• Kevin G Liu, Andy T Ton, Michael Brown, Kevin Mertz, Siddharth Patel, Hannah Shelby, Brandon Gettleman, Jonathan M Ragheb, Emily S Mills, Jeffrey C Wang, Raymond J Hah, and Ram K Alluri.
• Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA.
• World Neurosurg. 2024 Oct 1; 190: e435e442e435-e442.

ObjectiveThe present study compares postoperative outcomes between patients with and without sickle cell disease (SCD) undergoing 1-to 3-level lumbar spinal fusion for degenerative pathologies.MethodsPatients who underwent 1-to 3-level lumbar spinal fusion for degenerative pathologies from 2010 to 2021 were identified using the PearlDiver database. Patients were separated into 1) SCD and 2) non-SCD groups and were propensity-matched 1:1 for age, sex, Elixhauser Comorbidity Index, surgical approach, and various comorbidities. Complications were separately analyzed by single- and multilevel procedures using chi-squared and Mann-Whitney U testing.ResultsPropensity-score matching identified 1934 SCD and non-SCD patients who underwent single-level fusion and 2094 SCD and non-SCD patients who underwent multilevel fusion. Across single-level fusions, those with SCD had a significantly higher risk of neurovascular compromise (P < 0.001), venous thromboembolism (P = 0.004), pneumonia (P = 0.032), urinary tract infections (P = 0.001), and greater postoperative opioid usage out to 12 months (P = 0.018). Across multilevel fusions, SCD carried higher risk for neurovascular compromise (P < 0.001), pneumonia (P = 0.010), and urinary tract infections (P < 0.001). All SCD patients had significantly higher opioid use at 1 month (P = 0.001) and at 6 months (P = 0.009) postoperatively.ConclusionsPatients with SCD undergoing lumbar spinal fusion demonstrate higher risks for coagulopathic, ischemic, and infectious-related complications, as well as long-term postoperative opioid use. Awareness of the unique complication profile in SCD patients may help guide surgeons in refining perioperative management strategies to optimize outcomes in patients with SCD.Copyright © 2024 Elsevier Inc. All rights reserved.

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