North American Spine Society journal · 2026
Impact of solid organ transplant on postoperative outcomes following lumbar spine fusion surgery: A propensity-matched retrospective cohort analysis.
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Bui Vu, Yoon Kevin, Quan Theodore, Bellaire Christopher P, Japa Jonathan P, Ehioghae Mark, Mesfin Addisu
Аннотация
BACKGROUND: SOT recipients represent a complex and vulnerable population. The physiologic effects of chronic immunosuppression may predispose these patients to adverse postoperative events, yet large-scale analyses of lumbar spine fusion outcomes in this group remain limited.
METHODS: Adults over 18 years of age who underwent lumbar spine fusion between 2015 and 2024 were identified through procedural coding in the TriNetX database. Patients with a history of SOT were matched 1:1 to non-transplant controls based on baseline demographics and comorbidities. Postoperative complications were evaluated using statistical tools integrated within the database.
RESULTS: After 1:1 propensity score matching, each cohort included 408 patients. At 90 days, SOT patients had higher odds of wound dehiscence (OR 2.33, 95% CI 1.17-4.67), emergency department utilization (OR 1.86, 95% CI 1.26-2.74), and overall medical complications (OR 1.98, 95% CI 1.18-3.30) compared to matched non-SOT controls. At 1 year, transplant recipients had increased rates of reoperation (OR 2.2, CI 1.055-4.59) and pseudoarthrosis (OR 1.76, CI 1.38-2.58).
CONCLUSIONS: Increased morbidity associated with SOT was reflected by the higher risk for medical complications and wound complications in the short term. Long-term physiologic changes secondary to long-term immunosuppressive therapy were also represented by long-term surgical complications. Our findings highlight a need for a tailored, interdisciplinary approach for surgical planning and postoperative care for this high-risk patient population.
METHODS: Adults over 18 years of age who underwent lumbar spine fusion between 2015 and 2024 were identified through procedural coding in the TriNetX database. Patients with a history of SOT were matched 1:1 to non-transplant controls based on baseline demographics and comorbidities. Postoperative complications were evaluated using statistical tools integrated within the database.
RESULTS: After 1:1 propensity score matching, each cohort included 408 patients. At 90 days, SOT patients had higher odds of wound dehiscence (OR 2.33, 95% CI 1.17-4.67), emergency department utilization (OR 1.86, 95% CI 1.26-2.74), and overall medical complications (OR 1.98, 95% CI 1.18-3.30) compared to matched non-SOT controls. At 1 year, transplant recipients had increased rates of reoperation (OR 2.2, CI 1.055-4.59) and pseudoarthrosis (OR 1.76, CI 1.38-2.58).
CONCLUSIONS: Increased morbidity associated with SOT was reflected by the higher risk for medical complications and wound complications in the short term. Long-term physiologic changes secondary to long-term immunosuppressive therapy were also represented by long-term surgical complications. Our findings highlight a need for a tailored, interdisciplinary approach for surgical planning and postoperative care for this high-risk patient population.