Complications and in-hospital deaths more frequent among patients who undergo anterior rather than posterior spine fusion
Research Activities, July 2012, No. 383
Patients who undergo posterior spine fusion (PSF) surgery (approached from the person's back) are less likely to develop complications or die while in the hospital than those who undergo either anterior spine fusion (ASF)—in which surgeons approach the spine from the person's front, or anterior/posterior spine fusion (APSF)—in which the surgeons use both approaches, a new study finds. Even though APSF and ASF were performed in generally younger (44.8 and 44.2 vs. 52.1 years) and healthier patients than PSF, the procedure-related complications were lowest in patients who underwent PSF (15.7 percent) than those who underwent ASF and APSF (18.7 percent and 23.8 percent, respectively).
In addition, in-hospital mortality rates after ASF and APSF were nearly double that for PSF (0.51 percent and 0.44 percent, respectively vs. 0.26 percent). The researchers identified a number of risk factors for in-hospital mortality that need to be confirmed for use in counseling patients about the three types of spinal fusion. They note that the choice of approach is often dictated by the person's pathology and infrequently represents an equivalent choice.
Their findings were based on annual data from the National Inpatient Sample of the Hospital Cost and Utilization Project of the Agency for Healthcare Research and Quality (AHRQ) for 1998 through 2006 for 261,356 patients who underwent spine fusion surgery not involving the neck vertebrae (noncervical spine fusion). Information was gathered on patient demographics, characteristics of the hospital, and the prevalence of comorbidities and procedure-related complications. The study was funded in part by AHRQ (HS16075) to the Center for Education and Research on Therapeutics (CERT) at the Weill Medical College of Cornell University. For more information on the CERTs program, visit http://www.certs.hhs.gov.
More details are in "Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery," by Stavros G. Memtsoudis, M.D., Ph.D., Vassilios I. Vougioukas, M.D., Ph.D., Yan Ma, Ph.D., and others in the October 2011 Spine 36(22), pp. 1867-1877.