Association of Alcohol Use Disorder and Perioperative Complications and Adverse Events After Spinal Fusion Surgery During the In-Hospital Period: An Analysis of the National Inpatient Sample Database

OBJECTIVE: Alcohol use disorder (AUD) carries major effects shown to limit social support, increase recovery times, and lead to a higher incidence of surgical complications. This retrospective cohort study investigated the influence of AUD on perioperative outcomes and adverse events after spinal fusions in the largest sample size to date and spanning 11 years. METHODS: Data for adult (>18 years old) patients who underwent a spinal fusion as their primary surgery were identified from the National Inpatient Sample database for the years 2009-2020. Patients were separated into an AUD cohort and a no AUD (control) cohort. Univariable and multivariable linear and logistic regression analyses were utilized to highlight statistically significant differences in their perioperative complications and adverse events. RESULTS: A total of 4,896,757 patients who underwent spinal fusion were identified. AUD was present in 97,565 (2.0%) patients, with the remaining patients serving as a control group. On multivariable analysis, patients with AUD had significantly increased odds of longer length of stay (odds ratio [OR] = 3.40; 95% confidence interval [CI] [3.24-3.57] P < 0.001, and of the following perioperative complications and adverse events: neurologic injury (OR = 3.24; 95% CI [3.05-3.44] P < 0.001), respiratory-related (OR = 3.06; 95% CI [2.91-3.21] P < 0.001), systemic infectious (OR = 2.79; 95% CI [2.48-3.13] P < 0.001), neurologic (stroke) (OR = 2.73; 95% CI [2.22-3.35]) P < 0.001, urinary-related (OR = 2.23; 95% CI [2.11-2.36] P < 0.001), venous thrombotic-related (OR = 2.12; 95% [1.87-2.40] P < 0.001), gastrointestinal-related (OR: 1.91; 95% CI [1.79-2.03] P < 0.001), wound-related (OR = 2.32; 95% CI [2.10-2.56] P < 0.001), cardiac-related (OR = 1.44; 95% CI [1.34-1.55] P < 0.001), and fusion disorders (OR = 1.22; 95% CI [1.15-1.2] P < 0.001). CONCLUSIONS: We found that AUD carries a significantly negative influence over perioperative outcomes and adverse events after spinal fusion in a large database population.