1609. Is Parkinson’s Disease Associated with Increased Risk Following Decompression and Fusion?
Authors: William Kyle Miller; Andrew Caras, BS; Tarek Mansour, MD; Luke Mugge, BS; Azedine Medhkour, MD; Jason Schroeder, MD (Toledo, OH)
Spinal surgery in patients with Parkinson’s disease (PD) presents an unclear benefit, as described by Sarkiss et al. (2015). This study aims to compare complications and outcome of spinal decompression and fusion at any level in PD patients to non-PD patients using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database.
NIS data was extracted for adult patients in 2008-2014 who underwent spinal fusion (ICD-9 81.00-81.08), decompression (ICD-9 03.09) or revision (ICD-9 81.30-81.39). Patients with vertebral fracture and cancer were excluded.
496,109 patients were included; 2,917 (0.6%) had PD. Overall complication rate was greater in the PD cohort compared to non-PD patients (31.4% versus 18.7%; p < 0.001), as well as for several specific complications: acute post hemorrhagic anemia (16.63% versus 8.92%; p < 0.001), red blood cell transfusion (13.85% versus 6.29%; p < 0.001), mechanical complication of internal orthopedic device (6.45% versus 4.46%; p < 0.001), and hemorrhage (1.37% versus 0.96%; p < 0.025). Patients with PD had increased mortality (0.3% versus 0.1% respectively; p < 0.025), longer length of stay (4 versus 3 days; p < 0.001), higher proportion of revisions (5.8% versus 4.7%; p < 0.001) and greater median medical costs ($89,924 versus $73,126.50; p <0.001). Rate of elective admissions decreased in PD patients (86.1% versus 90.6%, respectively; p < 0.001).
Patients with PD undergoing spinal fusion or decompression at any level may bear significantly higher complication risks. Their increased medical costs may stem from a complex post-operative course, greater incidence of revision, and longer stay. Decreased elective admissions for PD patients may result from exacerbated spondylopathy upon presentation compared to non-PD patients. PD is not an absolute contraindication for spinal surgery, but both surgeon and patient must respect the potentially increased medical and socioeconomic risks in this cohort.