Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical fusion surgery: a nationwide analysis of 52,818 patients

Publication date: Available online 6 April 2018
Source:The Spine Journal
Author(s): David N. Bernstein, Etka Kurucan, Emmanuel N. Menga, Robert W. Molinari, Paul T. Rubery, Addisu Mesfin
Background ContextNumerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with non-cervical spine involvement.PurposeTo compare patient characteristics, comorbidities and complications in patients with and without RA undergoing primary non-cervical spine fusions.Study Design/SettingRetrospective national database review.Patient SampleA total of 52,818 adult spinal deformity patients undergoing non-cervical spine fusions (1,814 patients with RA and 51,004 patients without RA).Outcome MeasuresPatient characteristics, as well as complication and mortality rates.MethodsUsing the Nationwide Inpatient Sample (NIS) from 2003-2014, ICD-9-CM diagnosis and procedure codes were used to identify patients ≥ 18 years old with and without RA undergoing primary non-cervical spine fusions. Univariate analysis was utilized to determine patient characteristics, comorbidities, and complication values for each group. Bivariate analysis was used to compare the two groups. Significance was set at p<0.05.ResultsPatients with RA were older (p<0.001), were more likely to be women (p<0.001), had increased rates of osteoporosis (p<0.001), had a greater percentage of their surgeries reimbursed by Medicare (p<0.001) and more often had weekend admissions (p = 0.014). There was no difference in all other characteristics. Patients with RA had higher rates of iron deficiency anemia, congestive heart failure, chronic pulmonary disease, depression and fluid & electrolyte disorders (all, p<0.001). Patients without RA had higher rates of alcohol abuse (p = 0.027). There was no difference in all other complications. There was no difference in mortality rate (p = 0.99). Total complications were greater in patients with RA (p<0.001). Patients with RA had higher rates of infection (p = 0.032), implant-related complications (p 0.010), incidental durotomies (p = 0.001) and urinary tract infections (p<0.001). No difference existed between other complications.ConclusionsPatients with RA have an increased number of comorbidities and complication rate compared to patients without RA. Such knowledge can help surgeons and patients with RA have beneficial preoperative discussions regarding outcomes.



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