Burden and Predictors of Incisional Hernia Following Anterior Lumbar Fusion: A National Study.

Abstract

Study design: Retrospective cohort study.

Objectives: To determine the incidence and identify independent predictors of incisional hernia following anterior lumbar interbody fusion (ALIF).

Methods: The PearlDiver national database was queried to identify patients who underwent ALIF. Patients were stratified based on the presence or absence of an incisional hernia diagnosis. Chi-squared and Student's t-tests were used to identify demographic and comorbidities between the 2 cohorts. Multivariate logistic regression analysis was performed to identify independent risk factors for incisional hernia development.

Results: A total of 165,110 patients underwent ALIF during the study period, of whom 4164 (2.52%) developed an incisional hernia. The mean and median time to diagnosis were 1093 ± 1030 days and 728 days, respectively. Independent risk factors for incisional hernia included obesity (aOR: 1.19), smoking (aOR: 1.09), chronic obstructive pulmonary disease (COPD) (aOR: 1.25), ascites (aOR: 2.16), surgical site infection (SSI) (aOR: 1.96), malnutrition (aOR:1.56), and two-level ALIF (aOR: 1.12) (all P < 0.05).

Conclusion: The incidence of incisional hernia following ALIF is 2.52%, with obesity, smoking, COPD, ascites, SSI, malnutrition, and two-level surgeries identified as independent risk factors. Spine surgeons should implement risk mitigation strategies including weight loss, smoking cessation, and nutritional support. Future research should explore the impact of surgical techniques on hernia risk such as open vs minimally invasive ALIF, incision type, and suture methods, on hernia prevention, as well as evaluate the efficacy of targeted rehabilitation protocols in reducing hernia risk.