What does this research mean for the field?

Surgical outcomes after posterior lumbar interbody fusion (PLIF) have worsened over time, with increased 30-day complications and 90-day readmissions despite efforts in preoperative optimization. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The research aims to investigate national and regional trends in surgical outcomes following posterior lumbar interbody fusion (PLIF) procedures.

March 7, 2026

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

Key Points

The research aims to investigate national and regional trends in surgical outcomes following posterior lumbar interbody fusion (PLIF) procedures.
Identified patients who underwent PLIF through the PearlDiver Patient Claims Database from 2011 to 2022.
Analyzed demographic characteristics, comorbidities, and postoperative outcomes by U.S. region.
Used ICD-9, ICD-10, and CPT codes for classification of patients.
Performed statistical analysis with R, assessing significance at α = 0.05.
A total of 434,214 patients underwent PLIF during the study period.
Length of stay and complications increased nationally; hospital length of stay showed a significant rise.
Infection rates decreased across all regions, with the Northeast showing significant improvement.
Patients in more recent years had higher comorbidities, increased tobacco use, and more cases of overweight and obesity.
Preoperative opioid use significantly decreased over the years.

Abstract

Study DesignRetrospective cohort study.ObjectiveTo 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.MethodsPatients 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).Results434 214 patients underwent PLIF from 2011 to 2022. Nationally, LOS, 30-day complication, and 90-day readmission worsened over time. Hospital LOS increased (P P P < .0001).ConclusionsDespite 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.

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