TABLE 2. Operative Treatments, Complications, and Events.
| IDH | SpS | DS | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Not Diabetic, n = 768* | Diabetic, n = 24* | P | Not Diabetic, n = 351* | Diabetic, n = 53* | P | Not Diabetic, n = 345* | Diabetic, n = 40* | p | |
| Specific procedures, n (%)† | 0.73 | 0.33 | |||||||
| Decompression only | NA | NA | NA | 301 (88) | 47 (90) | 21 (6) | 1 (2) | ||
| Noninstrumented fusion | NA | NA | NA | 19 (6) | 3 (6) | 74 (22) | 6 (15) | ||
| Instrumented fusion | NA | NA | NA | 23 (7) | 2 (4) | 243 (72) | 33 (82) | ||
| Multi-level fusion | NA | NA | NA | 14 (4) | 2 (4) | 0.76 | 79 (23) | 10 (25) | 0.92 |
| Discectomy/decompression level, n (%)‡ | |||||||||
| L2–L3 | 14 (2) | 0 (0) | 0.91 | 124 (36) | 21 (40) | 0.65 | 35 (10) | 9 (23) | 0.039 |
| L3–4 | 27 (4) | 0 (0) | 0.71 | 239 (69) | 37 (71) | 0.93 | 168 (50) | 19 (49) | 0.97 |
| L4–L5 | 297 (39) | 14 (58) | 0.093 | 315 (92) | 51 (98) | 0.17 | 331 (97) | 39 (100) | 0.53 |
| L5–S1 | 438 (58) | 11 (46) | 0.34 | 135 (39) | 17 (33) | 0.45 | 104 (31) | 9 (23) | 0.43 |
| Levels decompressed, n (%) | 0.97 | 0.42 | |||||||
| None | NA | NA | NA | 7 (2) | 1 (2) | 3 (1) | 1 (2) | ||
| 1 | NA | NA | NA | 80 (23) | 12 (23) | 141 (41) | 16 (40) | ||
| 2 | NA | NA | NA | 110 (31) | 15 (28) | 126 (37) | 11 (28) | ||
| 3 + | NA | NA | NA | 154 (44) | 25 (47) | 75 (22) | 12 (30) | ||
| Operation time, min; mean (SD) | 76.4 (37.4) | 88 (37.9) | 0.14 | 127.3 (64.5) | 140.3 (73.2) | 0.19 | 205.7 (83.6) | 216.8 (83.4) | 0.43 |
| Blood loss, mL; mean (SD) | 63.8 (102.9) | 90.1 (72.1) | 0.22 | 299.5 (396.4) | 373.6 (436.9) | 0.21 | 571.6 (461.8) | 688.4 (527.1) | 0.14 |
| Blood Replacement, n (%) | |||||||||
| Intraoperative replacement | 6 (1) | 0 (0) | 0.45 | 32 (9) | 7 (13) | 0.52 | 111 (32) | 20 (51) | 0.029 |
| Postoperative transfusion | 0 (0) | 0 (0) | 15 (4) | 5 (9) | 0.21 | 66 (19) | 14 (36) | 0.028 | |
| Length of hospital stay, d; mean (SD) | 0.97 (1) | 1.1 (0.8) | 0.55 | 3.1 (2.2) | 3.8 (3.6) | 0.051 | 5.7 (20.1) | 5.1 (2.2) | 0.83 |
| Intraoperative complications, n (%)§ | |||||||||
| Dural tear/spinal fluid leak | 23 (3) | 1 (4) | 0.78 | 32 (9) | 5 (9) | 0.85 | 38 (11) | 2 (5) | 0.36 |
| Vascular injury | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (2) | 0.19 | ||
| Nerve root injury | 2 (0) | 0 (0) | 0.07 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Other | 3 (0) | 0 (0) | 0.17 | 3 (1) | 0 (0) | 0.86 | 6 (2) | 3 (8) | 0.084 |
| None | 741 (96) | 23 (96) | 0.70 | 314 (90) | 48 (91) | 0.91 | 302 (88) | 35 (88) | 0.81 |
| Postoperative complications/events, n (%)¶ | |||||||||
| Never-root injury | 1 (0) | 0 (0) | 0.006 | 0 (0) | 0 (0) | 1 (0) | 0 (0) | 0.19 | |
| Wound dehiscence | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0) | 0 (0) | 0.19 | ||
| Wound hematoma | 4 (1) | 0 (0) | 0.27 | 2 (1) | 2 (4) | 0.15 | 0 (0) | 1 (3) | 0.19 |
| Wound infection | 17 (2) | 1 (4) | 0.95 | 6 (2) | 3 (6) | 0.20 | 11 (3) | 0 (0) | 0.53 |
| Other | 26 (3) | 1 (4) | 0.71 | 15 (4) | 7 (13) | 0.021 | 32 (9) | 4 (10) | 0.91 |
| None | 719 (94) | 22 (92) | 0.95 | 310 (90) | 39 (74) | 0.002 | 242 (71) | 22 (56) | 0.092 |
| Postoperative mortality, n (%) | |||||||||
| Death within 6 wk of surgery | 0 (0) | 0 (0) | 1 (0.3) | 0 (0) | 0.31 | 1 (0.3) | 0 (0) | 0.21 | |
| Death within 3 mo of surgery | 1 (0.1)†† | 0 (0) | 1 (0.3) | 0 (0) | 0.31 | 1 (0.3) | 1 (2.3) | 0.53 | |
| Additional surgeries, n (%)‡‡ | |||||||||
| 1-yr rate | 43 (6) | 3 (12) | 0.13 | 20 (6) | 2 (4) | 0.51 | 23 (7) | 3 (7) | 0.83 |
| 2-yr rate | 58 (7) | 4 (17) | 0.08 | 30 (8) | 2 (4) | 0.22 | 42 (12) | 7 (17) | 0.36 |
| 3-yr rate | 65 (8) | 4 (17) | 0.13 | 42 (12) | 4 (7) | 0.31 | 47 (13) | 8 (20) | 0.30 |
| 4-yr rate | 76 (10) | 4 (17) | 0.23 | 47 (13) | 6 (11) | 0.60 | 49 (14) | 10 (24) | 0.09 |
| Recurrent disc herniation, n (%) | 45 (6) | 4 (17) | NA | N/A | NA | NA | NA | NA | |
| Recurrent stenosis/progressive listhesis, n (%) | NA | NA | NA | 19 (6) | 4 (8) | 16 (5) | 3 (8) | ||
| Pseudarthrosis/fusion exploration, | NA | NA | NA | 0 (0) | 0 (0) | 3 (0.9) | 1 | ||
| Complication or other, n (%) | 21 (3) | 0 | 17 (4.9) | 1 | 22 (6.5) | 3 (7.7) | |||
| New condition, n (%) | 9 (1) | 0 | 7 (2) | 1 | 8 (2.4) | 1 | |||
Surgical information was available for 768 IDH patients without diabetes and 24 IDH patients with diabetes, 351 SpS patients without diabetes and 53 SpS patients with diabetes, and 345 DS patients without diabetes and 40 DS patients with diabetes.
Specific procedure data was available for 343 SpS patients without diabetes and 52 SpS patients with diabetes, and 338 DS patients without diabetes and 40 DS patients with diabetes.
In IDH patients, discectomy level is recorded, and in DS and SpS patients, decompression level is recorded.
No cases were reported of aspiration into the respiratory tract or operation at wrong level.
Complications or events occurring up to 8 wk after surgery are listed. There were no reported cases of bone-graft complication, cerebrospinal fluid leak, paralysis, cauda equina injury, and pseudarthrosis.
Patient died after heart surgery at another hospital, the death was judged unrelated to spine surgery.
Rates of repeated surgery at 1, 2, 3, and 4 yr are Kaplan-Meier estimates. P values were calculated with the use of the log-rank test. Numbers and percentages are based on the first additional surgery if more than one additional surgery.
DS indicates degenerative spondylolisthesis; IDH, intervertebral disk herniation; SpS, spinal stenosis.