Characterizing Utilization Patterns and Reoperation Risk Factors of Interspinous Process Devices: Analysis of a National Claims Database
Hao Tan, Erin A Yamamoto, Spencer Smith, Jung Yoo, Jonathan Kark, Clifford Lin, Josiah Orina, Travis Philipp, Donald A Ross, Christina Wright, James Wright, Won Hyung A Ryu- Anesthesiology and Pain Medicine
- Neurology (clinical)
- General Medicine
Abstract
INTRODUCTION
Interspinous process devices (IPDs) were developed as minimally invasive alternatives to open decompression surgery for spinal stenosis. However, given high treatment failure and reoperation rates, there has been minimal adoption by the spine surgeons. This study leveraged a national claims database to characterize national IPD usage patterns and postoperative outcomes following IPD implantation.
METHOD
Using the PearlDiver database, we identified all patients who underwent 1- or 2-level IPD implantation between 2010 and 2018. Univariate and multivariable logistic regression was performed to identify predictors of the number of IPD levels implanted and reoperation up to 3 years after index surgery. Right-censored Kaplan-Meier curves were plotted for duration of reoperation-free survival and compared with log-rank tests.
RESULTS
4,865 patients received 1-level (n = 3,246) or 2-level (n = 1,619) IPDs. Patients who were older (aOR 1.02, 95% CI 1.01–1.03, p < 0.001), male (aOR 1.31, 95% CI 116–1.50, p < 0.001), and obese (aOR 1.19, 95% CI 1.05–1.36, p < 0.01) were significantly more likely to receive a 2-level IPD versus a 1-level IPD. The 3-year reoperation rate was 9.3% of patients when accounting for mortality during the follow-up period. Older age decreased (aOR 0.97, 95% CI 0.97–0.99, p = 0.0039) likelihood of reoperation while 1-level IPD (aOR 1.37, 95% CI 1.01–1.89, p = 0.048), CCI (aOR 1.07, 95% CI 1.01–1.14, p = 0.018) and performing concomitant open decompression increased the likelihood of reoperation (aOR 1.68, 95% CI 1.35–2.09, p = 0.0014).
CONCLUSION
Compared to one-level IPDs, two-level IPDs were implanted more frequently in older, male, and obese patients. The 3-year reoperation rate was 9.3%. Concomitant open decompression with IPD placement was identified as a significant risk factor for subsequent reoperation and warrants future investigation.