High-Risk Subgroup Membership Is a Predictor of 30-Day Morbidity Following Anterior Lumbar Fusion.

Abstract

Retrospective cohort study. To determine if membership in a high-risk subgroup is predictive of morbidity and mortality following anterior lumbar fusion (ALF). The American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify patients undergoing ALF between 2010 and 2014. Multivariate analysis was utilized to identify high-risk subgroup membership as an independent predictor of postoperative complications. Members of the elderly (≥65 years) (OR = 1.3, <i>P</i> = .02) and non-Caucasian (black, Hispanic, other) (OR = 1.7, <i>P</i> < .0001) subgroups were at greater risk for a LOS ≥5 days. Obese patients (≥30 kg/m² ) were at greater risk for an operative time ≥4 hours (OR = 1.3, <i>P</i> = .005), and wound complications (OR = 1.8, <i>P</i> = .024) compared with nonobese patients. Emergent procedures had a significantly increased risk for LOS ≥5 days (OR = 4.9, <i>P</i> = .021), sepsis (OR = 14.8, <i>P</i> = .018), and reoperation (OR = 13.4, <i>P</i> < .0001) compared with nonemergent procedures. Disseminated cancer was an independent risk factor for operative time ≥4 hours (OR = 8.4, <i>P</i> < .0001), LOS ≥5 days (OR = 15.2, <i>P</i> < .0001), pulmonary complications (OR = 7.4, <i>P</i> = .019), and postoperative blood transfusion (OR = 3.1, <i>P</i> = .040). High-risk subgroup membership is an independent risk factor for morbidity following ALF. These groups should be targets for aggressive preoperative optimization, and quality improvement initiatives.