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Incidence and Risk Factors for Gastrointestinal Hemorrhage After Lumbar Fusion

Fineberg, Steven J. MD*; Kurd, Mark F. MD*; Patel, Alpesh A. MD, FACS; Singh, Kern MD*

doi: 10.1097/BRS.0b013e318298768d

Study Design. Retrospective database analysis.

Objective. To determine rates of gastrointestinal (GI) hemorrhage after lumbar fusions, a population-based database was analyzed to identify incidence, mortality, and risk factors associated with anterior (ALF), posterior (PLF), and simultaneous anterior/posterior (APLF) lumbar fusions.

Summary of Background Data. GI hemorrhage after lumbar surgery is a rare complication that can have devastating consequences. Incidences of GI bleeding after lumbar fusion are not well characterized in the current literature.

Methods. Data from the Nationwide Inpatient Sample were obtained from 2002 to 2009. Patients undergoing ALF, PLF, and APLF for degenerative pathologies were identified and the incidence of GI hemorrhage was evaluated. Patient demographics, Charlson Comorbidity Index, length of stay, costs, and mortality were assessed. SPSS version 20 (IBM; Armonk, NY) was used to detect statistical differences between groups and perform logistic regression analyses to identify independent predictors of GI bleeding. A P value of <0.001 denoted significance.

Results. A total of 220,522 lumbar fusions were identified in the United States from 2002 to 2009. Of these, 19,762 were ALFs, 182,801 were PLFs, and 17,959 were APLFs. GI bleeding was noted in ALFs, with 1.1 events per 1000 cases, PLFs with 1.4 events, and APLFs with 1.7 events. Patients with GI bleeding demonstrated greater Charlson Comorbidity Index scores, length of stay, costs, and mortality (P < 0.001). Logistic regression analysis demonstrated independent predictors of GI hemorrhage including advanced age (>65 yr), male sex, blood loss anemia, fluid/electrolyte disorders, metastatic neoplasm, and weight loss (P < 0.001).

Conclusion. The results of our study demonstrate very low complication rates of GI hemorrhage across ALFs, PLFs, and APLF cohorts. Across all surgical procedures, the presence of GI bleeding complications was associated with greater comorbidity, length of stay, cost, and mortality. We strongly advise physicians to perform stringent perioperative assessments of risk factors and to provide prompt medical attention to minimize the impact of GI bleeding complications.

Level of Evidence: 3

A population-based database was analyzed to determine the incidence of in-hospital development of gastrointestinal hemorrhage from 2002 to 2009 in lumbar fusion surgical procedures. Demographic characteristics were examined to identify patients at increased risk for gastrointestinal bleeding. GI hemorrhage was associated with significant increases in hospitalizations, costs, and mortality.

*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and

Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Chicago, IL 60612; E-mail:

Acknowledgment date: March 15, 2013. First revision date: April 16, 2013. Acceptance date: April 20, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties and stock/stock options. Dr. Kern Singh is the editor in chief of the journal of Contemporary Spine Surgery (LWW).

© 2013 by Lippincott Williams & Wilkins