin said. Patients who had decompression alone had shorter hospital stays compared to the decompression and fusion group. The 90-day readmission rate for patients who had decompression alone was 2.1% compared to 1.5% for those in the decompression and fusion group. Alamin cited lack of randomization among the study limitations.

“It clearly represents different parts of the degenerative spondylolisthesis segment treated differently,” Alamin said. “This was an administrative data set. There is no ability to confirm the diagnosis independently, no ability to stratify the severity of the disease, and clearly, there is no radiographic data we can assess. That said, I think it is important to look at this as analysis to see what the actual results are of patients who were treated with either decompression or fusion with this primary diagnosis.”

Reference:

Alamin TF. Surgical options for lumbar degenerative spondylolisthesis: Evidence of differential readmission and reoperation rates. Presented at: the North American Spine Society 2012 Meeting. Oct. 24-27, 2012. Dallas.

Disclosure: Alamin receives royalties from Medtronic. He is on the Board of Directors for Simpirica Spine, is a consultant, owns stock and privately invests in the company, and is paid to travel for the company.