%0 Journal Article
%T High-Risk Subgroup Membership Is a Predictor of 30-Day Morbidity Following Anterior Lumbar Fusion.
%A Bronheim RS
%A Kim JS
%A Di Capua J
%A Lee NJ
%A Kothari P
%A Somani S
%A Phan K
%A Cho SK
%J Global Spine J
%V 7
%N 8
%D Dec 2017
%M 29238640
%F 2.23
%R 10.1177/2192568217696691
%X <B>METHODS: </B>Retrospective cohort study.<BR><B>OBJECTIVE: </B>To determine if membership in a high-risk subgroup is predictive of morbidity and mortality following anterior lumbar fusion (ALF).<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.