What is the clinical evidence from this study?

Study design: Cohort. Population: Lumbar spinal stenosis (n=60785). Intervention: Osteoporosis vs. Non-osteoporosis. Primary outcome: Perioperative complications (OR 1.273, 95% CI 1.123-1.442, p=<0.001).

July 25, 2025Asian Spine Journal1 citationsOpen Access

Impact of osteoporosis on perioperative complications in patients undergoing surgical treatment for lumbar spinal stenosis: a nationwide retrospective study

Q: What are the key findings of this study?

Osteoporosis was identified as an independent risk factor for perioperative complications (OR 1.273) in patients undergoing surgical treatment for lumbar spinal stenosis.

Q: What does this research mean for the field?

Osteoporosis is an independent risk factor for perioperative complications in patients undergoing surgical treatment for lumbar spinal stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

TTTomoyuki TanakaGraduate School of Health Care Sciences, Jikei Institute JKJunya KatayanagiDokkyo Medical University Saitama Medical Center HKHiroki KonumaDokkyo Medical University Saitama Medical Center

Key Result

Osteoporosis was identified as an independent risk factor for perioperative complications (OR 1.273) in patients undergoing surgical treatment for lumbar spinal stenosis.

Study Design

Type

Cohort (n=60,785)

Multicenter

Yes

Structured PICO

Does osteoporosis increase perioperative complications in patients undergoing surgical treatment for lumbar spinal stenosis?

Population

60,785 patients (mean age 71.8 years, 41% female) who underwent surgical treatment for lumbar spinal stenosis in Japan, analyzed to assess the impact of osteoporosis on perioperative complications.

Exposure

Presence of osteoporosis

Comparator

Absence of osteoporosis

Outcome

Perioperative complications (composite of surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, spinal fluid leakage, hematoma, and meningitis)composite

Osteoporosis is an independent risk factor for perioperative complications, increased healthcare costs, and greater blood transfusion requirements following lumbar spinal stenosis surgery.

Main Result

Odds Ratio: 1.273 (95% CI 1.123–1.442)

p-value: p=<0.001

Limitations

Residual confounding variables such as nutritional status were not accounted for in the analysis.
Retrospective analysis of large databases can be affected by coding errors.
The database only codes patients receiving treatment, potentially leading to undiagnosed or untreated osteoporosis cases in the non-osteoporosis group.

Abstract

STUDY DESIGN: Nationwide retrospective cohort study with propensity score matching (PSM) analysis. PURPOSE: To investigate the impact of osteoporosis on perioperative complications in patients undergoing surgery for lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: Progressive population aging has driven an increase in surgical procedures for degenerative spinal conditions such as LSS. While previous research has examined the impact of osteoporosis on implant-related complications, its specific impact on outcomes following LSS surgeries remains unclear. METHODS: This study analyzed 60,785 patients who underwent LSS surgery between April 2020 and March 2022, utilizing data from a nationwide Diagnosis Procedure Combination database. Perioperative complications, treatment costs, blood transfusion volume, and anesthesia time were compared between osteoporotic and non-osteoporotic patients. PSM was employed to account for confounding variables. Univariate and multivariate regression analyses were employed to identify risk factors for complications. RESULTS: The prevalence of osteoporosis in this cohort was 10.6%. On regression analyses, age, sex, body mass index, admission activities of daily living (ADL) score (Barthel index), hospital type, spinal fusion, Charlson comorbidity index score, and osteoporosis showed a significant association with perioperative complications. Before PSM, osteoporotic patients were older, predominantly female, and had lower body mass index and admission ADL scores, higher spinal fusion rates, and more complications. After PSM, osteoporotic patients exhibited significantly higher complication rates, increased costs, greater blood transfusion requirements, and longer anesthesia durations compared to non-osteoporotic patients. CONCLUSIONS: This nationwide analysis identified osteoporosis as an independent risk factor for perioperative complications following LSS surgery. Our findings underline the need for careful perioperative management in this population.

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