Risk Factors for Medical and Surgical Complications Following Single-Level ALIF

Winward Choy, Nikki Barrington, Roxanna M. Garcia, Robert B. Kim, Heron Rodriguez, Sandi Lam, Nader Dahdaleh, Zachary Adam Smith*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Study Design: Retrospective cohort study. Objective: The objective of the study was to determine rates of medical and surgical postoperative complications following anterior lumbar interbody fusion (ALIF) along with their associated predictors. Methods: Using the American College of Surgeons National Surgical Quality Improvement database, patients who underwent single-level ALIF surgery from 2006 to 2013 were identified. The 30-day rate of postoperative medical and surgical complications along with associated risk factors were evaluated by multivariable logistic regression. Results: In total, 1474 patients were included in the analysis. The overall rate of complications was 14.5%. The medical complication rate was 12.7%, while the surgical complication rate was 2.8%. Predictors of surgical complications were diabetes (odds ratio [OR] = 2.79, 95% CI = 1.20-6.01, P =.009), corticosteroid dependence (OR = 4.94, 95% CI = 1.73-14.08, P =.003), and preoperative transfusion of >4 units (OR = 7.12, 95% CI = 1.43-35.37, P =.016). Predictors of medical complications were longer operative times (OR = 4.25, 95% CI = 2.90-6.24, P <.001), preoperative anemia (OR = 2.29, 95% CI = 1.50-3.50, P <.001), >10% weight loss prior to surgery (OR = 6.79, 95% CI = 1.01-45.93, P =.049), and more severe American Society of Anesthesiologists classification (OR = 2.18, 95% CI = 1.54-3.11, P <.001). Conclusions: The present study determines postoperative medical and surgical complications among patients undergoing ALIF. The risk factors elucidated in this study indicate that clinical practices to curtail complications should be targeted toward patients with preoperative anemia, weight loss, corticosteroid dependence, and toward those at risk for perioperative transfusions.

Original languageEnglish (US)
Pages (from-to)141-147
Number of pages7
JournalGlobal Spine Journal
Issue number2
StatePublished - Apr 1 2017


  • ALIF
  • anterior lumbar interbody fusion
  • complication
  • morbidity
  • spine

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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