Nationwide and Regional Trends in Surgical Outcomes After Posterior Lumbar Interbody Fusion Over an 11-Year Period

Study Design Retrospective cohort study. Objective To examine national and regional trends in preoperative patient optimization and surgical outcomes among patients undergoing posterior lumbar interbody fusion (PLIF) in the United States from 2011 to 2022. Methods Patients who underwent PLIF were identified in the PearlDiver Patient Claims Database using ICD-9, ICD-10 and CPT codes. Demographic characteristics, comorbidities, and postoperative outcomes were analyzed over 11 years and by U.S. region (Midwest, Northeast, South, West). Variables included age, body mass index, tobacco use, Charlson Comorbidity Index (CCI), opioid use, 30-day complications, 90-day readmissions, infection, and hospital length of stay (LOS). Statistical analysis was performed using R (α = 0.05). Results 434 214 patients underwent PLIF from 2011 to 2022. Nationally, LOS, 30-day complication, and 90-day readmission worsened over time. Hospital LOS increased ( P < .0001) and infection rate decreased for all regions ( P < .001). The Northeast showed significant improvement, whereas the South, Midwest and West all had rising complications and readmissions. Patients in 2021-2022 were older, with more comorbidities, more likely to use tobacco, and had higher rates of overweight and obesity. Significant decreases were observed in preoperative opioid use ( P < .0001). Conclusions Despite an emphasis on preoperative optimization and demonstrated reductions in preoperative opiate use, surgical outcomes including 30-day complications, 90-day readmissions, and length of stay increased in recent years. Worsening outcomes imply potential gaps in optimization efforts and regional outcome variability may suggest a need for region-specific preoperative optimization strategies.