Postoperative complications, length of stay, and discharge disposition following single-level anterior lumbar interbody fusion in elderly and octogenarian patients.

BACKGROUND

Anterior lumbar interbody fusion (ALIF) has become a widely accepted treatment for degenerative lumbar spine pathologies, with increasing prevalence due to its effectiveness in restoring lumbar lordosis and improving spinal balance. This study aims to evaluate postoperative complications, length of stay (LOS), and discharge disposition following ALIF across different age groups.

METHODS

A total of 92,800 weighted cases of patients aged 50 and older underwent single-level ALIF in the National Inpatient Sample (NIS) from 2016 to 2020. Patients were stratified into age cohorts (50-64, 65-79, 80+). Exclusions were made for non-elective cases and missing data on key variables. Primary outcomes included postoperative complications (anemia, DVT, myocardial infarction, stroke, acute kidney injury, sepsis, anesthesia-related complications), LOS, and discharge disposition. Statistical comparisons between age groups were conducted using chi-square tests with a Bonferroni correction. Significance was set at P < 0.005.

RESULTS

The study identified significant variations in outcomes across age groups. The mean age differed significantly (P < 0.001). Older patients had higher rates of comorbidities and complications, with acute post-hemorrhagic anemia being most prevalent in the 65-79 group (16.78 %) and sepsis more common in the 80+ group (0.90 %). The LOS increased with age (P < 0.001), and total admission charges were highest in the 65-79 age group (P = 0.004). Routine discharge rates decreased significantly with age, while non-routine discharges increased (P < 0.001).

CONCLUSION

Age significantly influences postoperative outcomes following ALIF. Patients aged 65 and older are at increased risk for various complications, longer hospital stays, and non-routine discharges. These findings highlight the need for tailored perioperative care and robust discharge planning to improve outcomes for elderly patients undergoing ALIF. As with all retrospective database studies, this analysis is limited by potential coding inaccuracies and the absence of granular clinical details within the NIS.