Cost and Complications of Single-Level Lumbar Decompression in Those Over and Under 75: A Matched Comparison. Issue 1 (1st January 2021)

• Record Type: Journal Article
• Authors: Rosas, Samuel; Knio, Ziyad O.; Gowd, Anirudh K.; Luo, T. David; Emory, Cynthia L.; O'Gara, Tadhg J.
• Is Part Of: Spine. Volume 46:Issue 1(2021)
• Publication Date: 2021-01-01
• Subjects: costs -- deep venous thrombosis -- dural tear -- durotomy -- effectiveness -- laminectomy -- laminotomy -- lumbar decompression -- lumbar spinal stenosis -- readmission -- revision -- seroma; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003686
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective database analysis. Objective: This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older. Summary of Background Data: Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined. Methods: The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared. Results: The matched cohort included 89, 388 total patients (n = 44, 694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement. Conclusion: Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates. Level of Evidence: 3 Abstract : Supplemental Digital Content is available in the text