Abstract
Background Context
The United States Centers for Disease Control and Prevention estimates the prevalence
of inflammatory bowel disease (IBD) at more than 3.1 million people. As diagnostic
techniques and treatment options for IBD improve, the prevalence of IBD is expected
to increase. For spine surgeons, patients with IBD have a unique complication profile
because patients with IBD may present with poor nutritional status and because the
medications used to manage IBD have been associated with poor vertebral bone mineralization
and immunosuppression. Presently, there are very limited data regarding perioperative
outcomes among patients with IBD who undergo spinal surgery. The present study begins
to address this knowledge gap by describing trends in patients with IBD undergoing
lumbar fusion and by quantifying the association between IBD and immediate postoperative
outcomes using a large, national database.
Purpose
To advance our understanding of the potential pitfalls and risks associated with lumbar
fusion surgery in patients with IBD.
Design/Setting
Retrospective cross-sectional analysis.
Patient Sample
The Nationwide Inpatient Sample (NIS) database was queried from 1998 to 2011 to identify
adult patients (18+) who underwent primary lumbar fusion operations using International
Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding.
Outcome Measures
Incidence of lumbar fusion procedures, prevalence of IBD, complication rates, length
of stay, and total hospital charges.
Methods
The annual number of primary lumbar fusion operations performed between 1998 and 2011
was obtained from the NIS database. Patients younger than 18 years of age were excluded.
The prevalence of IBD in this population (both Crohn disease and ulcerative colitis)
was determined using ICD-9-CM codes. Logistic regression models were estimated to
determine the association between IBD and the odds of postoperative medical and surgical
complications, while controlling for patient demographics, comorbidity burden, and
hospital characteristics. The complex survey design of the NIS was taken into account
by clustering on hospitals and assuming an exchangeable working correlation using
the discharge weights supplied by the NIS. We accounted for multiple comparisons using
the Bonferroni correction and an alpha level for statistical significance of . 0028.
Results
The prevalence of IBD is increasing among patients undergoing lumbar fusion, from
0.21% of all patients undergoing lumbar fusion in 1998 to 0.48% of all patients undergoing
lumbar fusion in 2011 (p<.001). The odds of experiencing a postoperative medical or
surgical complication were not significantly different when comparing patients with
IBD with control patients without IBD after controlling for patient demographics,
comorbidity burden, and hospital characteristics (adjusted odds ratio=1.1, 95% confidence
interval [CI] 0.99–1.3, p=.08). On multivariable analysis, the presence of IBD in
patients undergoing lumbar fusion surgery was associated with longer length of stay
and greater hospitalization charges.
Conclusions
Among patients who underwent lumbar fusion, IBD is a rare comorbidity that is becoming
increasingly more common. Importantly, patients with IBD were not at increased risk
of postoperative complications. Spine surgeons should be prepared to treat more patients
with IBD and should incorporate the present findings into preoperative risk counseling
and patient selection.
Keywords
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Article info
Publication history
Published online: November 15, 2017
Accepted:
November 2,
2017
Received in revised form:
October 16,
2017
Received:
July 10,
2017
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: JET: Nothing to disclose. STK: Nothing to disclose. ECB: Royalties: Elsevier Pub (B), Thieme Pub (B); Stock Ownership: Axiomed (<1%), Depuy (<1%), Orthomems (<1%), Turning Point (<1%); Consulting: Axiomed (Amount not disclosed); Speaking and/or Teaching Arrangements: Multiple; Trips/Travel (Amount not disclosed): Multiple; Grants: OREF (F, Paid directly to institution/employer), Rawlings (F, Paid directly to institution/employer), outside the submitted work. MPS: Consulting: Biomet Spine (Amount not disclosed), outside the submitted work. TEM: Stock Ownership: PearlDiver Inc (none); Consulting: Globus Medical (B); Speaking and/or Teaching Arrangements: AO Spine (B).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
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© 2017 Elsevier Inc. All rights reserved.
