Evaluation of lumbar spine bracing as a postoperative adjunct to single-level posterior lumbar spine surgery

Saurabh Sinha; Ian Caplan; James Schuster; Matthew Piazza; Gregory Glauser; Nikhil Sharma; William Welch; Benjamin Osiemo; Scott Mcclintock; Ali Ozturk; Neil Malhotra

doi:10.4103/ajns.AJNS_35_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 333-337
DOI: 10.4103/ajns.AJNS_35_20

Original Article

Evaluation of lumbar spine bracing as a postoperative adjunct to single-level posterior lumbar spine surgery

Saurabh Sinha

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

Ian Caplan

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

James Schuster

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

Matthew Piazza

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

²Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA

,

Gregory Glauser

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

Nikhil Sharma

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

William Welch

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

Benjamin Osiemo

³Department of Neurosurgery, University of Pennsylvania

⁴Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA

,

Scott Mcclintock

⁴Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA

,

Ali Ozturk

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

,

Neil Malhotra

¹Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

²Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA

› Author Affiliations

Abstract

Background: Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. Methods: Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing at a three-hospital urban academic medical center (2013–2017) were undertaken (n = 906). Patient demographics and comorbidities were analyzed. Test of independence, Mann–Whitney–Wilcoxon test, and logistic regression were used to assess differences in length of stay (LOS), discharge disposition/need for postacute care, quality-adjusted life year (QALY), surgical site infection (SSI), hospital cost, total cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results: Among the study population, 863 patients were braced and 43 were not braced. No difference was seen between the two groups in short-term outcomes from surgery including LOS (P = 0.836), discharge disposition (P = 0.226), readmission (P = 1.000), ER visits (P = 0.281), SSI (P = 1.000), and QALY gain (P = 0.319). However, the braced group incurred a significantly higher direct hospital cost (median increase of 41.43%, P < 0.001) compared to the unbraced cohort (bracing cost excluded). There was no difference in graft type (P = 0.145) or comorbidities (P = 0.20–1.00) such as obesity (P = 1.000), smoking (P = 1.000), chronic obstructive pulmonary disease (P = 1.000), hypertension (P = 0.805), coronary artery disease (P = 1.000), congestive heart failure (P = 1.000), and total number of comorbidities (P = 0.228). Conclusion: Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes but will reduce cost.

Key-words:

Lumbar fusion - posterior lumbar spine fusion - single-level bracing

Full Text

References

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