{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:35:23Z","timestamp":1789799723282,"version":"4.0.1"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The etiology of lumbar spine revision surgery is multifactorial, involving mechanical, biological, and clinical factors that challenge sustained spinal stability. Comparative analysis reveals significantly higher complication rates, prolonged hospital stays, and increased costs for revision surgeries compared to primary fusions, despite low mortality rates. Leveraging a comprehensive dataset of 456,750 patients, this study identifies predictors of revision surgery and provides actionable insights to enhance patient outcomes and optimize healthcare resource allocation. Methods: A total of 456,750 patients registered in the National Inpatient Sample (NIS) database from 2016 to 2019 were identified as having undergone single-level lumbar fusion surgery (primary fusion: 99.5%; revision fusion: 0.5%). Multivariable logistic regression models adjusted for patient demographics, clinical comorbidities, and hospital characteristics were constructed to evaluate clinical outcomes and postoperative complications. Results: Patients undergoing revision lumbar fusion surgery were significantly younger compared to those undergoing primary fusion procedures (53.92 \u00b1 20.65 vs. 61.87 \u00b1 12.32 years, p &lt; 0.001); among the entire cohort, 56.4% were women. Compared with patients undergoing primary lumbar fusion, those undergoing revision fusion surgery were significantly more likely to experience surgical site infections (odds ratio [OR] 27.10; 95% confidence interval [95% CI] 17.12\u201342.90; p &lt; 0.001), urinary tract infections (OR 2.15; 95% CI 1.39\u20133.33; p &lt; 0.001), and prolonged length of stay (OR 1.53; 95% CI 1.24\u20131.89; p &lt; 0.001). Revision surgery patients had significantly lower odds of incurring high-end hospital charges (OR 0.65; 95% CI 0.51\u20130.83; p &lt; 0.001). Other complications, including respiratory complications, dural tears, thromboembolic events, and acute renal failure, showed no statistically significant differences between the two groups. In-hospital mortality rates were low and did not differ significantly between groups (revision: 0.2% vs. primary: 0.1%, OR 3.29; 95% CI 0.45\u201323.84; p = 0.23). Conclusions: Patients undergoing revision lumbar fusion surgeries face significantly higher risks of surgical site infections, urinary tract infections, and prolonged hospital stays compared to primary fusion procedures. These findings highlight the need for targeted interventions to improve perioperative management and reduce complications in revision lumbar fusion surgery.<\/jats:p>","DOI":"10.3390\/jcm14030723","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T05:49:54Z","timestamp":1737611394000},"page":"723","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparative Analysis of Primary and Revision Single-Level Lumbar Fusion Surgeries: Predictors, Outcomes, and Clinical Implications Using Big Data"],"prefix":"10.3390","volume":"14","author":[{"given":"Assil","family":"Mahamid","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Hillel Yaffe Medical Center, Hadera 3820302, Israel"},{"name":"Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fairoz","family":"Jayyusi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hillel Yaffe Medical Center, Hadera 3820302, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marah","family":"Hodruj","sequence":"additional","affiliation":[{"name":"Bnai-Zion Medical Center, Haifa 3339419, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Mansour","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hillel Yaffe Medical Center, Hadera 3820302, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Fishman","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hillel Yaffe Medical Center, Hadera 3820302, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8319-0182","authenticated-orcid":false,"given":"Eyal","family":"Behrbalk","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hillel Yaffe Medical Center, Hadera 3820302, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"B36","DOI":"10.1097\/BRS.0000000000000463","article-title":"Unanticipated Revision Surgery in Adult Spinal Deformity: An Experience With 815 Cases at One Institution","volume":"39","author":"Zhu","year":"2014","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/BRS.0b013e3181c91180","article-title":"Revision Rates Following Primary Adult Spinal Deformity Surgery: Six Hundred Forty-Three Consecutive Patients Followed-up to Twenty-Two Years Postoperative","volume":"35","author":"Pichelmann","year":"2010","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.spinee.2022.08.018","article-title":"Revision lumbar fusions have higher rates of reoperation and result in worse clinical outcomes compared to primary lumbar fusions","volume":"23","author":"Lambrechts","year":"2023","journal-title":"Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1016\/j.spinee.2024.04.013","article-title":"Risk factors of revision operation and early revision for adjacent segment degeneration after lumbar fusion surgery: A case-control study","volume":"24","author":"Park","year":"2024","journal-title":"Spine J."},{"key":"ref_5","first-page":"476","article-title":"5-Year Revision Rates After Elective Multilevel Lumbar\/Thoracolumbar Instrumented Fusions in Older Patients: An Analysis of State Databases","volume":"30","author":"Cummins","year":"2022","journal-title":"J. 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