Revision Discectomy with or without Fusion for the Treatment of Recurrent Lumbar Disc Herniation: A Nationwide Analysis of Risk Profiles and Short-Term Outcomes.
OBJECTIVE
We compared the demographics, risk factors, and complications for adult patients with recurrent lumbar disc herniation (RLDH) undergoing revision discectomy with or without concurrent fusion.


METHODS
The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who had undergone revision discectomy with or without simultaneous fusion. The demographic variables and various peri- and postoperative complications were compared between these 2 patient groups.


RESULTS
A total of 6901 discectomy patients were included in the present study, of whom 2996 (43.4%) had undergone revision discectomy with fusion and 3905 (56.6%) had undergone revision discectomy alone. The revision discectomy with fusion group was significantly more likely to be older, female, and White or Black and to have a higher average body mass index than was the revision discectomy alone group. The discectomy with fusion group had longer hospital lengths of stay and was more likely to have a diagnosis of hypertension, insulin-dependent and non-insulin-dependent diabetes, and chronic obstructive pulmonary disease. In addition, the patients who had undergone discectomy with fusion were significantly more likely to develop pneumonia, require ventilation for >48 hours, require a blood transfusion, and to develop urinary tract infection, myocardial infarction, deep vein thrombosis, or pulmonary embolism compared with the patients who had undergone revision discectomy only.


CONCLUSIONS
Our findings reveal that older patients with more comorbidities were more likely to undergo revision discectomy with fusion. Also, this surgical group experienced more adverse events after their procedure compared with the revision discectomy only group.
['Fuentes|Angelica M|AM|', 'Patil|Shashank|S|', 'Chiu|Ryan G|RG|', 'Glastris|Georgia|G|', 'Behbahani|Mandana|M|', 'Mehta|Ankit I|AI|']
D058186:Acute Kidney Injury D000328:Adult D000367:Age Factors D001803:Blood Transfusion D015992:Body Mass Index D002318:Cardiovascular Diseases D015897:Comorbidity D003924:Diabetes Mellitus, Type 2 D017586:Diskectomy D005006:Ethnicity D005260:Female D006801:Humans D006973:Hypertension D007239:Infections D007405:Intervertebral Disc Displacement D007902:Length of Stay D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D009765:Obesity D011183:Postoperative Complications D029424:Pulmonary Disease, Chronic Obstructive D012086:Reoperation D012121:Respiration, Artificial D012307:Risk Factors D012737:Sex Factors D013123:Spinal Fusion D016896:Treatment Outcome D055815:Young Adult
Revision discectomy Fusion Recurrent lumbar disc herniation Lumbar herniation Lumbar spine Postoperative outcomes