Impact of Surgical Approaches on Complications, Emergency Room Admissions, and Health Care Utilization in Patients Undergoing Lumbar Fusions for Degenerative Disc Diseases: A MarketScan Database Analysis

OBJECTIVE: To identify the impact of different surgical approaches for lumbar degenerative disc disease (DDD) on complications, reoperations/readmissions, and health care utilization. METHODS: We used International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes to extract data from MarketScan. Patients were divided into 6 groups: single-level anterior only (sA), single-level anterior + posterior (sAP), single-level posterior (sP), multilevel anterior (mA), multilevel anterior + posterior (mAP), and multilevel posterior only (mP). Outcomes of interest were cumulative complication rates, reoperation rates, readmission, and health care utilization at 6, 12, and 24 months. RESULTS: Of 148,499 patients, 3% had sA fusion and 54% had mP procedures. Patients in the mAP cohort incurred higher cumulative complication rates (21%) compared with sA (13%), sAP (15%), sP (14%), mA (18%), and mP (18%). Emergency room admissions within 30 days were highest in the mA cohort (14%) followed by mAP (11%) and mP (8%). At 12 and 24 months, patients with mA procedures were most likely to have either new fusion or refusion (8% and 12%) followed by sA (7% and 10%), sAP (4% and 7%), mAP (4% and 8%) mP (4% and 7%), and sP (3% and 7%). Compared with the mP cohort, patients in the mA cohort incurred 1.2 times the overall median payments, whereas mAP and sA incurred 1.1 times the payments at 12 months. This difference was further reduced at 24 months. CONCLUSIONS: mAP procedures are associated with higher cumulative complications and health care utilization compared with other procedures and the difference in health care utilization tends to decrease over 12 and 24 months.