Hepatitis C Virus Infection as a Predictor of Complications and Increased Costs Following Primary Lumbar Fusion Surgery. Issue 16 (15th August 2020)

• Record Type: Journal Article
• Authors: Donnally, Chester J.; Patel, Parthik D.; Canseco, Jose A.; Shenoy, Kartik; Divi, Srikanth N.; Goz, Vadim; Arain, Abdul R.; Vaccaro, Alexander R.
• Is Part Of: Spine. Volume 45:Issue 16(2020)
• Publication Date: 2020-08-15
• Subjects: comorbidities -- elective lumbar fusion -- hepatitis C virus -- patient outcomes; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003481
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective cohort study. Objective: The aim of this study was to identify whether hepatitis C virus (HCV) diagnosis influences in-hospital lengths of stay (LOS), postoperative complications, readmission rates, or costs following primary posterior lumbar fusions in an elective setting. Summary of Background Data: Although joint arthroplasty literature has shown increased complication rates and costs for patients seropositive with HCV without liver disease compared to those without HCV, this comorbidity has not been explored in the spine literature. To our knowledge, this is the first publication in the lumbar spine literature to solely focus on HCV as the disease burden. Methods: A national database was queried for patients who underwent primary lumbar spine fusion for degenerative lumbar pathology with Medicare insurance from 2005 to 2014. The 90-day postoperative complication rates, readmission rates, and treatment costs were queried. To limit confounding, HCV patients were matched with a control cohort of non-HCV patients using patient demographics, treatment modality, and comorbid conditions, and then analyzed by multivariate logistic regression. Patients with active liver disease were excluded to better isolate HCV as the comorbidity. Results: A cohort of 28, 841 patients were included in the final analysis. Postoperatively, compared to those without HCV infection, those with HCV had significantly higher odds of blood transfusions (odds ratio [OR]: 3.06), pneumonia (OR: 2.49), respiratory failure (OR: 2.49), urinary tract infections (OR: 1.89), wound-/implant-related infections (OR: 1.74), cerebrovascular events (OR: 1.70), or any postoperative complication within 90 days (OR: 2.93; all P < 0.0001). Furthermore, HCV positive patients had higher day of surgery costs ($28, 713.26 vs. $25, 448.26, P < 0.0001) and 90-day costs ($33, 447.39 vs. $29, 016.77, P < 0.0001). There was not a significant difference for patients with HCV infection compared to those without in regard to hospital LOS (10 days vs. 8 days, P = 0.332) and rates of a 90-day readmission (0.37% vs. 0.22%; OR: 1.70, 95% confidence interval: 1.00–2.90, P : 0.050). Conclusion: In patients undergoing primary lumbar fusion, a seropositivity for HCV without liver disease is associated with higher costs and complication rates, including higher rates of blood transfusion requirements and pneumonia-related complications. This data shed new light on elective spine surgery in HCV patients and may influence the risks and benefits considerations for surgeons considering lumbar fusion in this population. Level of Evidence: 3. Abstract : Supplemental Digital Content is available in the textCompared to patients without a concomitant diagnosis of hepatitis C virus (HCV), those seropositive for HCV (without active liver disease) have higher incidences of postoperative complications ( i.e., respiratory, urinary, infection, transfusion requirement), readmission rates, and hospital costs after undergoing primary lumbar fusions.