(SLC-014) Clinical and Economic Burden Associated with Dural Tears Among Patients Undergoing Spinal Fusion: A Retrospective Database Analysis

Background: A dural tear can manifest either inadvertently during various surgeries, especially those involving the spine, or deliberately during brain-related procedures like craniotomy. When dural tears lead to cerebrospinal fluid leakage, they can trigger potentially grave complications, including the development of hydrocephalus, meningitis and pseudomeningoceles.

Objectives: To estimate the incremental economic and clinical burden of dural tears among patients undergoing spinal fusion with evidence of dural repair with dural sealant and dural substitute using a large US healthcare database.

Methods: Retrospective analysis of hospital data from the PINC AITM Healthcare Database (PHD). Included patients aged ≥18 years and had an inpatient hospital encounter for spinal fusion between 10/1/2015-03/31/2023 (first=index). Patients were also required to have evidence of dural sealant and dural substitute use on the day of the procedure and their hospital must continue to contribute data to the PHD for at least 60 days post-discharge. Patients were grouped by presence vs. absence of a composite measure of one of the following complications: cerebrospinal fluid leak, hydrocephalus, meningitis, pseudomeningocele. Outcomes included intensive care unit (ICU) days, postoperative length of stay (LOS), total index hospital costs, and all-cause 30- and 60-day readmission. Generalized linear models were used to examine the association of complications with the outcomes, accounting for hospital-level clustering and adjusting for patient demographics and clinical characteristics, procedural, and hospital/provider characteristics.

Results: A total of 3,371 subjects were included for study: 57.5% females, 79.1% white, mean age of 64.9 (SD=12.2) years. A complication at index occurred in 7.2% and was associated with significant incremental increases in days spent in ICU (1.7 days, p< 0.001, 2.5 vs. 0.8 days), incremental LOS (3.3 days, p< 0.001, 9.2 vs. 5.9 days), and incremental total hospital costs ($14,252, p< 0.001, $66,913 vs. $52,661). Complications at index also significantly increased the risk of being readmitted at 30 days by 2.3 times (22.7% vs. 9.8%) and at 60 days by 2.4 times (26.1% vs. 11.0%), both p< 0.001.

Conclusions: This analysis demonstrates that dural tear complications resulting from spinal fusion were associated with substantial patient clinical and economic burden despite resource intensive intervention, suggesting an unmet need for more effective means of dural tear repair.