title: Prior abdominal surgery is associated with an increased risk of postoperative complications after anterior lumbar interbody fusion.
abstract: METHODS
  Retrospective medical record review.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether a history of abdominal/pelvic surgery confers an increased risk of retroperitoneal anterior approach-related complications when undergoing anterior lumbar interbody fusion.
  
  
  BACKGROUND
  As anterior lumbar interbody fusion gains popularity, both anterior retroperitoneal approach have become increasingly used.
  
  
  METHODS
  The records of 263 patients, who underwent infraumbilical retroperitoneal approach to the anterior aspect of the lower lumbar spine for a degenerative spine condition between 2007 and 2011 were retrospectively reviewed. Patient's demographics, risk factors, preoperative diagnosis, surgical history, level of the anterior fusion, and perioperative complications were collected. Anterior retroperitoneal approach to the spine was carried out by a single general surgeon.
  
  
  RESULTS
  Ninety-seven patients (37%) developed at least 1 complication. Forty-nine percent of patients with a history of abdominal surgery developed a postoperative complication compared with 28% of patients without such history (RR = 1.747, P≤ 0.001). After controlling for other factors such as age, sex, body mass index, diagnostic groups, and preoperative comorbidities (hypertension, diabetes, and smoking status), these differences remained statistically significant. When each type of complication was considered separately, there was a statistically significant difference in the incidence of general complications (RR = 2.384, P = 0.007), instrumentation-related complications (RR = 2.954, P = 0.010), and complications related to the anterior approach (RR = 1.797, P = 0.021).
  
  
  CONCLUSIONS
  Anterior lumbar interbody fusion via a midline incision and a retroperitoneal approach was associated with 37% overall rate of complication. Patients with a history of abdominal or pelvic surgery are at a higher risk of developing general, instrumentation, and anterior approach-related complications.
authors.affiliation: *Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA †Harvard Medical School, Boston, MA ‡Washington University Orthopaedics, Saint Louis, MO; and §Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Polina
authors.initials: P
authors.lastname: Osler
authors.forename: Sang D
authors.initials: SD
authors.lastname: Kim
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Hess
authors.forename: Philippe
authors.initials: P
authors.lastname: Phan
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Simpson
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Mansfield
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.forename: Vinicius Ladeira
authors.initials: VL
authors.lastname: Craveiro
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult