Retrospective cohort studying using a national, administrative
To determine the postoperative complications and quality outcomes of
single and multi-stage surgical management for lumbar degenerative
This study identified patients with who underwent surgery for LDD
between 2007 - 2016. Patients were stratified based on whether their
surgeon choose to correct their LDD in a single or multistage
manner, and these cohorts were mutually exclusive. Propensity score
matching (PSM) was then utilized to mitigate intergroup differences
between single and multi-stage patients. Patients who underwent
three or more levels surgical correction, were under the age of 18
years, or those with any prior history of trauma or tumor were
excluded from this study. Baseline comorbidities, postoperative
complication rates, and reoperation rates were determined.
A total of 47,190 patients underwent primary surgery for LDD, of
which 9,438 (20%) underwent multi-stage surgery. After propensity
score matching, baseline covariates of the two cohorts were similar.
The complication rate was 6.1% in the single stage cohort and 11.0%
in the multistage cohort. Rates of post-hemorrhagic anemia,
infection, wound complication, DVT, and hematoma were all higher in
the multistage cohort. Lengths of stay, revision, and readmission
rates were also significantly higher in the multi-stage cohort.
Through 2-years of follow up, multi-stage surgery was associated
with higher payments throughout the 2-year follow-up period ($57,036
vs $39,318, p < 0.05).
Single stage surgery for lumbar degenerative disc disease
demonstrates improved outcomes and lower healthcare utilization.
Spine surgeons should carefully consider single-stage surgery when
treating patients with less than three-level LDD.
Varshneya K, Wadhwa H, Stienen M N, Ho A L, Medress Z A, Herrick D
B, Desai A, Ratliff J K, Veeravagu A. Single vs Multistage Surgical
Management of Single and Two-Level Lumbar Degenerative Disease.
World Neurosurg 2021;.