Prior Abdominal Surgery Is Associated With an Increased Risk of Postoperative Complications After Anterior Lumbar Interbody Fusion

Spine ◽  
2014 ◽  
Vol 39 (10) ◽  
pp. E650-E656 ◽  
Author(s):  
Polina Osler ◽  
Sang D. Kim ◽  
Kathryn A. Hess ◽  
Philippe Phan ◽  
Andrew K. Simpson ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Increased Risk

scholarly journals 1044 Impact of Obesity on Complications from Anterior Lumbar Interbody Fusion

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Feeley ◽  
I Feeley ◽  
J Butler
Keyword(s):  
Back Pain ◽  
Postoperative Complications ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Risk Profile ◽  
Anterior Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Patient Cohort ◽  
Increased Risk

Abstract Aim Anterior Lumbar Interbody Fusion is a procedure growing in popularity for conditions including degenerative disc disease, and discogenic back pain. Obesity is a significant risk factor in the development of back pain, with patients with raised BMIs at increased of complications using the posterior approach. This review aims to evaluate the risk profile of this patient cohort using the anterior approach for lumbar interbody fusion. Method A systematic review of the search databases Pubmed; google scholar; and OVID Medline was carried out between September 2020-November 2020. Studies evaluating the risks associated with obesity during Anterior Lumbar Interbody Fusion (ALIF) were identified and included for review according to PRISMA guidelines. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications in patients with increased BMI during ALIF. Results Search terms yielded 435 articles for evaluation. 13 studies were included in this review after applying inclusion and exclusion criteria. Meta-analysis of studies demonstrated a significantly increased risk profile for overall complications in the obese patient cohort (CI = 0.04-0.16, p = 0.002) with significant heterogeneity (I2=86%). Patients with increased BMI were not significantly more likely to develop Vascular complications (CI= -.03-0.02, p = 0.62). Simple pooling demonstrated significant association between increased BMI and blood loss. Conclusions Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs.

scholarly journals The impact of obesity on perioperative complications in patients undergoing anterior lumbar interbody fusion

2020 ◽  
Vol 33 (3) ◽  
pp. 332-341
Author(s):  
Michael M. Safaee ◽  
Alexander Tenorio ◽  
Joseph A. Osorio ◽  
Winward Choy ◽  
Dominic Amara ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Anterior Lumbar Interbody Fusion ◽  
Wound Complications ◽  
Obese Patients ◽  
Lumbar Interbody Fusion ◽  
Increased Risk ◽  
The Mean

OBJECTIVEAnterior approaches to the lumbar spine provide wide exposure that facilitates placement of large grafts with high fusion rates. There are limited data on the effects of obesity on perioperative complications.METHODSData from consecutive patients undergoing anterior lumbar interbody fusion (ALIF) from 2007 to 2016 at a single academic center were analyzed. The primary outcome was any perioperative complication. Complications were divided into those occurring intraoperatively and those occurring postoperatively. Multivariate logistic regression was used to assess the association of obesity and other variables with these complications. An estimation table was used to identify a body mass index (BMI) threshold associated with increased risk of postoperative complication.RESULTSA total of 938 patients were identified, and the mean age was 57 years; 511 were females (54.5%). The mean BMI was 28.7 kg/m2, with 354 (37.7%) patients classified as obese (BMI ≥ 30 kg/m2). Forty patients (4.3%) underwent a lateral transthoracic approach, while the remaining 898 (95.7%) underwent a transabdominal retroperitoneal approach. Among patients undergoing transabdominal retroperitoneal ALIF, complication rates were higher for obese patients than for nonobese patients (37.0% vs 28.7%, p = 0.010), a difference that was driven primarily by postoperative complications (36.1% vs 26.0%, p = 0.001) rather than intraoperative complications (3.2% vs 4.3%, p = 0.416). Obese patients had higher rates of ileus (11.7% vs 7.2%, p = 0.020), wound complications (11.4% vs 3.4%, p < 0.001), and urinary tract infections (UTI) (5.0% vs 2.5%, p = 0.049). In a multivariate model, age, obesity, and number of ALIF levels fused were associated with an increased risk of postoperative complication. An estimation table including 19 candidate cut-points, odds ratios, and adjusted p values found a BMI ≥ 31 kg/m2 to have the highest association with postoperative complication (p = 0.012).CONCLUSIONSObesity is associated with increased postoperative complications in ALIF, including ileus, wound complications, and UTI. ALIF is a safe and effective procedure. However, patients with a BMI ≥ 31 kg/m2 should be counseled on their increased risks and warrant careful preoperative medical optimization and close monitoring in the postoperative setting.

scholarly journals 1046 Anterior Lumbar Interbody Fusion Approaches: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Feeley ◽  
I Feeley ◽  
K Clesham ◽  
J Butler
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Transperitoneal Approach ◽  
Ovid Medline ◽  
Vessel Injury ◽  
Hospital Stays

Abstract Aim Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal; transperitoneal; open; and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. We aim to elucidate the comparative rates of complications across approach type. Method A systematic review of the search databases Pubmed; google scholar; and OVID Medline was made in November 2020 to identify studies related to complications associated with anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications with ALIF for each approach. Results 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of Retrograde Ejaculation (RE) (p &lt; 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI=-0.04-0.07). Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). Conclusions Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intra- and postoperative complications, although confounders including use of BMP and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays, however its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.

scholarly journals Predictors of inpatient admission in the setting of anterior lumbar interbody fusion: a Minimally Invasive Spine Study Group (MISSG) investigation

2020 ◽  
Vol 33 (4) ◽  
pp. 446-454
Author(s):  
James M. Parrish ◽  
Nathaniel W. Jenkins ◽  
Michael T. Nolte ◽  
Dustin H. Massel ◽  
Nadia M. Hrynewycz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Regression Model ◽  
Preoperative Diagnosis ◽  
Interbody Fusion ◽  
Ambulatory Surgery ◽  
Anterior Lumbar Interbody Fusion ◽  
Inpatient Stay ◽  
Lumbar Interbody Fusion ◽  
Single Level

OBJECTIVEWhile the anterior lumbar interbody fusion (ALIF) procedure may be amenable to ambulatory surgery, it has been hypothesized that limitations such as the risk of postoperative ileus and vascular complications have hindered transition of this procedure to the outpatient setting. Identification of independent risk factors predisposing patients to inpatient stays of ≥ 24 hours after ALIF may facilitate better postsurgical outcomes, target modifiable risk factors, and assist in the development of screening tools to transition appropriate patients to the ambulatory surgery center (ASC) setting for this procedure. The purpose of this study was to identify the most relevant risk factors that predispose patients to ≥ 24-hour admission following ALIF.METHODSA prospectively maintained surgical registry was reviewed for patients undergoing single ALIF between May 2006 and December 2019. Demographics, preoperative diagnosis, perioperative variables, and postoperative complications were evaluated according to their relative risk (RR) elevation for an inpatient stay of ≥ 24 hours. A Poisson regression model was used to evaluate predictors of inpatient stays of ≥ 24 hours. Risk factors for inpatient admission of ≥ 24 hours were identified with a stepwise backward regression model.RESULTSA total of 111 patients underwent single-level ALIF (50.9% female and 52.6% male, ≤ 50 years old). Eleven (9.5%) patients were discharged in < 24 hours and 116 remained admitted for ≥ 24 hours. The average inpatient stay was > 2 days (53.7 hours). The most common postoperative complications were fever (body temperature ≥ 100.4°F; n = 4, 3.5%) and blood transfusions (n = 4, 3.5%). Bivariate analysis revealed a preoperative diagnosis of retrolisthesis or lateral listhesis to elevate the RR for an inpatient stay of ≥ 24 hours (RR 1.11, p = 0.001, both diagnoses). Stepwise multivariate analysis demonstrated significant predictors for inpatient stays of ≥ 24 hours to be an operation on L4–5, coexisting degenerative disc disease (DDD) with foraminal stenosis, and herniated nucleus pulposus (RR 1.11, 95% CI 1.03–1.20, p = 0.009, all covariates).CONCLUSIONSThis study provides data regarding the incidence of demographic and perioperative characteristics and postoperative complications as they pertain to patients undergoing single-level ALIF. This preliminary investigation identified the most relevant risk factors to be considered before appropriately transitioning ALIF procedures to the ASC. Further studies of preoperative characteristics are needed to elucidate ideal ASC ALIF patients.

scholarly journals Preoperative Nutritional Status as a Risk Factor for Major Postoperative Complications Following Anterior Lumbar Interbody Fusion

2018 ◽  
Vol 8 (7) ◽  
pp. 662-667 ◽  
Author(s):  
Chierika O. Ukogu ◽  
Samantha Jacobs ◽  
Willliam A. Ranson ◽  
Sulaiman Somani ◽  
Luilly Vargas ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Serum Albumin ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Preoperative Serum ◽  
Poor Nutritional Status

Study Design: Retrospective study. Objectives: To determine rates of medical and surgical postoperative complications in adults with hypoalbuminemia undergoing anterior lumbar interbody fusion (ALIF). Methods: This was a retrospective analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database of patients (≥18 years old) undergoing ALIF procedures, identified by CPT (Current Procedural Terminology) code from 2011 to 2014. Poor nutritional status was defined by a preoperative serum albumin level <3.5 g/dL, and albumin levels above this were considered normal. Multivariate logistic regression models were utilized to assess preoperative risk factors including nutritional status as predictors of specific postoperative complications. Significance was defined as P < .05 and odds ratios (ORs) were calculated with a 95% confidence interval (CI). This model was used to determine the strength of nutritional status as an adjusted predictor of adverse postoperative events. Results: There were 3184 ALIF cases, including 1,275 (40%) of which had preoperative serum albumin levels. 53 (4.15%) patients were classified as having poor nutrition status. Poor preoperative nutritional status was shown to be a strong independent predictor of length of stay ≥5 days (OR = 2.56, 95% CI 1.43-4.59, P = .002), urinary tract infection (OR = 5.93, 95% CI 2.11-16.68, P = .001), and sepsis (OR = 5.35, 95% CI 1.13-25.42, P = .035) compared to patients with normal preoperative serum albumin levels. Conclusions: Our analysis shows that patients with poor nutritional status before ALIF are independently at risk for sepsis as well as increased length of stay and urinary tract infection.

scholarly journals Perioperative Complications in Obese Patients Undergoing Anterior Lumbar Interbody Fusion: Results From 938 Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael Safaee ◽  
Alexander Tenorio ◽  
Dominic Amara ◽  
Lillian Lai ◽  
Annette Molinaro ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Anterior Lumbar Interbody Fusion ◽  
Wound Complications ◽  
Close Monitoring ◽  
Obese Patients ◽  
Lumbar Interbody Fusion ◽  
Nonobese Patients

Abstract INTRODUCTION Anterior lumbar interbody fusion (ALIF) is a versatile procedure with a role in the treatment of diverse lumbar pathologies. There are limited data on the effect of body mass index (BMI) and obesity on perioperative complications using this technique. METHODS Patients undergoing ALIF from 2007 to 2016 at a single academic center were analyzed. Obesity was defined as BMI = 30. The primary outcome was any perioperative complication, classified as intraoperative or postoperative. Intraoperative complications included vascular injury, visceral/bowel injury, and medical/cardiac. Postoperative complications included neurologic deficit, hematoma, wound complications (dehiscence, hernia, infection), ileus, and medical complications including deep venous thrombosis, urinary tract infection (UTI), pneumonia, and others. Univariate and multivariate analyses were used to assess potential associations with obesity and perioperative complications. RESULTS A total of 938 patients were included with mean age of 57 yr and 511 females (55%). Mean BMI was 28.7 with 354 (38%) of patients classified as obese. Complication rates were higher for obese vs nonobese patients (38.4% vs 30.5%, P = .013), a difference that was driven primarily by postoperative complications (37.6% vs 27.7%, P = .002) rather than intraoperative complications (3.4% vs 4.6%, P = .359). Obese patients had significantly higher rates of ileus (12.1% vs 7.0%, P = .008), wound-related complications (12.7% vs 4.8%, P < .001), and UTI (5.1% vs 2.4%, P = .028). In a multivariate model, age and obesity were associated with postoperative complications. CONCLUSION Obesity is associated with increased perioperative complications in ALIF. Interestingly, the rate of intraoperative complications was similar to nonobese patients. The increased complication rate was driven primarily by immediate postoperative complications including ileus, wound complications, and UTI. Obese patients warrant careful preoperative medical optimization and close monitoring in the postoperative setting.

The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

2020 ◽  
pp. 1-10
Author(s):  
Dominic Amara ◽  
Praveen V. Mummaneni ◽  
Shane Burch ◽  
Vedat Deviren ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Secondary Analysis ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

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