Preoperative Charlson comorbidity index and postoperative transfusion volume as key stratified predictors of in-hospital complications following elective posterior lumbar interbody fusion (PLIF)

Postoperative complications after posterior lumbar interbody fusion (PLIF) remain a significant concern. This study aimed to identify independent predictors of in-hospital complications, focusing on the Charlson Comorbidity Index (CCI), American Society of Anesthesiology (ASA) score, perioperative transfusion volume, radiologic muscle mass, and nutritional status. A cohort of 747 patients who underwent PLIF between 2005 and 2014 was analyzed. Preoperative data, including the CCI, ASA score, psoas and back muscle cross-sectional area (CSA), and the Prognostic Nutritional Index (PNI), were collected. Univariate and preoperative to perioperative multivariable logistic regression models were subsequently constructed to distinguish baseline patient risk from operative factors, with receiver operating characteristic (ROC) curves determining optimal cut-offs. The CCI and transfusion volume were significant independent predictors of complications. A CCI ≥ 3.0 (area under ROC curve 0.831) and transfusion volume ≥ 1.0 pack (odds ratio 1.319 per 1.0 pack increase) were screening threshold. In contrast, muscle CSA of the psoas and back muscles showed no significant association with complications ( p = 0.713, p = 0.105). PNI was lower in the complication group but did not remain significant in multivariate analysis. Preoperative CCI was the strongest preoperative predictor of in-hospital complications, whereas perioperative transfusion volume was independently associated with postoperative complications. A CCI ≥ 3.0 and transfusion volume ≥ 1.0 pack are important clinical thresholds for identifying high-risk patients. Radiologic muscle mass, based solely on CSA, did not predict acute postoperative complications. These findings highlight the importance of preoperative risk assessment and perioperative blood management strategies in spine surgery.