Thirty-day readmission rate and risk factors for patients undergoing single level elective anterior lumbar interbody fusion (ALIF)

• Overall 30-day readmission rate following anterior lumbar interbody fusion (ALIF) was 5.19%.
• Poor post-operative pain control and surgical site infections were the most common readmission reasons.
• Severe chronic obstructive airways disease, post-operative pneumonia, and postoperative superficial surgical site infection were predictors of readmission.

Anterior lumbar interbody fusion (ALIF) represents a common interbody fusion technique and is advantageous given reduced risk of damage to the paraspinal muscles, posterior ligaments, and neural elements. In this study, we identified the readmission rate, common causes, and risk factors associated with single level ALIF 30-day readmission. Patients who underwent elective single level ALIF surgery from 2011 to 2013 were identified in the American College of Surgeons–National Surgical Quality Improvement Program (ACS–NSQIP) database. Segmental fusion, emergency, and trauma cases were excluded. A total of 2,042 patients were identified from the ACS-NSQIP database from 2011 to 2013. The proportion of patients readmitted was 5.19% (106/2,042) and approximately 59.81% (64/106) had a reportable cause. The top three causes were poor post-operative pain control (11%), deep (9%) and superficial (9%) surgical site infections. Risk factors associated with 30-day readmission included age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.00–1.03, p value = 0.05), history of severe chronic obstructive pulmonary disease (COPD), (OR = 2.11, 95% CI: 0.95–4.70, p value = 0.08), post-operative pneumonia (OR = 6.58, 95% CI: 2.36–18.30, p value < 0.001), and presence of superficial surgical site infection (OR = 11.68, 95% CI: 4.88–27.95, p value < 0.001). Bleeding disorders, anemia, and perioperative blood loss was not associated with 30-day readmission. Limitations include retrospective level 3 data, and missing data. This study represents the first nation-wide descriptive evaluation of 30-day readmission causes and risk factors for patients undergoing an ALIF procedure.