OBJECTIVES

Proximal junction failure (PJF) is a serious post-operative complication of multi-level spinal surgery. PJF can lead to additional complications such as pain and reoperations, making it a costly complication. Furthermore, there are few cohort studies that evaluate PJF in non-academic hospital settings. This study aims to describe the incidence and risk factors of PJF in an integrated delivery network (IDN) of community hospitals.

METHODS

Through data partnership with Mercy Technology Services, adult patients who underwent multi-level thoracic and/or lumbar spine fusion surgery were extracted from 2011-2018 Mercy electronic health records (EHR), which is one of the comprehensive real-world databases including preoperative and intraoperative information. Occurrence of PJF 24 months after fusion was collected from the EHR using natural language processing. Kaplan-Meier curves for overall cohort and by surgical anatomy, were generated. To evaluate risk factors for PJF, cox proportional hazard models were fitted with anatomy and patient characteristics as covariates.

RESULTS

Of the 585 patients included for analysis, 45 (7.7%) experienced PJF within 24-months of the index fusion surgery. The incidence of PJF for “thoracic or lumbar” group was 5.5% (23/414) versus 12.9% for thoracolumbar group (22/171). Compared to patients without PJF (n=540, 92.3%), after covariate adjustment, significant risk factors for PJF were fusion surgeries spanning the thoracolumbar spine (adjusted Hazard Ratio (aHR), 2.35,95% Confidence Interval (CI),1.30-4.25; p-0.005) and older age (aHR,1.02,95% CI,0.998-1.05; p-0.068). No significant association between higher BMI (aHR,0.999,95% CI,0.991-1.01, p-0.86), and osteoporosis (aHR,1.29,95% CI,0.60-2.76, p-0.51) were observed with PJF.

CONCLUSIONS

The observed 24-month incidence of PJF in an IDN setting is 7.7%. Spinal fusion surgeries spanning both the thoracic and lumbar regions were significantly associated with a higher incidence of PJF. Further investigations with a larger cohort size are needed to appropriately identify potential risk factors for PJF.