The impact of hypercoagulable states on perioperative complications in patients undergoing cervical spinal fusion: a retrospective nationwide inpatient sample database study

Hypercoagulable states (HCS) have been demonstrated to confer an elevated risk of complications such as thromboembolism following arthroplasty procedures; however, their influence on perioperative outcomes in cervical spinal fusion (CF) remains unclear. This study aims to determine the impact of hypercoagulable states on perioperative complications, healthcare resource utilization, and in-hospital mortality in patients undergoing cervical spinal fusion surgery. Adult inpatients undergoing cervical fusion between 2013 and 2022 were retrospectively identified from the National Inpatient Sample (NIS) database. Hypercoagulable states were ascertained via validated ICD-9-CM/ICD-10 diagnostic codes. Propensity-score matching (PSM) was employed to mitigate confounding factors. Primary endpoints encompassed medical and surgical complications, length of stay (LOS), total charges, and mortality. Univariate and multivariate logistic regression analyses were fitted to evaluate the association between hypercoagulable states and each outcome. All outcomes were identified using ICD codes and represent coded inpatient events from an administrative database, not clinically adjudicated complications. For pre-PSM analyses, complex-samples procedures were applied to account for NIS discharge weights and hospital-level clustering, ensuring nationally representative estimates. Post-PSM analyses were unweighted and estimate associations within the matched analytic sample, not nationally weighted population-average effects. Among 333,922 patients undergoing cervical fusion surgery, 1115 (prevalence 0.33%) were documented with hypercoagulable state. Multivariate analysis after propensity-score matching demonstrated that hypercoagulable states were significantly associated with deep vein thrombosis (aOR = 3.944), pulmonary embolism (aOR = 2.918), acute hemorrhagic anemia (aOR = 1.436), respiratory failure (aOR = 1.539), and blood transfusion (aOR = 2.044) in the matched cohort. Correspondingly, patients harboring hypercoagulable states exhibited a significantly prolonged LOS (aOR 1.687) and augmented aggregate hospitalization expenditures (aOR = 1.567). There was no statistically significant difference in in-hospital mortality between cohorts. This nationwide inpatient sample analysis demonstrates that hypercoagulable states are associated with a significantly elevated risk of coded perioperative complications and increased resource utilization in patients undergoing cervical fusion. Given the administrative nature of the NIS database, the identification of hypercoagulable states relies on ICD codes, which may introduce classification bias and limit causal inference. Future prospective studies incorporating standardized coagulation assessments are warranted to validate these findings and guide clinical interventions.