Single-Stage Versus Multistage Surgical Management of Single- and Two-Level Lumbar Degenerative Disease

-OBJECTIVE: To determine postoperative complications and quality outcomes of single-stage and multistage sur-gical management for lumbar degenerative disease (LDD). -METHODS: This retrospective cohort study using a na-tional administrative database identified patients who un-derwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether their surgeon chose to perform single-stage or multistage LDD surgery, and these cohorts were mutually exclusive. Propensity score matching was used to mitigate intergroup differences be-tween single-stage and multistage patients. Patients who -nderwent double dagger 3 levels of surgical correction, who were <18 years old, or who had any prior history of trauma or tumor were excluded from the study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined. -RESULTS: Primary surgery for LDD was performed in 47,190 patients; 9438 (20%) of these patients underwent multistage surgery. After propensity score matching, baseline covariates of the 2 cohorts were similar. The complication rate was 6.1% in the single-stage cohort and 11.0% in the multistage cohort. Rates of posthemorrhagic anemia, infection, wound complication, deep vein throm-bosis, and hematoma all were higher in the multistage cohort. Length of stay, revisions, and readmissions were also significantly higher in the multistage cohort. Through 2 years of follow-up, multistage surgery was associated with higher payments throughout the 2-year follow-up period ($57,036 vs. $39,318, P < 0.05). -CONCLUSIONS: Single-stage surgery for LDD demon-strated improved outcomes and lower health care utiliza-tion. Spine surgeons should carefully consider single-stage surgery when treating patients with LDD requiring <3 levels of correction.

Automated summary

Single-stage surgery for lumbar degenerative disease showed improved outcomes and lower healthcare utilization, suggesting it should be carefully considered for patients requiring less than 3 levels of correction.