Background context:

RA is a systemic disease state with prominent musculoskeletal manifestations associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in RA patients following lumbar surgery.

Objective:

The aim of the study is to evaluate if Rheumatoid arthritis (RA) patients undergoing PLF have increased postoperative complications and economic burden compared to those without.

Methods:

Patients under the age of 85 who underwent elective one- or two-level instrumented PLF for degenerative lumbar pathology between the years of 2006-2012 were identified in the Medicare insurance claims database. Same day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with a history of RA prior to fusion and those without (controls). All outcomes of interest were then compared using multivariate regression. Reoperation-free survival at one- and two-year follow-up was analyzed used Log Rank test. Significance was defined as p<0.05.

Results:

RA patients had significantly higher risk of 90-day readmission(OR 1.27, p<0.001), thromboembolic events(OR 1.39, p=0.010), sepsis(OR 2.32, p<0.001), pneumonia(OR 1.57, p=0.001), and wound complications(OR 1.41, p<0.001). Reoperation-free survival was significantly lower in RA patients at two-year follow-up(90.4% vs 92.4%, p<0.001). Following adjusted regression RA independently contributed to a $1,491 increase in additional 90-day costs(p<0.001).

Conclusion:

Preexisting RA may increase the risk for short-term postoperative medical complications following PLF, specifically infectious events. In addition, these patients have higher rates of subsequent reoperation following index surgery. Patients be should counseled of these risks accordingly.