Anterior Lumbar Spinal Fusion Remains a Safe Surgical Option with Low Perioperative Morbidity and Mortality: Analysis of the US National Inpatient Sample (NIS)

The purpose of this study was to examine the patient characteristics, morbidity and mortality of patients undergoing anterior lumbar interbody fusion (ALIF) from 2005 to 2013 in the United States utilizing a National Data-base. Patients undergoing elective lumbar fusion surgery via an anterior approach were identified by the International Classification for Diseases, Ninth Revision (ICD-9-CM) code. Demographics and frequencies of complications and mortality were recorded and analyzed from data gathered prior to patient discharge following the index procedure. A total of 27,912 patients were identified, representing an estimated 137,928 of weighted patients who underwent primary anterior lumbar spine fusion procedures. Patients undergoing ALIF had a mean age of 54.3 (SD ± 14.1) with 56.3% being female patients. The majority of patients were white (82.2%), privately insured (50.4%), had a median household income of $48,000−62,999 (27.1%) and had a Charlson Comorbidity Index (CCI) score of 0.44 (SD ± 0.8). The majority of procedures were performed in the South region of the U.S. (39.5%), in nonteaching hospitals (54.5%), in hospitals that were private/not-for-profit (70.4%). The overall complications rate was 4.7% and the mortality rate was 0.2% for the procedure. The most common complications were durotomy (1.2%) followed by cardiac complications (0.7%), hematomas (0.7%), DVT (0.6%) and infections (0.6%). Neurologic complications rates were 0.4% and PE was the lowest reported complication observed in the study at 0.1%. This study showed that ALIF has low complication and mortality rate making it a safe and viable surgical option in the management of various lumbar pathologies.