by Elizabeth Hofheinz, M.P.H., M.Ed.
While many outcomes have been explored as far as lumbar fusion, until now, there has been no data on how Hepatitis C virus affects outcomes. A new retrospective review has examined in-hospital lengths of stay (LOS), post-operative complications, readmission rates or costs following primary posterior lumbar fusions.
Co-author Alexander Vaccaro, M.D., Ph.D. is President of the Rothman Orthopaedic Institute in Philadelphia. He told OSN, “Although many people have Hepatitis C virus [HCV], the effect of this condition has not been previously explored in the setting of lumbar spinal disease.”
Indeed, approximately 7 million people in the U.S. have HCV.1
Using a national database, the authors examined data from patients (with Medicare) who had primary lumbar spine fusion for degenerative lumbar pathology from 2005-2014. HCV patients were matched with non-HCV patients using patient demographics, treatment modality, and comorbid conditions (congestive heart failure, diabetes mellitus, hypertension, osteoporosis, and rheumatoid arthritis). Individuals with active liver disease were excluded.
Dr. Vaccaro: “We had nearly 29,000 patients in the final group, with the data showing that those with HCV had a significantly higher chance of: requiring a blood transfusion, contracting pneumonia, respiratory failure, urinary tract infections, wound-/implant-related infections, cerebrovascular events, or any 90-day postop complication.”
And the difference in resources used?
“Those patients with HCV had higher surgery costs ($28,713.26 vs. $25,448.26) and 90-day costs. However, we found no difference for patients with HCV compared to those without the infection as far as LOS (10-days versus 8-days) and rates of a 90-day readmission (0.37% versus 0.22%).”
A patient counseling tool…
“When patients tell surgeons their comorbidities and HCV is one of them, now surgeons can say, ‘Because of your HCV history, while you will be better off than if we do nothing, your outcomes won’t be superior to someone who has never had this infection.’ Then they can discuss that person’s specific risks and benefits in detail. Although the ideal situation is when a HCV patient can be preoperatively optimized via various measures, such treatment is incredibly expensive.”