Outcomes following single level posterior lumbar fusion in patients with systemic and discoid lupus: A retrospective national database study

Background context: Posterior lumbar fusion (PLF) is a common procedure, for which patients with systemic conditions may be considered. Autoimmune conditions, such as lupus are 1 such class of conditions and include systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). Purpose: To characterize outcomes following single-level PLF in patients with SLE and DLE. Study Design/Setting: Retrospective study Patient Sample: Adult patients without and with SLE or DLE who underwent single-level PLF with or without interbody fusion from 2010 to 2021 Q1 PearlDiver Database were identified and separately matched 4:1 based on age, sex and Elixhauser Comorbidity Index. Exclusion criteria included: age < 18 years, recent history of infection, neoplasm, or trauma, as well as database inactivity within 90 days postoperatively. Outcome Measures: Ninety-day postoperative adverse events and readmission rates Methods: Univariable analyses and multivariable logistic regression of postoperative adverse events and readmission rates. Results: Overall, 191,765 patients who underwent PLF between 2010 and 2021 Q1 and met inclusion criteria were identified, of which 2,068 (1.1%) had a diagnosis of SLE and 242 (0.1%) had a diagnosis of DLE. On multivariable analysis of the matched populations, patients with SLE were at most increased odds of 90-day (in decreasing ORs): pneumonia (OR 4.45), urinary tract infection (OR 4.24), minor adverse events (OR 3.17), all adverse events (OR 2.78), deep vein thrombosis (OR 2.71), acute kidney injury (OR 2.62), transfusion (OR 2.08), pulmonary embolism (OR 1.98), sepsis (OR 1.66), surgical site infection (OR 1.29) (p<.0033 for all). Patients with SLE were not at increased odds of 90-day re-admissions or wound dehiscence (p>.0033 for both). On multivariable analysis, patients with DLE were only at increased odds of 90-day all adverse events (OR 1.83) and minor adverse events (OR 1.77) (p<.0033 for all). Conclusions: The current study examined the largest to our knowledge cohort of SLE and DLE patients undergoing PLF. Patients with these conditions were at greater odds of several perioperative adverse outcomes.