Short-Term Burden of Adding Fusion to Posterior Decompression for Thoracic Ossification of the Ligamentum Flavum: A Nationwide Inpatient Database Study
Shingo Morishita, Takashi Hirai, Kentaro Yamada, Yu Matsukura, Satoru Egawa, Hiroaki Onuma, Atsuyuki Kawabata, Takuya Takahashi, Motonori Hashimoto, Kiyohide Fushimi, Toshitaka YoshiiStudy Design:
Retrospective cohort study using a nationwide inpatient database.
Objective:
To quantify the short-term perioperative and economic burden associated with adding fusion to posterior decompression (PD) in patients with thoracic ossification of the ligamentum flavum (T-OLF)
Summary of Background Data:
PD and PD with fusion (PDF) are commonly used surgical strategies for T-OLF. Fusion may provide biomechanical stability and durable decompression in selected cases; however, its impact on perioperative morbidity and health care resource utilization in large-scale real-world settings remains insufficiently characterized.
Materials and Methods:
Patients with T-OLF who underwent PD or PDF between 2012 and 2018 were identified using the Japan Diagnosis Procedure Combination database. Propensity score matching was performed to balance baseline characteristics between groups. Outcomes were perioperative complications (systemic and local), reoperation, length of hospital stay, hospitalization costs, blood transfusion, mortality, and discharge destination.
Results:
A total of 2931 patients were identified, and 1228 matched pairs were analyzed. The PDF group demonstrated a higher incidence of systemic complications than the PD group (13.6%
Conclusion:
PDF for T-OLF was associated with greater short-term perioperative morbidity and increased health care resource utilization. These findings quantify the short-term burden associated with fusion and should be interpreted in the context of its potential long-term benefits in appropriately selected patients.