Assessing Risk of Anterior Exposure for Anterior Lumbar Interbody Fusion in Obese Patients

Maura Walsh; Rachel Drgastin; Cade Habel; Ali Oran; Matthew McIntyre; Jesse J Liu; Rhusheet Patel; Timothy Liem; Enjae Jung

doi:10.1016/j.jss.2025.06.031

Assessing Risk of Anterior Exposure for Anterior Lumbar Interbody Fusion in Obese Patients

J Surg Res. 2025 Jul 8:313:11-17. doi: 10.1016/j.jss.2025.06.031. Online ahead of print.

Authors

Maura Walsh¹, Rachel Drgastin², Cade Habel², Ali Oran³, Matthew McIntyre⁴, Jesse J Liu⁵, Rhusheet Patel⁶, Timothy Liem⁷, Enjae Jung⁸

Affiliations

¹ Department of Surgery, General Surgery Resident at Oregon Health & Sciences University, Portland, Oregon. Electronic address: walshma@ohsu.edu.
² Medical Student at Oregon Health & Sciences University School of Medicine, Portland, Oregon.
³ Department of Surgery, Senior Biostatistician at Oregon Health & Sciences University, Portland, Oregon.
⁴ Department of Neurosurgery, Neurosurgery Resident at Oregon Health & Sciences University, Portland, Oregon.
⁵ Division of Skull Base and Cerebrovascular, Assistant Professor of Neurological Surgery at Oregon Health & Sciences, Portland, Oregon.
⁶ Division of Vascular Surgery, Assistant Professor of Surgery at Oregon Health & Sciences University, Portland, Oregon.
⁷ Division of Vascular Surgery, Professor of Surgery at Oregon Health & Sciences University, Portland, Oregon.
⁸ Division of Vascular Surgery, Associate Professor of Surgery at Oregon Health & Sciences University, Portland, Oregon.

PMID: 40633431
DOI: 10.1016/j.jss.2025.06.031

Abstract

Introduction: Though obesity is common in patients undergoing anterior lumbar interbody fusion (ALIF), complications in those with BMI ≥30 kg/m² are incompletely characterized. This retrospective study of ALIF patients aims to establish predictors of perioperative complications relating to anterior exposure. Our hypothesis was that obesity would be associated with increased rates of intraoperative and postoperative complications.

Methods: We retrospectively reviewed patients who underwent ALIF from 2013 to 2023 at our institution, excluding patients with age <18 y, incalculable body mass index (BMI), or revision ALIF. The primary end point was perioperative complications (intraoperative injury, wound infection, wound dehiscence, hernia, deep venous thrombosis/pulmonary embolism, ileus, new neurologic deficit, and mortality). Secondary end points included length of stay, need for reoperation, and 30-d readmission rates. Regression (univariate and multivariate) analyses were conducted to compare patients with BMI ≥30 kg/m² versus BMI <30 kg/m².

Results: Of 478 patients, 230 (48.1%) had BMI <30 kg/m². BMI ≥30 kg/m² was associated with an increased risk of anterior wound complication (odds ratio (OR): 3.45, 95% confidence interval (CI): 1.39, 9.84, P = 0.0012). In addition, BMI 30-35 kg/m² and BMI ≥40 kg/m² were associated with a 3.25 (95% CI: 1.19, 9.74, P = 0.025) and 5.67 (95% CI: 1.48-20.9, P = 0.009) increased odds of anterior wound complication, respectively. This included wound dehiscence, superficial site infection, and/or abscess, occurring in 29 patients. Of the six patients who subsequently required operative take back, five were obese. Intraoperative injury occurred in 30 patients (6.3%) during the anterior exposure, including vessel injury (n = 24) and bladder injury (n = 1) and trended to be more frequent in obese patients (OR: 1.95, 95% CI: 0.88-4.59, P = 0.11).

Conclusions: In patients who undergo ALIF, there is a significant association between anterior wound complications and obesity. However, the overall rate of intraoperative complications was low. We demonstrated safe performance of ALIF in our patient group with higher BMI.

Keywords: Anterior exposure; Anterior lumbar interbody fusion; General surgery; Perioperative complication; Spine surgery; Vascular surgery.