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Updated: Jul 13, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Incidence and Related Risk Factors of Pulmonary Complications After Spinal Fusion Surgery: A Retrospective Nationwide
Yue Wang1, Yu-Dong Liao2, Yuheng Zhang1
1Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Background:
Postoperative pulmonary complications (PPCs) are common surgical complications and have a significant cost impact. However, the incidence, risk factors, and cost burden of US health care associated with PPCs after spine fusion surgery have not been comprehensively analyzed through large national databases.
Methods:
A retrospective analysis utilized the Nationwide Inpatient Sample (NIS) database from 2010 to 2019. Adult patients (≥18 years) undergoing spinal fusion were identified via ICD-9-CM/ICD-10-CM procedural codes. PPCs-defined as pneumonia, acute respiratory failure (ARF), pulmonary embolism, or pulmonary edema-were identified by diagnostic codes. Multivariate and stratified logistic regression analyses examined overall and subtype-specific risk factors.
Results:
Among 812,609 patients, 17,121 (2.11%) developed PPCs, including 9,591 (1.18%) with ARF, 7,376 (0.91%) with pneumonia, 2,159 (0.27%) with pulmonary embolism, and 553 (0.07%) with pulmonary edema. The overall PPCs' rate increased from 2014 to 2019, driven primarily by rising ARF incidence. Patients with PPCs had longer hospital stays (9 vs. 3 days), higher total charges ($197,994 vs. $85,233), and greater in-hospital mortality (5.82% vs. 0.08%, all P < 0.001). Multivariate analysis identified advanced age (≥75: OR = 1.86), multiple comorbidities (OR = 10.98), pulmonary circulation disorders (OR = 11.38), continuous trauma ventilation (OR = 13.34), and septicemia (OR = 14.34) as high-risk factors. Stratified analyses revealed distinct risk profiles: impaired pulmonary reserve and frailty were associated with pneumonia and ARF; venous thromboembolism risk factors with pulmonary embolism; and cardiac, renal, and fluid-related disorders with pulmonary edema. Protective factors included female sex (OR = 0.70), elective admission (OR = 0.32), lumbar fusion (OR = 0.76), and private insurance (OR = 0.89).
Conclusion:
PPCs after spinal fusion are increasing, primarily due to rising ARF rates. These complications exhibit clinically distinct risk profiles that support subtype-specific assessment and individualized prevention strategies targeting pulmonary reserve, thromboembolic risk, and cardiopulmonary vulnerability.