Impact of osteoporosis on perioperative complications in patients undergoing surgical treatment for lumbar spinal stenosis: a nationwide retrospective study.

Abstract

Study design: Nationwide retrospective cohort study with propensity score matching (PSM) analysis.

Purpose: To investigate the impact of osteoporosis on perioperative complications in patients undergoing surgery for lumbar spinal stenosis (LSS).

Overview of literature: Progressive population aging has driven an increase in surgical procedures for degenerative spinal conditions such as LSS. While previous research has examined the impact of osteoporosis on implant-related complications, its specific impact on outcomes following LSS surgeries remains unclear.

Methods: This study analyzed 60,785 patients who underwent LSS surgery between April 2020 and March 2022, utilizing data from a nationwide Diagnosis Procedure Combination database. Perioperative complications, treatment costs, blood transfusion volume, and anesthesia time were compared between osteoporotic and non-osteoporotic patients. PSM was employed to account for confounding variables. Univariate and multivariate regression analyses were employed to identify risk factors for complications.

Results: The prevalence of osteoporosis in this cohort was 10.6%. On regression analyses, age, sex, body mass index, admission activities of daily living (ADL) score (Barthel index), hospital type, spinal fusion, Charlson comorbidity index score, and osteoporosis showed a significant association with perioperative complications. Before PSM, osteoporotic patients were older, predominantly female, and had lower body mass index and admission ADL scores, higher spinal fusion rates, and more complications. After PSM, osteoporotic patients exhibited significantly higher complication rates, increased costs, greater blood transfusion requirements, and longer anesthesia durations compared to non-osteoporotic patients.

Conclusions: This nationwide analysis identified osteoporosis as an independent risk factor for perioperative complications following LSS surgery. Our findings underline the need for careful perioperative management in this population.