Staged Versus Same-Day Circumferential Lumbar Fusion for Degenerative Disease: Which is the Safer Approach?

Abstract

Study DesignRetrospective cohort study.ObjectivesTo evaluate utilization trends and outcomes of same-day vs staged circumferential lumbar fusion (cLF) in lumbar degenerative disease.MethodsThe PearlDiver national database was queried for patients with lumbar degenerative disease who underwent same-day or staged cLF, defined as anterior lumbar interbody fusion followed by posterior fusion within 1 to 14 days after. Annual utilization trends (2010-2021) were analyzed. Multivariate regression adjusted for age, gender, comorbidity index, obesity, smoking, and multi-level PSF was used to evaluate 30-day complications, readmissions, and revision rates at 1 and 2 years.ResultsOf 45,204 patients undergoing cLF, 40,052 (88.60%) underwent same-day cLF, and 5152 (11.40%) underwent staged procedures. Patients who underwent staged procedures had higher comorbidity rates and longer fusion constructs. Annual utilization of staged cLF increased on average by 3.76% from 2010. Staged procedures had higher risks of 30-day readmissions (aOR: 1.14), infection (aOR: 1.38), DVT (aOR: 2.62), epidural hematoma (aOR: 1.73), seroma (aOR:1.77), AKI (aOR: 1.34), cardiac arrest (aOR: 2.45), blood loss anemia (aOR: 1.56), urinary retention (aOR: 1.50), UTI (aOR: 1.36), ileus (aOR: 1.64), durotomy (aOR: 4.67), mechanical complications (aOR: 3.39), and blood transfusions (aOR: 2.57) (all <i>P</i> < 0.05). No significant differences in revision rates were found.ConclusionStaged cLF, utilized in 11.40% of cases, particularly for longer fusions and patients with higher comorbidity risk, is associated with higher risks of hospital readmissions and complications, but is not an independent risk factor. Further research is needed to identify patients who may benefit most from staging.