Decompression and fusion for lumbar degenerative spondylolisthesis is associated with higher early morbidity rates and risk of perioperative complications compared with decompression alone: a retrospective study in the United States.

Abstract

A retrospective cohort study. To assess differences in 30-day morbidity and mortality and postoperative complications between two surgical treatment options. The choice of decompression with fusion or decompression alone for the management of degenerative spondylolisthesis (DS) is controversial. The American College of Surgeons National Quality Improvement Program database was queried for laminectomy or laminotomy with and without fusion from 2015 to 2020. The estimated 30-day mortality and morbidity, 30-day complications, and American Society of Anesthesiologist (ASA) classification were evaluated through chi-square and analysis of variance tests, with the results further stratified according to the ASA classification. Of the 4,120 patients, 2,384 (58%) underwent a laminectomy or laminotomy without fusion and 1,736 (42%) underwent a laminectomy or laminotomy with fusion. Patients undergoing decompression with fusion had higher mean mortality (estimated probability 0.0034 vs. 0.0027, p<0.001), mean morbidity (estimated probability 0.053 vs. 0.048, p<0.001), mean length of stay (3.62±3.4 days vs. 3.15±4.3 days, p<0.001), and bleeding risk necessitating transfusion (9.5% vs. 7.6%, p =0.038). There was a higher rate of overall 30-day postoperative complications associated with an increasing ASA score for both cohorts. Decompression with fusion was associated with higher estimated mortality, morbidity, and 30-day complications. Decompression alone is an appealing treatment option for lumbar DS, particularly for patients with higher ASA scores and those at higher risk.