Study DesignRetrospective cohort study.ObjectiveTo examine national and regional trends in preoperative patient optimization and surgical outcomes among patients undergoing posterior lumbar interbody fusion (PLIF) in the United States from 2011 to 2022.MethodsPatients who underwent PLIF were identified in the PearlDiver Patient Claims Database using ICD-9, ICD-10 and CPT codes. Demographic characteristics, comorbidities, and postoperative outcomes were analyzed over 11 years and by U.S. region (Midwest, Northeast, South, West). Variables included age, body mass index, tobacco use, Charlson Comorbidity Index (CCI), opioid use, 30-day complications, 90-day readmissions, infection, and hospital length of stay (LOS). Statistical analysis was performed using R (α = 0.05).Results434 214 patients underwent PLIF from 2011 to 2022. Nationally, LOS, 30-day complication, and 90-day readmission worsened over time. Hospital LOS increased (P P P < .0001).ConclusionsDespite an emphasis on preoperative optimization and demonstrated reductions in preoperative opiate use, surgical outcomes including 30-day complications, 90-day readmissions, and length of stay increased in recent years. Worsening outcomes imply potential gaps in optimization efforts and regional outcome variability may suggest a need for region-specific preoperative optimization strategies.
Nguyen et al. (Wed,) studied this question.