The impact of post-polio syndrome on outcomes following lumbar fusion

Study Design: Retrospective cohort study. Objective: The goal of this study was to analyze the rates of postoperative medical and surgical complications and health care utilization in patients with post-polio syndrome (PPS) undergoing lumbar fusion surgery. Summary of Background Data: Patients with post-polio syndrome (PPS) are often older and thus have a higher incidence of degenerative spine disease. Previous research has suggested that patients with PPS may be at increased risk of complications after surgery. To date, there is a paucity of data on the impact of PPS on outcomes after spinal fusion. Methods: Using the PearlDiver database, patients diagnosed with PPS and who underwent single-level lumbar fusion from 2010 to 2022 were identified and matched in a 1:4 ratio to controls based on age, sex, and relevant baseline comorbidities. A multivariate logistic regression, controlling for significant baseline comorbidity differences, was employed to evaluate for differences in outcomes between the PPS and control groups. Outcomes assessed included 90-day medical complications, 90-day ED visits/inpatient readmissions, and 2-year surgical complications, including implant failure and the need for revision. Results: Patients with PPS experienced significantly higher rates of postoperative complications, including arrhythmia (OR=2.32, P <0.001), pneumonia (OR=4.89, P =0.002), UTI (OR=2.18, P =0.005), instrumentation failure (OR=3.50, P =0.004), and need for revision surgery (OR=2.92, P =0.001). In addition, patients with PPS demonstrated increased rates of postoperative health care utilization, including ED visits (OR=2.51, P <0.001) and inpatient readmissions (OR=4.80, P <0.001). Conclusions: Patients with PPS are at heightened risk of both medical and surgical postoperative complications after undergoing lumbar fusion. Similarly, patients with PPS also had increased rates of postoperative health care utilization, including visits to the ED and hospital readmission. These results may assist spine surgeons in appropriate preoperative counseling of patients with PPS and explore mitigation strategies in the perioperative setting.