Donald MacElroy, BS: No financial relationships to disclose
Introduction: Recent re-evaluation of the Women’s Health Initiative Hormone Therapy Trials has established that hormone replacement therapy (HRT) can be beneficial for patients, if begun shortly after menopause. With increasing amounts of postmenopausal women receiving HRT, it is important to consider the implications of this population of patients undergoing spinal fusion surgery. The current study examines the demographics, perioperative complications, and clinical outcomes of postmenopausal patients receiving HRT who undergo posterior spinal fusion surgery.
Methods: The National (Nationwide) Inpatient Sample was queried from 2016-2020 using International Classification of Diseases (10th Edition) codes for postmenopausal women undergoing posterior lumbar fusion. HRT for postmenopausal symptoms was defined using ICD-10 procedure codes. Demographic characteristics were evaluated via unmatched analysis. Spinal fusion complications and clinical outcomes were evaluated for HRT versus non-HRT patients following 1:1 propensity score matching (PSM).
Results: Of the total 135,340 postmenopausal patients who underwent posterior lumbar spinal fusion, 1,540 were receiving HRT. Following unmatched analysis, HRT patients were more likely to have private insurance (29.7% vs. 21.7%, p < 0.001), be of white race (85.2% vs. 79.2%, p < 0.001), and have routine discharge (65.6% vs. 50.6% < 0.001). After 1:1 PSM resulting in 1,540 HRT patients and 1,540 non-HRT controls, HRT patients continued to have higher likelihood of routine discharge (65.6% vs. 54.5%, OR: 1.588, 95% CI: 1.373, 1.836) and lower likelihood of transfer to a skilled nursing facility (16.2% vs. 21.1%, OR: 0.725, 95% CI: 0.604, 0.870). There were no significant differences found in incidence of osteoporosis, pseudoarthrosis, length of stay, DVT, PE and MI.
Conclusion : Women receiving HRT did not have significantly increased risk of perioperative complications during spinal fusion surgery. HRT showed mild protective effects in several outcome measures. This study supports the notion that HRT is a viable treatment option for vasomotor symptoms and osteoporosis in postmenopausal women, and enhances spine surgeons' understanding of the management of this patient population. Our findings support the compatibility of HRT with successful perioperative outcomes.