Clinical utility of immediate postoperative radiographs in spinal fusion surgery.

Abstract

It is a common practice to obtain immediate postoperative radiographs prior to hospital discharge after instrumented spinal fusion. There is limited evidence to support the clinical benefits of such a practice, which may result in unnecessary radiation exposure and added healthcare costs. To determine differences in 90-day and 1-year reoperation between patients who underwent instrumented cervical, thoracic, or lumbar fusion and received immediate postoperative radiographs prior to hospital discharge compared to those who did not. Retrospective cohort study PATIENT SAMPLE: We identified patients who underwent cervical, thoracic, or lumbar instrumented fusion between 2016 and 2023. All patients had at least 1-year follow up. Primary outcome was all cause revision at 90-days and 1-year. Secondary outcome consisted of mechanical failure. Patients were dichotomized into those who had immediate postoperative radiographs prior to hospital discharge versus those that did not. Patient age, biologic sex, body mass index, race, American Society of Anesthesiologists Classification, spinal region of surgery and number of surgical levels were recorded. Incidence of all cause or mechanical revision at 90-day and 1-year were documented for each patient. Inverse probability weighting was used to determine associations between obtaining predischarge radiographs and subsequent revision surgery while adjusting for confounders. We included a total of 1,678 patients. Of these cases, 833 (49.6%) did not have immediate postoperative x-rays and 845 (50.4%) did. Following inverse probability weighting, there were no significant differences in 90-day all cause revision (Odds ratio (OR) 1.58, 95% CI 0.85-2.95, p=.15) or 1-year all cause revision (OR 1.39, 95% CI 0.91-2.13, p=.13) between patients who did not have an immediate postoperative x-ray versus those that did. Similarly, there were no significant differences in rates of 90-day mechanical revision (OR 0.43, 95% CI 0.08-2.49, p=.36) or 1-year mechanical revision (OR 1.37, 95% CI 0.60-3.14, p=.41)) between the 2 groups. Obtaining routine formal postoperative radiographs prior to hospital discharge following spinal fusion surgery did not result in any clinically meaningful benefit. To reduce cost and radiation exposure, spine surgeons should consider obtaining formal postoperative radiographs for specific indications only, such as increasing postoperative pain or neurologic deficits.