Objectives:

To 1) compare the rates of different fusion techniques using a nationwide database over the last decade and 2) identify differences in complications and readmissions based on fusion technique.

Methods:

All elective, single-level lumbar fusions performed by orthopaedic surgeons from 2011-2020 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Rates of lumbar fusion technique (posterolateral fusion (PLDF), transforaminal lumbar interbody fusion + PLDF (TLIF), anterior lumbar interbody fusion (ALIF/LLIF), and anterior lumbar interbody fusion + PLDF (ALIF/LLIF+PLDF) were recorded. 30-day complications and readmissions were compared. Secondary analysis included multiple logistic regression to determine independent predictors of each outcome.

Results:

A total of 28,413 fusions met inclusion criteria. Of those, 8,749 (30.8%) fusions were PLDFs, 11,973 (42.1%) were TLIFs, 4,769 (16.8%) were ALIF/LLIFs, and 2,922 (10.3%) were ALIF/LLIF+PLDFs. The number of fusions increased over time with 1,227 performed in 2011, and 3,958 fusions performed in 2019. Interbody fusions also increased over time with a subsequent decreased in PLDFs (2011: 39.0% 2020: 25.2%). Patients were more likely to discharge home over the course of the decade (2011: 85.4%; 2020: 95.0%). No difference was observed between the techniques in regard to complications or readmissions. The Modified 5-item Frailty Index (MFI-5) was predictive of complications (OR, 2.05, p=0.001) and readmissions (OR, 2.61, p<0.001).

Conclusion:

Lumbar fusions have continued to increase over the last decade with an increasing proportion of interbody fusions. Complications and readmissions appear to be driven by patient comorbidity and not fusion technique.