{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:40:07Z","timestamp":1788219607862,"version":"build-2803163510"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify factors associated with delayed reoperation following cervical and lumbar fusion and characterize long-term healthcare utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients undergoing cervical or lumbar fusion for degenerative pathology within the PearlDiver Mariner 170 dataset were identified using ICD-10 and CPT codes. Delayed reoperation was assessed using narrow and broad definitions at 2-, 5-, and 10-year follow-up. Kaplan-Meier survivorship analysis and multivariable Cox proportional hazards modeling were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 286,398 cervical and 175,874 lumbar fusion patients met inclusion criteria for the 2-year cohort. By 10 years, narrow delayed reoperation occurred in 11.16% of cervical fusion patients and 14.07% of lumbar fusion patients (p&lt;0.001), while broad delayed reoperation occurred in 14.67% and 17.1%, respectively (p&lt;0.001). Fusion construct length demonstrated the largest observed association with delayed reoperation across cervical and lumbar cohorts. Three-or-more level cervical fusion was associated with a nearly tenfold increase in reoperation risk (HR 9.62, p&lt;0.001), while three-or-more level lumbar fusion demonstrated the highest risk among lumbar constructs (HR 3.79, p&lt;0.001). Lumbar fusion patients demonstrated significantly greater postoperative complication rates and cumulative healthcare utilization burden (p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Delayed reoperation accumulates progressively following cervical and lumbar fusion and is associated with substantial long-term healthcare burden. Across all analyses, fusion construct length was consistently associated with increased risk of delayed reoperation, exceeding the influence of traditional patient-specific risk factors. These findings highlight construct length as a critical determinant of long-term surgical burden and may improve patient counseling, risk stratification, and operative decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261481451","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T10:14:26Z","timestamp":1787220866000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Fusion Construct Length is Associated With Increased Risk of Delayed Reoperation Following Cervical and Lumbar Fusion"],"prefix":"10.1177","author":[{"given":"Roman","family":"Rahmani","sequence":"first","affiliation":[{"name":"Hoag Orthopedics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6507-5326","authenticated-orcid":false,"given":"Evan R.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Hoag Orthopedics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0518-6729","authenticated-orcid":false,"given":"Zachary T.","family":"Mills","sequence":"additional","affiliation":[{"name":"Hoag Orthopedics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunter","family":"Hitchens","sequence":"additional","affiliation":[{"name":"Hoag Orthopedics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon I.","family":"White","sequence":"additional","affiliation":[{"name":"Hoag Orthopedic Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey","family":"Slattery","sequence":"additional","affiliation":[{"name":"Hoag Orthopedic Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vance","family":"Gardner","sequence":"additional","affiliation":[{"name":"Hoag Orthopedics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Smith","sequence":"additional","affiliation":[{"name":"Hoag Orthopedic Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xnsj.2023.100305"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199904000-00009"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e318232d4f2"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.4103\/jcvjs.JCVJS_10_20"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2015.11.SPINE15700"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.01.013"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4469-5"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.11.SPINE12226"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B6.31149"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2025.10.002"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2016.10.013"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2025.07.032"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2023.12.008"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261481451","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682261481451","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261481451","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T12:20:24Z","timestamp":1787401224000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682261481451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":14,"alternative-id":["10.1177\/21925682261481451"],"URL":"https:\/\/doi.org\/10.1177\/21925682261481451","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"article-number":"21925682261481451"}}