Association Between Alcohol Use Disorder and Perioperative Risks and Complications Following Spinal Fusion Surgery: Insights from the National Inpatient Sample (NIS) Database

Introduction: Alcohol use disorder (AUD) is associated with social challenges, slower recovery times, and higher surgical complication rates. This retrospective cohort study aimed to assess how AUD affects perioperative outcomes and adverse events after spinal fusion, using a large patient dataset over an 11-year period.

Methods: Data was obtained from the Nationwide Inpatient Sample (NIS) database, focusing on adults over 18 who had spinal fusion as the primary procedure from 2009 to 2020. Patients were grouped into an AUD cohort and a control group without AUD. Both univariate and multivariate linear and logistic regression analyses were conducted to identify significant differences in perioperative complications and adverse events.

Results: The study included 4,896,757 patients who underwent spinal fusion, with 97,565 (2%) identified as having AUD. Multivariate analysis indicated that patients with AUD had significantly higher odds of extended hospital stays (odds ratio [OR]=3.40; 95% confidence interval [CI][3.24-3.57]p < 0.001) and several perioperative complications, including: neurological injury (OR=3.24; 95% CI[3.05-3.44]p < 0.001), respiratory issues (OR=3.06; 95% CI[2.91-3.21]p < 0.001), systemic infections (OR=2.79; 95% CI[2.48-3.13]p < 0.001), stroke (OR=2.73; 95% CI[2.22-3.35]p < 0.001), urinary complications (OR=2.23; 95% CI[2.11-2.36]p < 0.001), venous thrombotic events (OR=2.12; 95% CI[1.87-2.40]p < 0.001), gastrointestinal complications (OR:1.91; 95% CI[1.79-2.03]p < 0.001), wound complications (OR=2.32; 95% CI[2.10-2.56]p < 0.001), cardiac issues (OR=1.44; 95% CI[1.34-1.55]p < 0.001), and complications related to spinal fusion (OR=1.22; 95% CI[1.15-1.2]p < 0.001).

Conclusion : AUD significantly worsens perioperative outcomes and increases adverse events in patients undergoing spinal fusion, as shown in this large-scale analysis. These findings underscore the need to consider AUD as a major factor in preoperative risk assessments and tailored patient management.