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Incidence and risk factors for gastrointestinal hemorrhage after lumbar fusion

Steven J Fineberg1, Mark F Kurd, Alpesh A Patel

  • 1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

Spine
|May 2, 2013
PubMed

Insights

Gastrointestinal hemorrhage after lumbar fusion is rare, with low incidence across anterior, posterior, and combined approaches. However, bleeding complications are linked to increased comorbidity, longer hospital stays, higher costs, and greater mortality.

Area of Science:

  • Spine surgery
  • Gastroenterology
  • Surgical complications

Background:

  • Gastrointestinal (GI) hemorrhage is a rare but serious complication following lumbar fusion surgery.
  • Current literature lacks comprehensive data on the incidence and risk factors of GI bleeding after various lumbar fusion techniques.

Purpose of the Study:

  • To determine the incidence, mortality, and risk factors of GI hemorrhage after anterior lumbar fusion (ALF), posterior lumbar fusion (PLF), and anterior/posterior lumbar fusion (APLF).

Main Methods:

  • Retrospective analysis of the Nationwide Inpatient Sample database (2002-2009).
  • Identification of patients undergoing ALF, PLF, and APLF for degenerative conditions.
  • Evaluation of GI hemorrhage incidence, patient demographics, comorbidities, length of stay, costs, and mortality using logistic regression analysis.

Main Results:

  • A total of 220,522 lumbar fusions were analyzed, with GI bleeding incidence of 1.1/1000 for ALF, 1.4/1000 for PLF, and 1.7/1000 for APLF.
  • Patients experiencing GI bleeding had significantly higher Charlson Comorbidity Index scores, longer hospital stays, increased costs, and higher mortality (P < 0.001).
  • Independent predictors for GI hemorrhage included advanced age, male sex, anemia, fluid/electrolyte disorders, metastatic neoplasm, and weight loss (P < 0.001).

Conclusions:

  • Lumbar fusion procedures (ALF, PLF, APLF) are associated with very low rates of GI hemorrhage.
  • GI bleeding complications correlate with increased comorbidity, resource utilization, and mortality.
  • Physicians should conduct thorough perioperative risk assessments and provide prompt management for potential GI bleeding.
Abstract

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