Assessment of Postoperative Complications, Length of Stay, and Discharge Outcomes Following Single-Level Anterior Lumbar Interbody Fusion in Elderly and Octogenarian Patients

Introduction: 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 1) postoperative complications, 2) length of stay (LOS), and 3) discharge disposition following ALIF across different age groups.

Methods: Data from the National Inpatient Sample (NIS) from 2016 to 2020 were analyzed to study patients aged 50 and older undergoing single-level ALIF, identified by ICD-10 code 0SG00A0. Non-elective cases and those with missing key demographic and clinical data were excluded. Variables such as age, sex, length of stay (LOS), hospital characteristics, and comorbidities were collected. The primary outcomes included postoperative complications, LOS, total charges, and discharge disposition. Statistical analyses were performed using R, with chi-square tests for group comparisons and Bonferroni correction applied, setting significance at 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 impacts postoperative outcomes following ALIF, with patients aged 65 and older facing higher risks of complications, longer hospital stays, and non-routine discharges. These findings underscore the importance of tailored perioperative care and effective discharge planning for elderly patients.