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This study aims to investigate short-term outcomes and complications following multi-level posterior spinal instrumentation.

May 7, 2026Open Access

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Early Postoperative Adverse Events Following Multi-Level Posterior Segmental Spinal Instrumentation: A Decade-Spanning Retrospective Analysis

SYShahabeddin YazdanpanahNortheast Ohio Medical University AHAmy HuangUniversity of California, Irvine AKAndrew KimUniversity of California, Irvine

Key Points

This study aims to investigate short-term outcomes and complications following multi-level posterior spinal instrumentation.
Retrospective analysis using the ACS-NSQIP database (2014-2023) with 1348 patients.
Exclusion of cases with missing variables or complexity-increasing add-ons.
Utilized descriptive statistics, multivariable logistic regression, and threshold analyses.
Composite adverse events occurred in 24% of patients (major: 21%, minor: 5%, infection-related: 5%).
Age, disseminated cancer, and operative time were significant predictors of adverse events (p<0.05).
Operative times over 286 minutes and admission-to-operation intervals over 1 day significantly increased adverse event rates.

Abstract

Multi-level posterior segmental spinal instrumentation procedures have increased considerably in recent decades; however, short-term findings remain incompletely generalized. Therefore, this study investigates 30-day outcomes following these procedures to better highlight profiles and associations. The ACS-NSQIP database (2014-2023) was queried for patients undergoing multi-level posterior segmental instrumentation. Cases with missing variables or select complexity-increasing add-ons were excluded. A composite any adverse event (AAE) variable was examined, alongside various other complication subgroupings. Statistics included descriptive transformations, multivariable logistic regressions, and threshold analyses, where appropriate. A total of 1348 patients were included (mean age=60±14; body mass index=31±7 kg/m 2 ; 49% male; 83% medium-length constructs 3-6 levels; 14% long 7-12; 3% very long 13+). AAE occurred in 24%: major in 21%, minor in 5%, and infection-related in 5%. Age (odds ratio OR=1.019), male sex (OR=0.694), disseminated cancer (OR=2.628), admission-to-operation interval (OR=1.033), and operative time (OR=1.005) were independently associated with AAE (all p<0.05). Relative to medium constructs, long (OR=2.081) and very long (OR=6.981) fixations showed progressively greater AAE odds (all p<0.05). Threshold analysis identified an admission-to-operation cutoff of 1 day (76 th percentile), with AAE rate increasing from 20% below to 34% above (Benjamini-Hochberg corrected p<0.001). Similarly, operative time greater than 286 minutes (73 rd percentile) corresponded to increased AAE odds (corrected p<0.001), rising from 16% below to 42% above. In this decade-spanning analysis, multi-level posterior segmental spinal instrumentation demonstrated meaningful short-term complication rates. Targeted preoperative counseling and facilitation of timely operative intervention may be warranted, and future studies should further evaluate these associations.

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Early Postoperative Adverse Events Following Multi-Level Posterior Segmental Spinal Instrumentation: A Decade-Spanning Retrospective Analysis

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