RA is a systemic disease state with prominent musculoskeletal manifestations associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in RA patients following lumbar surgery.
The aim of the study is to evaluate if Rheumatoid arthritis (RA) patients undergoing PLF have increased postoperative complications and economic burden compared to those without.
Patients under the age of 85 who underwent elective one- or two-level instrumented PLF for degenerative lumbar pathology between the years of 2006-2012 were identified in the Medicare insurance claims database. Same day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with a history of RA prior to fusion and those without (controls). All outcomes of interest were then compared using multivariate regression. Reoperation-free survival at one- and two-year follow-up was analyzed used Log Rank test. Significance was defined as p<0.05.
RA patients had significantly higher risk of 90-day readmission(OR 1.27, p<0.001), thromboembolic events(OR 1.39, p=0.010), sepsis(OR 2.32, p<0.001), pneumonia(OR 1.57, p=0.001), and wound complications(OR 1.41, p<0.001). Reoperation-free survival was significantly lower in RA patients at two-year follow-up(90.4% vs 92.4%, p<0.001). Following adjusted regression RA independently contributed to a $1,491 increase in additional 90-day costs(p<0.001).
Preexisting RA may increase the risk for short-term postoperative medical complications following PLF, specifically infectious events. In addition, these patients have higher rates of subsequent reoperation following index surgery. Patients be should counseled of these risks accordingly.