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

Study Design: Retrospective cohort study. Objective: To determine if membership in a high-risk subgroup is predictive of morbidity and mortality following anterior lumbar fusion (ALF). Methods: 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. Results: Members of the elderly (≥65 years) (OR = 1.3, P =.02) and non-Caucasian (black, Hispanic, other) (OR = 1.7, P <.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, P =.005), and wound complications (OR = 1.8, P =.024) compared with nonobese patients. Emergent procedures had a significantly increased risk for LOS ≥5 days (OR = 4.9, P =.021), sepsis (OR = 14.8, P =.018), and reoperation (OR = 13.4, P <.0001) compared with nonemergent procedures. Disseminated cancer was an independent risk factor for operative time ≥4 hours (OR = 8.4, P <.0001), LOS ≥5 days (OR = 15.2, P <.0001), pulmonary complications (OR = 7.4, P =.019), and postoperative blood transfusion (OR = 3.1, P =.040). Conclusions: 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.