Thirty-Day Complications Following Anterior Lumbar Interbody Fusion Versus Lumbar Disc Arthroplasty: A Propensity Score Matched Analysis

The anterior lumbar interbody fusion (ALIF) and lumbar disc arthroplasty (LDA) procedures are both commonly performed to improve the quality of life and pain in people with lower back pain. However, few recent studies have compared 30-day complications on a large scale. The objectives of this study were to compare the 30-day complications seen after ALIF and LDA and identify risk factors for these complications. The National Surgical Quality Improvement Program (NSQIP) database was queried between the years 2012–2021 (10 years in total) for records of patients who underwent either ALIF or LDA as a primary procedure. Patients in each group underwent a 1:1 propensity match for age, gender, BMI, ASA status, diabetes mellitus (DM), hypertension requiring medication, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), inpatient/outpatient status, smoking status, and bleeding disorders. Bivariate and multivariate analyses were performed to determine significant differences in complications and risk factors between these cohorts. A total of 1218 propensity-matched subjects, with 609 receiving ALIF and 609 receiving LDA, were included in the analyses of this study. The incidence of extended length of stay (LOS) (>4 days) was higher in the ALIF cohort compared to the LDA cohort (14.6% vs. 4.76%, p < 0.001). Multivariate analysis demonstrated that subjects who underwent LDA had lower odds (Odds Ratio [OR]: 0.457; 95% Confidence Interval [CI]: 0.283–0.738, p = 0.001) of experiencing extended LOS compared to the ALIF cohort. Longer operative times increased the odds of prolonged LOS in both cohorts. The results of this study suggest that ALIF is associated with longer LOS than LDA when baseline demographic data are controlled. Further, longer operative times increase the odds that subjects receiving either ALIF or LDA will experience a prolonged LOS. Besides extended LOS, ALIF and LDA produce a relatively similar 30-day complication profile.