Long-term aspirin use and perioperative outcomes in lumbar interbody fusion: a population-based study using US national inpatient sample database.

Abstract

To evaluate the impact of long-term aspirin use (L-AU) on perioperative outcomes in Lumbar interbody fusion (LIF) using the US National Inpatient Sample (NIS) database. Data from 485,224 LIF patients (2010-2019) were extracted from the NIS. A 1:1 propensity score matching (PSM) was performed to balance baseline characteristics between L-AU and non-L-AU groups. Multivariate logistic regression was used to compare complication risks and healthcare economic indicators. Despite a higher baseline comorbidity burden in the L-AU group, PSM-adjusted analysis revealed that L-AU significantly increased the risk of acute cerebrovascular events (aOR = 1.334, 95% CI 1.201-1.481, P < 0.001) and was associated with prolonged hospitalization. However, L-AU significantly reduced the risk of prosthetic-related complications (uOR = 0.595, P < 0.001) and orthopedic device-related complications (uOR = 0.682, P < 0.001). Healthcare economic analysis showed that L-AU increased hospitalization costs by $181 (P < 0.001) but shortened length of stay by 0.07 days (P < 0.001). L-AU exhibits a dual effect in the perioperative period of LIF, potentially increasing cerebrovascular risk while reducing implant-related complications through anti-inflammatory mechanisms.