Readmission rates and hospital charges: a comparative study of surgical interventions in degenerative spondylolisthesis and spinal canal stenosis.

OBJECTIVE

Degenerative spondylolisthesis and spinal canal stenosis are some of the more common clinical conditions associated with low back pain, with various surgical techniques available, ranging from standalone decompression to fusion. Interspinous spacer devices (ISD) have emerged as an intermediary surgical option. The aim was to compare 90-day all-cause readmission rates between techniques, with secondary outcomes including total hospital charges and postoperative complications.

METHODS

Utilizing the 2020 Nationwide Readmissions Database (NRD), adult patients (> 18 years) were selected by primary diagnosis ICD-10 code for spondylolisthesis and/or spinal stenosis. Patients were categorized by surgical treatment: ISD, decompression, or single-level posterior fusion. Treatment techniques were compared using a multivariable logistic and linear regression while adjusting for potential confounding factors. Propensity score adjustments were performed as a sensitivity analysis.

RESULTS

In total 37,503 patients met our inclusion criteria, with (81.2%) having received a decompression, 18.3% a fusion and 0.49% an ISD. The 90-day all-cause readmission rates were 8%, 9%, and 9% respectively (p= 0.85). ISD had the lowest mean raw hospital charges at $109,676 (p< 0.001), compared to fusion charges of $205,024. Early c omplication rates were similar across all groups, except for neurological and gastrointestinal complications.

CONCLUSION

ISD had comparable readmission and early postoperative complication rates versus decompression or fusion surgeries, with lower raw charges compared to fusion. Our results suggest that ISD may be a viable option for some patients compared to more traditional surgical techniques for spondylolisthesis or spinal stenosis. Further research into the long-term cost-effectiveness and clinical outcomes will be needed.