Effects of Underlying Liver Disease on 30-Day Outcomes After Posterior Lumbar Fusion

Objective: To examine the effects of underlying liver disease on 30-day postoperative complications after elective posterior lumbar fusion (PLF). Methods: We performed a retrospective American College of Surgeons National Surgical Quality Improvement Program study of patients who had undergone elective PLF from 2011 to 2014. The patients were divided into 2 groups stratified by the presence of liver disease, assessed using the Model for End-stage Liver Disease plus sodium score (liver disease, ≥10; no liver disease, <10). The baseline patient and operative characteristics were compared between the 2 groups using univariate analysis. Subsequent multivariate regression analysis adjusted for differences in baseline characteristics was performed to identify 30-day postoperative complications independently associated with liver disease. Results: Of 2965 patients, 55.9% had underlying liver disease. Those with liver disease were more frequently aged >65 years, male, and underweight or overweight and had had American Society of Anesthesiologists class ≥3, diabetes, pulmonary comorbidity, cardiac comorbidity, renal comorbidity, bleeding disorder, preoperative dyspnea at rest, and a prolonged operative time. On univariate analysis, patients with liver disease had a greater incidence of cardiac complications, pulmonary complications, renal complications, blood transfusion, sepsis, urinary tract infection, and prolonged hospitalization. On adjusted multivariate regression analysis, liver disease was independently associated with renal complications, pulmonary complications, sepsis, urinary tract infection, prolonged hospitalization, and blood transfusion. Conclusions: As the long-term survival of patients with liver disease continues to increase, a better understanding of the relationship between liver dysfunction and surgical outcomes is needed. The identification of modifiable risk factors would allow them to be addressed and optimized preoperatively to decrease the incidence and severity of complications and improve patient outcomes after PLF.