Complications of Elective Lumbar Spine Fusion in Patients With COVID-19

TL;DR

Elective lumbar spine fusion surgery performed within two weeks of a COVID-19 diagnosis is linked to higher medical complications, longer hospital stays, and increased costs.

Contribution

This study provides evidence-based guidance on delaying elective spine surgery after recent COVID-19 infection.

Findings

Patients with recent COVID-19 had significantly longer hospital stays and higher 30-day costs.

Recent COVID-19 diagnosis was independently associated with increased 30-day and 90-day readmission rates.

Medical complications like pneumonia and acute kidney injury were more common in patients with recent COVID-19.

Abstract

Introduction: The COVID-19 pandemic led to widespread delays in elective surgery, and prior studies have shown increased perioperative risk when surgery is performed soon after infection. While recommendations exist for delaying elective arthroplasty following COVID-19, data guiding the timing of elective spine surgery remain limited. This study evaluates complication rates in patients undergoing elective lumbar fusion within 14 days of a COVID-19 diagnosis using a large national database.

Methods: The PearlDiver Mariner Database was queried to identify all adult patients who underwent primary elective lumbar fusion between 2020 and April 2023. Patients diagnosed with COVID-19 within 14 days preoperatively were included, while those with COVID-19 diagnoses 15-90 days before surgery were excluded. A control cohort without COVID-19 diagnoses within 90 days of surgery was established. Demographics, length of stay, 30-day costs, readmissions, and postoperative complications were analyzed. Nearest-neighbor 10:1 propensity score matching was performed based on age, Elixhauser Comorbidity Index (ECI), and gender. Multivariable logistic regression adjusted for age, ECI, gender, and number of levels fused, assessed the association between recent COVID-19 infection and postoperative outcomes with reported odds ratios (OR).

Results: Of 128,337 patients undergoing lumbar fusion, 548 (0.43%) had a COVID-19 diagnosis within 14 days of surgery. After propensity matching, patients with recent COVID-19 infection had significantly longer hospital stays (7.96 vs. 4.46 days, p<0.001) and higher 30-day costs ($9,464 vs. $7,543, p<0.001). Recent COVID-19 diagnosis was independently associated with increased risk of 30-day (OR 14.54, p<0.001) and 90-day (OR 11.67, p<0.001) all-cause readmissions, intraoperative transfusion (OR 2.81, p<0.01), and multiple medical complications, including pneumonia (OR 6.87), respiratory failure (OR 3.86), acute kidney injury (AKI, OR 2.41), sepsis (OR 1.86), shock OR 3.12), and cardiac arrhythmias (OR 1.78) (all p<0.05). No significant differences were observed in surgical complications or incision and drainage (I&D) rates.

Conclusion: Patients undergoing elective lumbar spine fusion within 14 days of a COVID-19 diagnosis experience significantly higher rates of medical complications, hospital readmissions, length of stay, and healthcare costs. These support consideration of delaying non-urgent elective lumbar fusion for at least two weeks following COVID-19 infection, with careful assessment of patient comorbidities and infection severity.

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