Complications After Anterior Lumbar Interbody Fusion in Patients with Prior Abdominal Surgery

Study Design. Retrospective cohort study Objective. To investigate the association between postoperative complications after ALIF and prior abdominal surgery. Summary of Background Data. Anterior lumbar interbody fusion (ALIF) is a common spinal surgery associated with a variety of complications. Previous abdominal surgery is thought to influence the rate at which these postoperative complications occur. Methods. Using PearlDiver, patients were identified who had undergone an ALIF from 2010 to 2024. Patients were separated based on surgical history (cesarean section, non-obstetric abdominal surgery, any abdominal surgery or no prior abdominal surgery). Complications were measured (30 d, 90 d, 1 y). Univariate and multivariate logistic regression were performed. Significance was set at P <0.05. Results. Among 1,123,841 ALIF patients, complications occurred in 2.6% at 30 days, 3.5% at 90 days, and 5.4% at 1 year. On unadjusted analysis, prior non-obstetric abdominal surgery (ABD) or any abdominal surgery (ANYABD) more than doubled complication risk (1-year OR 2.3, 95% CI 2.2–2.4; P <0.0001), while cesarean section (CSEC) showed no significant increase (OR 1.16, 95% CI 0.99–1.35; P =0.07). After adjusting for age, sex, and comorbidities, no significant differences remained. Comorbidity burden (ECI) emerged as the strongest predictor (OR 1.08, 95% CI 1.07–1.09; P <0.0001). Conclusions. While complications after ALIF are not uncommon, prior studies have suggested a higher risk among patients with a history of abdominal surgery. While raw complication rates appear significantly higher in patients with prior abdominal surgery, these differences become nonsignificant once comorbidity burden is adjusted for. Our findings demonstrate that prior abdominal surgery itself does not independently increase postoperative complications, rather, patients with prior abdominal operations tend to have a greater comorbidity burden, which likely explains their higher unadjusted complication rates.