National trends and complications in the surgical management of diffuse idiopathic skeletal hyperostosis (DISH).

PURPOSE: Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory disorder characterized by calcification and ossification of ligaments and entheses of the spine. Limited literature exists on the characteristics, complications, and outcomes of patients undergoing different surgical approaches for DISH. This study aims to identify patient factors associated with postoperative complications and predictors of surgical approach.

METHODS

The 2016 to 2021 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of DISH. From this cohort, those who underwent spine surgery were further identified and subdivided based on the surgical approach and analyzed for demographics, comorbidities, and other patient characteristics to identify associations and trends.

RESULTS

Among 5,322 DISH patients, surgical intervention increased from 9.0% in 2016 to 21.5% in 2021. Of 1,560 surgical patients, PDF was more common (68.3%), followed by ADF (18.0%) and APDF (8.7%). ADF had the shortest time to treatment (0.8 ± 2.1 days, p < 0.001), shortest hospital stay (6.0 ± 7.5 days, p < 0.001), and lowest costs ($147,525 ± 137,728, p < 0.001). APDF had the longest hospital stay (9.4 ± 10.6 days, p < 0.001) and highest costs ($361,124 ± 345,692, p < 0.001). Neurologic complications were highest in APDF (14.1% vs. 3.9%, p < 0.001), while ADF had higher dysphagia/aspiration pneumonia rates (35.6% vs. 10.6%, p < 0.001). ADF patients were more likely to be discharged home (55.9% vs. 26.7% PDF, p < 0.001), whereas PDF and APDF patients were more often discharged to skilled nursing/rehabilitation facilities. Independent predictors for PDF included older age (OR: 1.02, p < 0.01) and thoracic spine pathology (OR: 9.31–18.48, p < 0.05).

CONCLUSION

Surgical approach in DISH patients influences outcomes. ADF demonstrates advantages in recovery and costs but increases dysphagia risk. Awareness of surgical risks can improve patient selection and outcomes.