1469. Acute Exacerbation of Symptoms after Lumbar Decompression Surgery: An Analysis Readmissions and Reoperations in 81,365 patients
Authors: Andre Samuel; Avani Vaishnav, MBBS; Steven McAnany, MD; Todd Albert, MD; Sravisht Iyer, MD; Catherine Himo Gang, MPH; Sheeraz Qureshi, MD, MBA (New York, NY)
Introduction: While lumbar spine decompression is a common surgical procedure, acute readmission or reoperation for exacerbation of symptoms is a rare occurrence that has not been extensively studied. Methods: A retrospective review was conducted of a national cohort of patients who underwent lumbar spine decompression surgery between 2013 and 2016. Readmission within 30 days postoperatively, due to exacerbation of back pain, leg pain, or neurological deficits were identified. Reoperations within 30 days for revision spinal decompression or fusion were also measured. Multivariate logistic regression was utilized to determine preoperative patient and surgical factors associated with 30-day readmissions or reoperations. Results: A total of 81,365 patients who underwent lumbar decompression surgery between 2013 and 2016 were identified. Of those patients, 40% underwent a laminectomy or bilateral decompression and 62% underwent a foraminotomy or unilateral decompression. A total of 3,188 patients (3.9%) were readmitted within 30-days postoperatively due to exacerbation of back pain, leg pain, or neurological deficits. A total of 1,967 patients (2.4%) underwent reoperation for revision spinal decompression or fusion within 30-days postoperatively. Revision decompression (OR: 2.0, P < 0.01), additional levels of foraminotomy/unilateral decompression levels (OR: 1.3, 1.5, and 2.5 for 1, 2, and 3+ levels, P < 0.05), microscopic laminectomy (OR: 1.5, P = 0.04), and female sex (Odds ratios [OR]: 1.2, P < 0.01) were associated with increased likelihood for readmission. Revision decompression surgery (OR: 2.0) and additional foraminotomy/unilateral decompression levels (OR: 1.9, 1.8, and 2.3 for 1, 2, and 3+ levels, P < 0.05) were associated with an increased likelihood of reoperation. Conclusion: While acute readmission or reoperation for symptom exacerbation after lumbar decompression is a rare occurrence, incidence of exacerbation increases with revision decompression surgery and multilevel foraminotomies/unilateral decompression.