The Effect of Hyperlipidemia as a Risk Factor on Postoperative Complications in Patients Undergoing Anterior Cervical Discectomy and Fusion.

Study Design: Retrospective cohort study.
Objective: To analyze the effect of hyperlipidemia (HLD) on postoperative complications in patients who underwent anterior cervical discectomy and fusion (ACDF).
Summary of Background Data: ACDF represents the standard procedure performed for focal anterior nerve root or spinal cord compression with low complication rates. HLD is well known as a risk factor for major complications after vascular and transplant surgery, and orthopedic surgery. To date, there have been no studies on HLD as a risk factor for cervical spine surgery.
Patients and Methods: Patients who underwent ACDF from 2010 through quarter 3 of 2020 were enrolled using the MSpine subset of the PearlDiver Patient Record Database. The patients were divided into single-level ACDF and multilevel ACDF groups. In addition, each group was divided into subgroups according to the presence or absence of HLD. The incidence of surgical and medical complications was queried using relevant International Classification of Disease and Current Procedural Terminology codes. Charlson Comorbidity Index was used as a broad measure of comorbidity. χ 2 analysis, with populations matched for age, sex, and Charlson Comorbidity Index, was performed.
Results: A total of 24,936 patients who underwent single-level ACDF and 26,921 patients who underwent multilevel ACDF were included. In the multilevel ACDF group, wound complications were significantly higher in the patients with HLD. Among medical complications, myocardial infarction, renal failure, and urinary tract infection/urinary incontinence were significantly higher in the patients with HLD in both groups. Revision surgery and readmission were significantly higher in the patients with HLD who underwent multilevel ACDF.
Conclusions: In patients who underwent ACDF, several surgical and medical complications were found to be higher in patients with HLD than in patients without HLD. Preoperative serum lipid concentration levels and management of HLD should be considered during preoperative planning to prevent postoperative complications in patients undergoing ACDF.
Competing Interests: Z.B.–Grants/Research support: AO Spine (co-PI on a AO Spine Knowledge Forum grant, Paid directly to institution/employer); Nexus Spine (Paid directly to institution/employer), Medical Metrics (Paid directly to institution/employer); MiMedx (past, Paid directly to institution/employer), SBIR NIH (past, Paid directly to institution/employer); Medical Metrics (past, Paid directly to institution/employer); Next Science (past, Paid directly to institution/employer); Consultancy: Next Science (paid directly to institution/employer); NIH (advisor consultant); Scientific Advisory Board: Medtronic, Medical Metrics; Trips/Travel: AO Spine (Travel Expense Reimbursement, travel reimbursements for AO Spine Knowledge forum meetings and congresses), NASS (Travel Expense Reimbursement); Board of Directors: LSRS (Nonfinancial, Co-chair of Program Committee); Committees: AO Spine Knowledge Forum Degenerative (Steering Committee Member); North American Spine Society: Research Project Management Committee (Vice chair), Section on Biologics & Basic Research (Co-chair), The Spine Journal Peer Reviewers (Committee member). Patents (issued): Biomarkers for painful intervertebral discs and methods of use thereof. J.C.W.-royalties: SeaSpine, Depuy, Zimmer; consulting - Precision OS (no money paid); expert testimony; AO Foundation Board (honorarium), National Spine Health Foundation (volunteer); stocks/personal investment: PearlDiver, Bone Biologics, Surgitech; Fellowship Funding (paid to institution): AO Foundation. The remaining authors declare no conflict of interest.
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