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Code Description 22533 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression), single interspace 22534 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression), additional interspace 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression), single interspace 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression), additional interspace 22612 Arthrodesis, posterior or posterolateral technique, single level 22614 Arthrodesis, posterior or posterolateral technique, additional level 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace 22632 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), additional interspace 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), additional interspace and segment Note: Listing of current procedural terminology codes used to select lumbar spine fusion patients for this study. All codes were referenced through standardized listings prepared by the American Academy of Professional Coders.15
Stage 1 (n = 76,137) Stage 2 (n = 92,698) Stage 3a (n = 20,926) Stage 3b (n = 7551) Stage 4 (n = 1552) Stage 5 (n = 869) Variable Steroid
(n = 3413)No Steroid
(n = 72,724)P Value Steroid
(n = 4351)No Steroid
(n = 88,347)P Value Steroid
(n = 1368)No Steroid
(n = 19,558)P Value Steroid
(n = 593)No Steroid
(n = 6958)P Value Steroid
(n = 155)No Steroid
(n = 1397)P Value Steroid
(n = 45)No Steroid
(n = 824)P Value Sex (women) 1931 35,978 4.65E−16 2786 46,801 <2.2e−16 916 11,455 7.49E−10 372 4411 0.756 90 799 0.864 13 299 0.343 Diabetes 625 11,349 3.13E−05 810 16,171 0.602 335 5642 0.00052 236 2620 0.3104 65 709 0.042 12 339 0.0612 Smoker 768 21,263 <2.2E−16 571 13,854 4.06E−06 123 2327 0.00094 39 694 0.0059 11 191 0.0227 12 149 0.1665 Dyspnea 318 3378 <2.2E−16 445 5474 <2.2E−16 203 1848 1.055E−09 79 794 0.1604 28 177 0.07879 4 84 1 Independent functional status 3114 70,062 <2.2E−16 4074 85,548 <2.2E−16 1297 18,725 0.03438 534 6528 0.0002586 135 1266 0.1427 37 687 1 COPD 344 3050 <2.2E−16 483 4446 <2.2E−16 172 1323 1.274E−13 40 569 0.2388 17 90 0.04377 5 64 0.3936 CHF 15 127 0.001853 44 322 1.48E−08 12 158 0.7545 9 113 1 6 47 0.6451 2 47 1 Hypertension 1878 33,571 <2.2E−16 2965 55,310 9.49E−14 1093 15,806 0.4145 511 6060 0.5244 136 1268 0.2473 42 673 0.04524 Dialysis 2 19 0.2421 4 31 0.08007 0 21 0.3962 0 13 0.6171 6 113 0.07784 38 630 0.2763 Sepsis 154 1289 <2.2E−16 85 767 1.06E−10 16 229 1 13 122 0.419 4 83 0.0968 4 88 1 Disseminated cancer 387 1485 <2.2E−16 167 1059 <2.2E−16 47 291 1.04E−06 21 116 0.003216 3 33 1 2 16 0.238 Superficial wound infection 1 12 0.4615 0 5 1 0 0 1 0 2 1 0 0 1 0 0 1 Deep wound infection 3 51 0.7396 3 23 0.1247 0 6 1 0 3 1 0 3 1 0 1 1 Weight loss >10% 68 591 2.79E−10 31 425 0.04443 18 88 0.000167 10 31 0.000994 6 19 0.032 0 20 0.6186 Bleeding disorder 121 992 <2.2E−16 154 1636 9.80E−13 72 589 1.95E−05 34 248 0.01241 9 90 0.8637 2 72 0.4194 Age ≥70 y 369 5114 3.88E−15 1748 32,244 1.04E−06 798 10,904 0.06311 322 4644 1.76E−09 94 844 1 10 224 0.6047 Albumin <3.4 g/dL 421 3029 <2.2E−16 290 2410 <2.2E−16 81 761 0.00412 58 396 0.001283 24 237 0.631 19 233 0.4008 WBC >11,000/µL 578 5770 <2.2E−16 583 4940 <2.2E−16 198 1288 <2.2E−16 83 525 4.15E−07 32 142 0.00044 5 83 0.8004 Platelets <150,000/µL 280 3028 <2.2E−16 276 4262 1.29E−05 101 1242 0.1536 52 547 0.4792 21 151 0.3489 11 161 0.4451 BUN >23 mg/dL 206 2327 2.31E−16 658 9098 <2.2E−16 523 6739 0.005498 404 4491 0.04341 139 1223 0.4219 42 619 0.003679 BMI ≥30 1498 34,825 1.08E−05 2070 43,256 0.0927 655 10,475 2.91E−05 265 3851 2.29E−06 60 749 0.0003443 10 361 0.004889 Note: Comparison of preoperative variables between lumbar spine fusion patient groups stratified by CKD stage. For each CKD stage, patients with reported chronic steroid use were compared with patients without chronic steroid use using Fisher exact tests. Statistical significance was defined as P value ≤0.05.
BMI, body mass index; BUN, blood urea nitrogen; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; WBC, white blood cells.
Stage 1 (n = 76,137) Stage 2 (n = 92,698) Stage 3a (n = 20,926) Stage 3b (n = 7551) Stage 4 (n = 1552) Stage 5 (n = 869) Variable Steroid
(n = 3413)No Steroid
(n = 72,724)P Value Steroid
(n = 4351)No Steroid
(n = 88,347)P Value Steroid
(n = 1368)No Steroid
(n = 19,558)P Value Steroid
(n = 593)No Steroid
(n = 6958)P Value Steroid
(n = 155)No Steroid
(n = 1397)P Value Steroid
(n = 45)No Steroid
(n = 824)P Value Wound infection 101 1127 8.05E−09 154 1281 <2.2E−16 45 349 0.000273 16 146 0.3032 3 50 0.3579 3 42 0.5019 Pulmonary event 116 1060 4.27E−15 123 1217 2.68E−12 28 426 0.8476 29 219 0.02978 9 89 1 4 73 1 VTE 109 1117 1.96E−11 129 1482 6.18E−09 16 364 0.07382 22 151 0.02158 3 55 0.268 2 29 0.672 MACE 28 390 0.03271 58 710 0.00042 25 292 0.3036 5 150 0.03277 6 53 1 1 65 0.2455 Renal event 16 128 0.0007748 13 288 0.8913 16 99 0.003718 15 86 0.01424 1 66 0.0113 1 4 0.2339 Death within 30 d 73 252 <2.2E−16 49 403 7.28E−08 9 109 0.5748 4 81 0.4136 3 38 0.7919 0 33 0.4083 Sepsis 54 768 0.006418 92 766 4.37E−13 31 244 0.002941 20 110 0.004306 5 58 0.8291 4 29 0.08541 UTI 81 1104 0.0002175 152 1674 1.88E−11 53 548 0.02893 34 247 0.01225 7 69 1 2 12 0.1609 Transfusion within 72 h 782 10,356 <2.2E−16 941 13,805 <2.2E−16 330 3818 5.39E−05 153 1670 0.3422 53 436 0.4663 11 326 0.05818 Return to OR 197 2851 3.23E−07 265 3169 3.64E−15 102 872 2.09E−06 47 324 0.0009916 11 121 0.6483 13 89 0.001095 LOS ≥10 d 515 5763 <2.2E−16 450 4935 <2.2E−16 150 1437 3.95E−06 85 617 3.41E−05 34 322 0.7639 19 333 0.7562 Note: Comparison of postoperative variables between lumbar spine fusion patient groups stratified by CKD stage. For each CKD stage, patients with reported chronic steroid use were compared with patients without chronic steroid use using Fisher exact tests. Statistical significance was defined as P value ≤0.05.
CKD, chronic kidney disease; LOS, length of stay; MACE, major adverse cardiovascular event; OR, operating room; UTI, urinary tract infection; VTE, venous thromboembolism.
Outcome and CKD Stage Adjusted OR 95% CI P Value Wound Infection Stage 1 1.458 1.119–1.900 0.00512 Stage 2 2.218 1.780–2.765 1.33E−12 Stage 3a 1.577 1.048–2.373 0.0287 Stage 3b 1.114 0.542–2.289 0.768 Stage 4 0.468 0.130–1.686 0.246 Stage 5 1.689 0.487–5.856 0.408 Pulmonary Event Stage 1 1.514 1.191–1.924 0.000704 Stage 2 1.010 0.752–1.356 0.944 Stage 3a 1.063 0.681–1.661 0.786 Stage 3b 1.654 0.989–2.766 0.0550 Stage 4 0.843 0.398–1.784 0.656 Stage 5 0.811 0.276–2.377 0.703 Venous thromboembolism Stage 1 1.293 0.993–1.684 0.0561 Stage 2 1.423 1.110–1.825 0.00540 Stage 3a 0.624 0.336–1.158 0.135 Stage 3b 2.209 1.306–3.735 0.0031 Stage 4 0.550 0.161–1.869 0.338 Stage 5 1.703 0.366–7.928 0.497 MACE Stage 1 1.248 0.7977–1.952 0.332 Stage 2 1.148 0.775–1.700 0.489 Stage 3a 0.929 0.507–1.702 0.814 Stage 3b 0.127 0.017–0.925 0.0417 Stage 4 0.665 0.257–1.719 0.401 Stage 5 0.236 0.031–1.768 0.160 Renal event Stage 1 0.773 0.320–1.865 0.567 Stage 2 0.561 0.228–1.381 0.209 Stage 3a 3.873 1.993–7.526 6.44E−05 Stage 3b 1.922 0.944–3.914 0.0715 Stage 4 0.098 0.013–0.732 0.0235 Stage 5 6.34E−08 0–inf 0.998 Death within 30 d Stage 1 2.134 1.528–2.980 8.48E−06 Stage 2 1.252 0.814–1.924 0.305 Stage 3a 1.650 0.772–3.530 0.196 Stage 3b 0.973 0.331–2.853 0.960 Stage 4 0.612 0.170–2.194 0.451 Stage 5 1.78E−07 0–inf 0.986 Sepsis Stage 1 0.940 0.662–1.335 0.731 Stage 2 2.202 1.634–2.967 2.09E−07 Stage 3a 0.975 0.585–1.626 0.925 Stage 3b 1.869 1.004–3.479 0.0483 Stage 4 0.940 0.360–2.457 0.901 Stage 5 2.296 0.750–7.022 0.145 Urinary tract infection Stage 1 1.050 0.775–1.422 0.750 Stage 2 1.535 1.208–1.950 0.000446 Stage 3a 0.946 0.635–1.409 0.788 Stage 3b 1.826 1.130–2.951 0.0138 Stage 4 1.171 0.508–2.699 0.711 Stage 5 2.506 0.525–11.946 0.249 Transfusion within 72 h Stage 1 1.270 1.135–1.422 2.98E−05 Stage 2 1.358 1.225–1.504 5.09E−09 Stage 3a 1.046 0.878–1.245 0.611 Stage 3b 0.961 0.746–1.238 0.761 Stage 4 1.203 0.833–1.737 0.324 Stage 5 0.368 0.177–0.765 0.00738 Return to operating room Stage 1 1.186 0.973–1.445 0.0905 Stage 2 1.687 1.421–2.002 2.07E−09 Stage 3a 1.276 0.948–1.719 0.107 Stage 3b 1.103 0.684–1.777 0.687 Stage 4 0.940 0.476–1.856 0.860 Stage 5 3.744 1.844–7.602 0.000258 Length of stay ≥10 d Stage 1 0.988 0.854–1.145 0.882 Stage 2 1.144 0.981–1.334 0.0853 Stage 3a 0.970 0.750–1.254 0.820 Stage 3b 1.031 0.728–1.461 0.859 Stage 4 1.024 0.659–1.590 0.916 Stage 5 0.876 0.464–1.656 0.686 Note: Adjusted OR for each postoperative outcome variable stratified by CKD staging. For each CKD stage, multivariate logistic regression modeling used patients without chronic steroid use as the reference group to determine adjusted ORs. Statistical significance was defined as a Bonferroni-adjusted P value ≤0.017.
CKD, chronic kidney disease; MACE, major adverse cardiovascular event.
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