Impact of Preoperative Osteoporosis on Postoperative Complications and Implant Outcomes Following Degenerative Disease Spine Surgery: A Propensity-Matched Cohort Study

Introduction: Osteoporosis, a condition marked by decreased bone density, may adversely impact outcomes in degenerative spine deformity surgery due to compromised bone quality. This study evaluates 90-day major medical complications and 2-year implant-related outcomes in patients with preoperative osteoporosis undergoing spine deformity correction.

Methods: This retrospective cohort analysis utilized a multi-institutional database of 8,476 patients (4,238 per group) identified through CPT and ICD-10 codes. Patients with documented osteoporosis within three months before surgery were matched 1:1 with controls without osteoporosis based on demographics, comorbidities, and surgical characteristics. Primary outcomes included 90-day postoperative complications and 2-year implant-related outcomes.

Results: Following matching, both cohorts showed similar baseline characteristics. The osteoporosis group had significantly higher rates of 90-day complications, including deep vein thrombosis (1.9% vs. 1.1%, RR=1.77, p=0.002), stroke (1.9% vs. 1.1%, RR=1.69, p=0.003), readmission (24.7% vs. 17.0%, RR=1.46, p< 0.001), pneumonia (3.8% vs. 1.6%, RR=2.41, p< 0.001), transfusion (10.3% vs. 5.2%, RR=1.98, p< 0.001), and renal failure (4.0% vs. 2.8%, RR=1.41, p=0.003). Increased emergency department visits (13.7% vs. 11.3%, RR=1.22, p=0.001) and wound complications (6.4% vs. 4.8%, RR=1.34, p=0.001) were also noted in the osteoporosis group.

Conclusion : Preoperative osteoporosis is associated with higher rates of 90-day complications, including thromboembolic events, infections, and readmissions, following degenerative spine deformity surgery. These findings underscore the need for preoperative optimization in patients with osteoporosis to potentially improve postoperative outcomes and implant stability.