For a study, researchers sought to determine cause-specific 5-year revision rates and risk variables following elective multilevel lumbar instrumented fusion in older individuals. Patients over the age of 60 who received elective multilevel (3+) lumbar instrumented fusions were found in state inpatient databases and tracked for 5 years for revision surgeries due to mechanical failure, degenerative disease (DD), infection, postlaminectomy syndrome, and stenosis. Cox proportional hazards multivariate analyses were performed to assess the risk variables associated with revision for each diagnostic cause.
There were 5,636 patients in the cohort (female-3,285; average age-71.6 years). The majority of the surgeries (97.4%) were 3 to 7 levels, with a mean duration of stay of 5.4 days. The total 5-year revision rate was 16.5%, with DD (50.7%), mechanical failure (32.2%), and stenosis being the most common etiologies (8.0%). The revision process during the index surgery was related to an elevated revision risk for DD (hazards ratio [HR]=1.59, 95% CI, 1.29 to 1.98, P<0.001) and mechanical failure (HR=1.56, 95% CI, 1.19 to 2.04, P=0.020). Male sex was significantly related to a lower revision risk for DD (HR=0.75, 95% CI, 0.62 to 0.91, P=0.04). Age, race, and the number of comorbidities had no discernible influence on overall or cause-specific revision risk. The most prevalent etiologies in the comprehensive database research were DD and mechanical failure, with a 5-year revision rate of 16.5% following elective multilevel lumbar instrumented fusion in elderly patients. Revision surgeries and female patients were the most vulnerable to revision.