National trends in postoperative complications for lumbar spinal fusion from 2009 to 2022

Although posterior lumbar fusions (PLFs) have risen in popularity due to minimally invasive techniques and favorable outcomes, complications still arise. Studies show relatively constant rates of postoperative complications from 2006 to 2016, but there are limited studies evaluating outcomes after 2016. Consequently, we aim to investigate trends in postoperative complications for PLFs from 2009 to 2022.

The American College of Surgeons National Surgical Quality Improvement Program was queried for single-level PLFs between 2006 and 2022. Patients between 2006 and 2008 were excluded due to limited sample size. Inclusion criteria included >18 years old and Current Procedural Terminology code 22612. Baseline demographics and comorbidities were recorded. Annual 30-day complication rates of wound infection, readmission, reoperation, length of stay, intraoperative blood transfusions (IBTs), and mortality were recorded. Analysis of variance and multivariable Poisson log-linear regression were performed to compare complication rates between years and outcomes between 2020-2022 and 2017-2019.

Wound infection rates declined from 3.7% in 2009 to 2.7% in 2019, with an increase to 3.0% by 2022 (P = 0.015). IBT decreased significantly, from 20.58% in 2010 to 9.40% in 2022 (P < 0.001). Sepsis rates fell from 2.15% in 2009 to 0.88% in 2022 (P = 0.017). The average length of stay decreased from 2009 to 2019 (P < 0.001). Wound infection (P = 0.006) and pneumonia (P = 0.039) rates significantly increased between 2020 and 2022.

Rates of older age, diabetes, and hypertension increased among PLF patients between 2009 and 2022, while most complication rates remained constant. Rates of wound infection, IBT, sepsis, and average length of stay have improved since 2009 despite an increase in wound infection and pneumonia from 2020 to 2022.