Inflammatory bowel disease is associated with greater odds of complications following posterior lumbar fusion and further amplified for patients exposed to monoclonal antibody biologics

Background

Posterior lumbar fusion (PLF) is a common spine surgery that may be considered in patients with underlying comorbidities, such as inflammatory bowel disease (IBD). Prior literature examining the association of this disease and PLF outcomes was done in the National Inpatient Sample (NIS), which only assessed in-hospital data and did not reveal an elevated risk of medical or surgical complications. However, characterization of PLF outcomes beyond hospital discharge is important and remains unknown for patients with IBD.

Methods

Patients with IBD who underwent single-level PLF ± interbody fusion were identified from the M165Ortho PearlDiver database. Exclusion criteria included: patients <18 years old, those undergoing concurrent cervical, thoracic, anterior, or multi-level fusion, those with prior trauma, neoplasm, or infection diagnosed within 90-days, and <90-days of follow-up. Adult patients with IBD were matched 1:4 with non-IBD patients based on age, sex, and Elixhauser Comorbidity Index (ECI). The odds of 90-day individual and aggregated any, severe, and minor adverse events (AAE, SAE, and MAE, respectively), emergency department (ED) visits, and hospital readmission were compared by multivariable logistic regression. Five-year reoperation was assessed by Kaplan-Meier survival analysis and compared by log-rank test.

Results

Overall, 4,392 (1.4%) of patients undergoing PLF were identified with IBD. These patients demonstrated elevated odds ratios (ORs) of aggregated MAE (OR 2.29), AAE (OR 2.27), and SAE (OR 1.84), as well as ED visits (OR 2.69) (p<.001 for all). Conversely, 5-year reoperation rates were not different for those with vs without IBD (p=.70).

Conclusions

The current study highlights the importance of investigating post-discharge outcomes, as these findings were not detected by prior inpatient literature. Our findings reveal the odds of various complications may be significantly elevated for IBD patients within 90-days postoperatively, however, these inferior outcomes encouragingly did not translate to an elevated rate of 5-year reoperation.