Incidental durotomy occurred more often in older patients lengthened hospital stays

SAN FRANCISCO — Results of an analytical study presented here showed that among 17,232 cases of primary, short posterior fusions for lumbar spinal stenosis, 801 cases had an incidental durotomy for a rate of 4.65% and an odds ratio of 3.8.

Findings from the study also showed durotomy was associated with hospital stays that were 1.4 days longer, as well as with higher in-hospital costs compared with cases without a durotomy, according to S. Tim Yoon, MD, PhD.

At the International Society for the Study of the Lumbar Spine Annual Meeting, Yoon presented results of the study he conducted with J. Stewart Buck, MD.

“We feel that the data that we showed here today can be used in a cost model and future quality measurements,” Yoon said.

Yoon and Buck identified patients with a primary diagnosis for lumbar stenosis from the Nationwide Inpatient Sample database who were operated on at one to two levels between 2009 and 2011. They excluded patients with presence of infection, tumors and fractures.

Patients were grouped by whether or not they incurred an incidental durotomy.

When Yoon and Buck looked at where these surgeries were performed, they found a greater incidence of durotomy at teaching hospitals than at non-teaching hospitals, with rates of 5% vs. 4%, respectively.

In addition, they found for each increasing year of a patient’s age, the odds ratio for a dural tear increased by 2%.

“The hospital costs increased almost $4,000 with a durotomy,” Yoon said.

A number of complications were identified in the group with durotomy, which led Yoon and Buck to perform a multivariable analysis to account for confounding variables.

“We showed that the only thing that was positive were neurological complications,” Yoon said.

“Therefore, we conclude that neurological complication rates had an odds ratio of 2.8 when there is an incident of durotomy,” he said.

Yoon speculated that, were an appropriate closure method to be found and used, it might reduce the length of stay related to durotomy, as well as the associated costs. – by Susan M. Rapp

Reference:

Buck JS, et al. Paper #39. Presented at: International Society for the Study of the Lumbar Spine Annual Meeting; June 8-12, 2015; San Francisco.

Disclosure: Yoon reports no relevant financial disclosures.