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Impact of chronic hyperlipidemia on perioperative complications in patients undergoing lumbar fusion: a propensity score matching analysis



Lumbar fusion is widely used to treat degenerative and traumatic conditions of the spine, with various perioperative complications. This study compared lumbar fusion complications in patients with and without chronic hyperlipidemia.


Using the MSpine division of the PearlDiver database, patients with or without chronic hyperlipidemia who underwent lumbar fusions were identified. The appropriate Current Procedural Terminology (CPT) codes identified patients with single- or multi-level lumbar spinal fusion surgeries. International Classification of Diseases (ICD-9 and ICD-10) codes identified patients with chronic hyperlipidemia. The surgical and medical complications were obtained utilizing the appropriate ICD-9, ICD-10, and CPT codes. Propensity score matching analysis was used to control for confounding factors. Chi-square test was applied to compare the incidence of complications among different groups.


In single-level fusion group, patients with hyperlipidemia had a higher incidence of wound complications (P < 0.001), surgical site infection (P < 0.001), failed back syndrome (P < 0.001), hardware removal (P < 0.001), deep venous thrombosis/pulmonary embolism (P = 0.031), myocardial infarction (P < 0.001) cerebrovascular accident (P < 0.001), renal failure (P < 0.001), sepsis (P < 0.001), and urinary tract infection/incontinence (P < 0.001).

In multi-level fusion group, patients with hyperlipidemia had a higher incidence of nerve root injury (P = 0.034), wound complications (P < 0.001), surgical site infection (P < 0.001), failed back syndrome (P < 0.001), hardware removal (P < 0.001), revision (P = 0.002), myocardial infarction (P < 0.001), renal failure (P < 0.001), and urinary tract infection/incontinence (P < 0.001).


Following lumbar fusion, patients with chronic hyperlipidemia have an increased risk of perioperative complications, including wound complications, surgical site infection, failed back surgery syndrome, hardware removal, myocardial infarction, renal failure, and urinary tract infection/incontinence.

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  1. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, Sharan AD, Ratliff JK (2010) Complications in spine surgery. J Neurosurg Spine 13(2):144–157.

    Article  PubMed  Google Scholar 

  2. Epstein NE (2017) Predominantly negative impact of diabetes on spinal surgery: a review and recommendation for better preoperative screening. Surg Neurol Int 8:107.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Karr S (2017) Epidemiology and management of hyperlipidemia. Am J Manag Care 23(9 Suppl):S139–S148

    PubMed  Google Scholar 

  4. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW, American Heart Association Council on E, Prevention Statistics C, Stroke Statistics S (2021) Heart disease and stroke statistics-2021 update: a report from the american heart association. Circulation 143(8):e254–e743.

    Article  PubMed  Google Scholar 

  5. Garcia GH, Liu JN, Wong A, Cordasco F, Dines DM, Dines JS, Gulotta LV, Warren R (2017) Hyperlipidemia increases the risk of retear after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 26(12):2086–2090.

    Article  PubMed  Google Scholar 

  6. Shoji H, Hirano T, Watanabe K, Ohashi M, Mizouchi T, Endo N (2018) Risk factors for surgical site infection following spinal instrumentation surgery. J Orthop Sci 23(3):449–454.

    Article  PubMed  Google Scholar 

  7. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36(1):8–27.

    CAS  Article  PubMed  Google Scholar 

  8. Lotan R, Oron A, Anekstein Y, Shalmon E, Mirovsky Y (2008) Lumbar stenosis and systemic diseases: is there any relevance? J Spinal Disord Tech 21(4):247–251.

    Article  PubMed  Google Scholar 

  9. Longo UG, Denaro L, Spiezia F, Forriol F, Maffulli N, Denaro V (2011) Symptomatic disc herniation and serum lipid levels. Eur Spine J 20(10):1658–1662.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Leino-Arjas P, Kaila-Kangas L, Solovieva S, Riihimaki H, Kirjonen J, Reunanen A (2006) Serum lipids and low back pain: an association? A follow-up study of a working population sample. Spine (Phila Pa 1976) 31(9):1032–1037.

    Article  Google Scholar 

  11. Leino-Arjas P, Kauppila L, Kaila-Kangas L, Shiri R, Heistaro S, Heliovaara M (2008) Serum lipids in relation to sciatica among Finns. Atherosclerosis 197(1):43–49.

    CAS  Article  PubMed  Google Scholar 

  12. Battie MC, Videman T, Gill K, Moneta GB, Nyman R, Kaprio J, Koskenvuo M (1991) 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine (Phila Pa 1976) 16(9):1015–1021

    CAS  Article  Google Scholar 

  13. Kauppila LI, Mikkonen R, Mankinen P, Pelto-Vasenius K, Maenpaa I (2004) MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain. Spine (Phila Pa 1976) 29(19):2147–2152.

    Article  Google Scholar 

  14. Sakaura H, Miwa T, Yamashita T, Kuroda Y, Ohwada T (2016) Lifestyle-related diseases affect surgical outcomes after posterior lumbar interbody fusion. Glob Spine J 6(1):2–6.

    Article  Google Scholar 

  15. Shi E, Jex M, Patel S, Garg J (2019) Outcomes of wound healing and limb loss after transmetatarsal amputation in the presence of peripheral vascular disease. J Foot Ankle Surg 58(1):47–51.

    Article  PubMed  Google Scholar 

  16. Hosseinrezaei H, Rafiei H, Amiri M (2012) Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery. J Wound Care 21(8):408–411.

    CAS  Article  PubMed  Google Scholar 

  17. Schoell K, Wang C, D’Oro A, Heindel P, Lee L, Wang JC, Buser Z (2019) Depression increases the rates of neurological complications and failed back surgery syndrome in patients undergoing lumbar spine surgery. Clin Spine Surg 32(2):E78–E85.

    Article  PubMed  Google Scholar 

  18. Bordoni B, Marelli F (2016) Failed back surgery syndrome: review and new hypotheses. J Pain Res 9:17–22.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shapiro CM (2014) The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am 25(2):319–340.

    Article  PubMed  Google Scholar 

  20. Nelson RH (2013) Hyperlipidemia as a risk factor for cardiovascular disease. Prim Care 40(1):195–211.

    Article  PubMed  Google Scholar 

  21. Glazer NL, Smith NL, Heckbert SR, Doggen CJ, Lemaitre RN, Psaty BM (2005) Risk of myocardial infarction attributable to elevated levels of total cholesterol among hypertensives. Am J Hypertens 18(6):759–766.

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Zorica Buser.

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The authors declare that they have no conflict of interest related to this study. Disclosures outside of submitted work: ZB- consultancy: Cerapedics (past); Research Support: SeaSpine (past, paid to the institution), Next Science (past, paid directly to institution), Medical Metrics (past, paid directly to institution), NIH SBIR Subaward (past, paid to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Educational Committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee- committee member: Patents (issued): Biomarkers for painful intervertebral discs and methods of use thereof JCW - 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.

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Mesregah, M.K., Mgbam, P., Fresquez, Z. et al. Impact of chronic hyperlipidemia on perioperative complications in patients undergoing lumbar fusion: a propensity score matching analysis. Eur Spine J (2022).

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  • Hyperlipidemia
  • High cholesterol
  • High triglycerides
  • Lumbar surgery
  • Lumbar fusion
  • Complications