Testosterone Replacement Therapy in Posterior Lumbar Fusion Patients: A Propensity Score-Matched Analysis of Long-Term Outcomes.

Abstract

Study DesignRetrospective Cohort study.ObjectivePosterior lumbar fusion (PLF) carries notable risks of bleeding and implant-related complications. Testosterone replacement therapy (TRT) has been associated with a myriad of medical and postsurgical-related complications in orthopedic procedures, but its impact on PLF outcomes remains unclear.MethodsUsing the TriNetX Research Network, adults undergoing PLF were identified and grouped by perioperative TRT use. After 1:1 propensity score matching demographics, comorbidities, and 3,380 patients remained per cohort. Outcomes included acute postoperative events and long-term surgical sequelae, assessed through 2 years. Risk ratios (RR), 95% confidence intervals (CI), and p-values were calculated; Kaplan-Meier curves assessed long-term event incidence.ResultsThe TRT cohort had lower rates of readmission (2.07% vs. 3.05%; RR 0.69, 95% CI 0.51-0.94; p=0.016) and ED visits (2.66% vs. 4.26%; RR 0.64, 95% CI 0.49-0.83; p=0.001). There were no statistically significant differences between cohorts for DVT intensive care unit admission, PE, wound dehiscence, SSI, or AKI at 90 days. TRT use was associated with increased revision PLF (8.05% vs. 6.15%; RR 1.31, 95% CI 1.10-1.56; p=0.002). No statistically significant differences were observed for implant displacement or pseudoarthrosis.ConclusionsPerioperative TRT exposure is associated with a favorable immediate postoperative recovery timeline, with subsequent increased revision surgery. Recognition of these risks should inform preoperative counselling, postoperative surveillance, and multidisciplinary care planning for patients undergoing PLF.