Introduction: Compared to other lumbar fixation techniques, anterior lumbar interbody fusion (ALIF) carries a unique and complication profile. There have been very few significant multicenter studies evaluating short term postoperative complications following ALIF procedures. The present study aims to establish rates of surgical and medical complications following single-level ALIF, and identify key predictors of medical and surgical complications utilizing the large, multi-center and validated database.
Methods: Using the American College of Surgeons National Surgical Quality Improvement (ACS NSQIP) database, patients who underwent single level anterior lumbar interbody fusion surgery from 2006 to 2013 were identified. The 30-day rate of postoperative medical and surgical complications along with associated risk factors were evaluated by multivariable logistic regression.
Results: In total, 1474 patients were included in the analysis. The overall rate of complications was 14.5%. The medical complication rate was 12.7% while the surgical complication rate was 2.6%. Predictors of surgical complications were diabetes (HR 2.66, 95% CI: 1.20-5.90, p =0.016), corticosteroid dependence (HR 3.94, 95% CI: 1.26-12.32, p =0.018), and preoperative transfusion of > 4 units (HR 7.60, 95% CI: 1.54-37.37, p =0.013). Predictors of medical complications were longer operative times (HR 4.25, 95% CI: 2.90-6.24, p < 0.001), preoperative anemia (HR 2.29, 95% CI: 1.50-3.50, p <0.001), >10% weight loss prior to surgery (HR 6.79, 95% CI: 1.01-45.93, p = 0.049), and more severe ASA classification (HR 2.18, 95% CI: 1.54-3.11, p < 0.001)
Conclusions: The present study determines postoperative medical and surgical complications among patients undergoing ALIF. The risk factors elucidated in this study indicate that clinical practices to curtail complications should be targeted toward patients with preoperative anemia, weight loss, corticosteroid dependence, and toward those at risk for perioperative transfusions.
Patient Care: ALIF is associated with a unique complication profile as compared to other approaches that do not require anterior access. The present study establishes rates of surgical and medical complications following single level ALIF based on large multicenter data. Importantly, the data elaborates on key risk factors to better identify high risk patients to minimize preventable morbidity and mortality
Learning Objectives: By the conclusion of this session, participants should be able to: 1) identify rate of complications following ALIF, 2) identify risk factors for medial and surgical postoperative morbidity following ALIF