Early Postoperative Adverse Events Following Multi-Level Posterior Segmental Spinal Instrumentation: A Decade-Spanning Retrospective Analysis.
retrospective_cohort · Level III
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- Also identified by DOI 10.1016/j.wneu.2026.125025.
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Abstract
Multi-level posterior segmental spinal instrumentation procedures have increased considerably in recent decades; however, short-term findings remain incompletely generalized. Therefore, this study investigates 30-day outcomes following these procedures to better highlight profiles and associations. The ACS-NSQIP database (2014-2023) was queried for patients undergoing multi-level posterior segmental instrumentation. Cases with missing variables or select complexity-increasing add-ons were excluded. A composite any adverse event (AAE) variable was examined, alongside various other complication subgroupings. Statistics included descriptive transformations, multivariable logistic regressions, and threshold analyses, where appropriate. A total of 1348 patients were included (mean age=60±14; body mass index=31±7 kg/m<sup>2</sup>; 49% male; 83% medium-length constructs [3-6 levels]; 14% long [7-12]; 3% very long [13+]). AAE occurred in 24%: major in 21%, minor in 5%, and infection-related in 5%. Age (odds ratio [OR]=1.019), male sex (OR=0.694), disseminated cancer (OR=2.628), admission-to-operation interval (OR=1.033), and operative time (OR=1.005) were independently associated with AAE (all p<0.05). Relative to medium constructs, long (OR=2.081) and very long (OR=6.981) fixations showed progressively greater AAE odds (all p<0.05). Threshold analysis identified an admission-to-operation cutoff of 1 day (76<sup>th</sup> percentile), with AAE rate increasing from 20% below to 34% above (Benjamini-Hochberg corrected p<0.001). Similarly, operative time greater than 286 minutes (73<sup>rd</sup> percentile) corresponded to increased AAE odds (corrected p<0.001), rising from 16% below to 42% above. In this decade-spanning analysis, multi-level posterior segmental spinal instrumentation demonstrated meaningful short-term complication rates. Targeted preoperative counseling and facilitation of timely operative intervention may be warranted, and future studies should further evaluate these associations.