Legal blindness as a risk factor for complications and prolonged hospitalization after spinal fusion

Legally blind patients represent a vulnerable group who may face barriers to safe mobility, postoperative rehabilitation, and discharge planning. There is limited evidence describing perioperative course during spinal fusion surgery in this population. This study aimed to evaluate the association between legal blindness, operative complications and discharge disposition in patients undergoing cervical or lumbar spinal fusion.

The National Inpatient Sample was queried from 2016 to 2021, identifying adult hospitalizations for cervical or lumbar spinal fusion using ICD-10 procedure codes. The primary exposure was legal blindness (ICD-10-CM: H54.8). Outcomes included: major medical complications, non-home discharge and extended length of stay (>3 days). Survey-weighted logistic regression was used to evaluate associations between legal blindness and complications.

Among 338,578 hospitalizations for cervical or lumbar spinal fusion that met our inclusion criteria, 315 involved legally blind patients. In multivariate analysis adjusting for demographics, comorbidities and hospital level covariates, legal blindness was independently associated with higher odds of major medical complications (aOR 1.58, 95 % CI 1.08-2.32), non-home discharge (aOR 2.57, 95 % CI 1.98-3.32), and extended length of stay (aOR 1.67, 95 % CI 1.31-2.12).

Legal blindness is independently associated with increased major medical complications, extended hospital stays and higher rates of non-home discharge following spinal fusion procedures. These findings highlight the importance of recognizing visual impairment as a marker of perioperative vulnerability in the context of spinal fusion surgery and highlight the need for targeted perioperative strategies to support this underrepresented population.