A Nationwide Comparison of Outcomes and Resource Use in Staged vs Simultaneous Cervical and Lumbar Fusions: A Retrospective Database Study

Abstract

Background: Although the coexistence of cervical and lumbar spinal conditions is fairly common, surgical treatments are usually staged, even though simultaneous fusion of the cervical and lumbar spine may be a viable option for appropriate candidates. Purpose: We sought to investigate the outcomes of staged vs simultaneous cervical and lumbar fusions in terms of differences in postoperative complications and resource use. Methods: We performed a retrospective cohort study using claims data from the 2006 to 2020 all-payer Premier Health Database. Data were extracted for patients who underwent both a cervical and a lumbar fusion procedure either simultaneously (same hospitalization) or staged (within 1 year). Multivariable regression models measured the association between simultaneous or staged procedures and combined complications (including venous thromboembolism, infection, acute renal failure, or vascular/pulmonary/gastrointestinal complications), intensive care unit (ICU) admission, and prolonged length of stay. We report odds ratios (ORs) and 95% confidence intervals (CI). Results: Overall, 560 (5.2%) and 10 187 (94.8%) of total 10 747 cervical and lumbar fusion procedures were performed simultaneously and staged, respectively. When comparing outcomes after simultaneous procedures to those after staged procedures (for which outcomes from the cervical and lumbar procedures were pooled), simultaneous procedures were associated with higher rates of ICU admission and longer hospital stays, but there were no differences in rates of combined complications. Conclusion: Our retrospective, nationwide database study found that simultaneous cervical and lumbar fusion is relatively rare and its rates of complications do not differ meaningfully from those of staged procedures. However, we found an association between simultaneous cervical and lumbar fusion and higher rates of ICU admission and prolonged length of stay. Further study is warranted.