Dallas E Kramer, Tyson S Barrett, Charlotte Drury-Gworek, Keith LeJeune, Boyle C Cheng, Praveer Vyas, Kevin Walsh, Edward Richard Prostko, Daniel T Altman, Lara Massie
{"title":"腰椎微椎间盘切除术后2年内与翻修微椎间盘切除术或后续脊柱融合相关的危险因素。","authors":"Dallas E Kramer, Tyson S Barrett, Charlotte Drury-Gworek, Keith LeJeune, Boyle C Cheng, Praveer Vyas, Kevin Walsh, Edward Richard Prostko, Daniel T Altman, Lara Massie","doi":"10.1097/BRS.0000000000005302","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of insurance claims and electronic medical records of a major blended health organization in the eastern United States.</p><p><strong>Objective: </strong>Primary objective was to report rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy. Secondary objectives were to identify patient characteristics and comorbidities predictive for revision surgeries.</p><p><strong>Summary of background information: </strong>Incidence of disc reherniation after lumbar microdiscectomy ranges from 3% to 18%. Although rates of revision microdiscectomy are well reported, rates of fusion after index microdiscectomy and risk factors for subsequent fusion beyond history of prior discectomy warrants further investigation.</p><p><strong>Methods: </strong>Retrospective review of health insurance claims data for index lumbar microdiscectomy between January 2016, and December 2019. Rates of revision microdiscectomy and fusion within two years were reported, and cohort demographics and Charlson Comorbidity Index (CCI) comorbidities were analyzed using Pearson χ 2 analyses and Fisher exact tests. Time-to-event modeling and multivariate Cox proportional hazards regression assessed for predictors of revision surgery.</p><p><strong>Results: </strong>The full sample consisted of 8158 members. The rate of revision microdiscectomy was 3.5% within one year and 5.5% within two years of index surgery. The rate of fusion was 2.9% within one year and 6.6% within two years of index surgery. Age 40 to 59 ( P <0.001), female sex ( P =0.024), and presence of ≥1 CCI comorbidities ( P <0.001) were significantly associated with time-to-fusion but not revision microdiscectomy. Increasing CCI score was associated with a significantly greater likelihood of need for fusion (CCI=1, HR 1.35, P =0.045; CCI=2, HR 1.85, P <0.001; CCI ≥ 3, HR 2.47, P <0.001).</p><p><strong>Conclusion: </strong>Rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy were 5.5% and 6.6%, respectively. Age 40 to 59 years, female sex, and having ≥1 CCI comorbidity, were significantly predictive of time-to-fusion but not revision microdiscectomy. Having at least one comorbidity increased the likelihood of fusion by 80%.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1392-1399"},"PeriodicalIF":3.5000,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors Associated With Revision Microdiscectomy or Subsequent Spinal Fusion Within Two Years of Index Lumbar Microdiscectomy.\",\"authors\":\"Dallas E Kramer, Tyson S Barrett, Charlotte Drury-Gworek, Keith LeJeune, Boyle C Cheng, Praveer Vyas, Kevin Walsh, Edward Richard Prostko, Daniel T Altman, Lara Massie\",\"doi\":\"10.1097/BRS.0000000000005302\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective review of insurance claims and electronic medical records of a major blended health organization in the eastern United States.</p><p><strong>Objective: </strong>Primary objective was to report rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy. Secondary objectives were to identify patient characteristics and comorbidities predictive for revision surgeries.</p><p><strong>Summary of background information: </strong>Incidence of disc reherniation after lumbar microdiscectomy ranges from 3% to 18%. Although rates of revision microdiscectomy are well reported, rates of fusion after index microdiscectomy and risk factors for subsequent fusion beyond history of prior discectomy warrants further investigation.</p><p><strong>Methods: </strong>Retrospective review of health insurance claims data for index lumbar microdiscectomy between January 2016, and December 2019. Rates of revision microdiscectomy and fusion within two years were reported, and cohort demographics and Charlson Comorbidity Index (CCI) comorbidities were analyzed using Pearson χ 2 analyses and Fisher exact tests. Time-to-event modeling and multivariate Cox proportional hazards regression assessed for predictors of revision surgery.</p><p><strong>Results: </strong>The full sample consisted of 8158 members. The rate of revision microdiscectomy was 3.5% within one year and 5.5% within two years of index surgery. The rate of fusion was 2.9% within one year and 6.6% within two years of index surgery. Age 40 to 59 ( P <0.001), female sex ( P =0.024), and presence of ≥1 CCI comorbidities ( P <0.001) were significantly associated with time-to-fusion but not revision microdiscectomy. Increasing CCI score was associated with a significantly greater likelihood of need for fusion (CCI=1, HR 1.35, P =0.045; CCI=2, HR 1.85, P <0.001; CCI ≥ 3, HR 2.47, P <0.001).</p><p><strong>Conclusion: </strong>Rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy were 5.5% and 6.6%, respectively. Age 40 to 59 years, female sex, and having ≥1 CCI comorbidity, were significantly predictive of time-to-fusion but not revision microdiscectomy. Having at least one comorbidity increased the likelihood of fusion by 80%.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"1392-1399\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-10-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005302\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005302","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Risk Factors Associated With Revision Microdiscectomy or Subsequent Spinal Fusion Within Two Years of Index Lumbar Microdiscectomy.
Study design: Retrospective review of insurance claims and electronic medical records of a major blended health organization in the eastern United States.
Objective: Primary objective was to report rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy. Secondary objectives were to identify patient characteristics and comorbidities predictive for revision surgeries.
Summary of background information: Incidence of disc reherniation after lumbar microdiscectomy ranges from 3% to 18%. Although rates of revision microdiscectomy are well reported, rates of fusion after index microdiscectomy and risk factors for subsequent fusion beyond history of prior discectomy warrants further investigation.
Methods: Retrospective review of health insurance claims data for index lumbar microdiscectomy between January 2016, and December 2019. Rates of revision microdiscectomy and fusion within two years were reported, and cohort demographics and Charlson Comorbidity Index (CCI) comorbidities were analyzed using Pearson χ 2 analyses and Fisher exact tests. Time-to-event modeling and multivariate Cox proportional hazards regression assessed for predictors of revision surgery.
Results: The full sample consisted of 8158 members. The rate of revision microdiscectomy was 3.5% within one year and 5.5% within two years of index surgery. The rate of fusion was 2.9% within one year and 6.6% within two years of index surgery. Age 40 to 59 ( P <0.001), female sex ( P =0.024), and presence of ≥1 CCI comorbidities ( P <0.001) were significantly associated with time-to-fusion but not revision microdiscectomy. Increasing CCI score was associated with a significantly greater likelihood of need for fusion (CCI=1, HR 1.35, P =0.045; CCI=2, HR 1.85, P <0.001; CCI ≥ 3, HR 2.47, P <0.001).
Conclusion: Rates of revision microdiscectomy and fusion within two years of index lumbar microdiscectomy were 5.5% and 6.6%, respectively. Age 40 to 59 years, female sex, and having ≥1 CCI comorbidity, were significantly predictive of time-to-fusion but not revision microdiscectomy. Having at least one comorbidity increased the likelihood of fusion by 80%.
期刊介绍：
Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store.
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
