Risk factors for and complications after surgical delay in elective single-level lumbar fusion

Scott C. Wagner*, Joseph S. Butler, Ian D. Kaye, Arjun S. Sebastian, Patrick B. Morrissey, Christopher K. Kepler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Study Design. Retrospective cohort. Objective. To assess the incidence of and risk factors for delay of elective lumbar fusion surgery, as well as medical and surgical complications associated with surgical delay. Summary of Background Data. Lumbar fusion is a wellestablished treatment for patients with degenerative spondylolisthesis with stenosis who have failed conservative management. Rarely, patients admitted for elective lumbar fusion may experience a delay in surgery past the day of admission. The incidence of, and risk factors for, delay of elective lumbar fusion surgery and the complications associated therewith have never been previously evaluated. Methods. We retrospectively reviewed the ACS-NSQIP registry utilizing Current Procedural Terminology (CPT) codes 22612, 22558, 22630, and 22633 to identify all patients undergoing a single level spinal fusion. The data were then subdivided into cohorts consisting of patients with and without surgical delay. Demographic information, preoperative risk factors for delay, as well as intraoperative and postoperative complications were compared between the groups. Results. We identified 2758 (5.46%) patients as experiencing a delay before lumbar fusion. Multivariate analysis was then performed and identified male sex, American Society of Anesthesiologists classes 3 and 4, and chronic steroid use as risk factors increasing the rate of surgical delay. Multiple complication rates were also significantly higher in the delayed group, including an almost 10-fold increase in mortality rate (0.2% vs. 1.9%, respectively, P<0.001). Conclusion. Delays in elective surgery can affect medical system resource utilization, increasing costs and leading to worse patient outcomes. Patients with chronic steroid use and higher American Society of Anesthesiologists class may be at risk for surgical delay in lumbar fusion beyond the day of admission, and are at increased risk for significant complications postoperatively. Thorough medical evaluation and preoperative optimization may be indicated for these patients.

Original languageEnglish
Pages (from-to)228-233
Number of pages6
Issue number3
StatePublished - 1 Feb 2018
Externally publishedYes


  • Arthrodesis
  • Complications
  • Degenerative disease
  • Elective surgery
  • Incidence
  • Lumbar
  • Lumbar fusion
  • Risk factors
  • Surgical delay


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