Intraoperative Venous Injury During Anterior Lumbar Interbody Fusion: Incidence, Risk Factors, and Complications.

Study DesignRetrospective cohort study.ObjectivesTo evaluate the incidence, risk factors, and complications associated with intraoperative venous injury during anterior lumbar interbody fusion (ALIF).MethodsThis retrospective review included patients who underwent one- to four-level ALIF at an academic spine center. Patients <18 years old or those with surgical indications for trauma, infection, or malignancy were excluded. Patients were stratified by the presence of venous laceration requiring primary suture repair. Comparative analyses were performed using Student's t test and Pearson's Chi-squared test. Univariable and multivariable logistic regression identified independent risk factors and postoperative complications.ResultsAmong 554 patients, 92 (16.61%) sustained a venous laceration. Independent predictors included age (aOR: 1.03, P < 0.01), chronic kidney disease (aOR: 5.17, P < 0.01), ALIF at L4-5 (aOR: 3.88, P < 0.01), and two-level ALIF (aOR: 1.70, P < 0.01). ALIF at L5-S1 was protective (aOR: 0.24, P < 0.001). Venous laceration was associated with longer operative times (8.02 ± 2.95 vs 6.48 ± 2.81 hours, P < 0.001), greater mean blood loss (1,271 mL vs 600.71 mL, P < 0.001), and increased risks of deep vein thrombosis (DVT) (aOR: 3.33, [1.59-10.17], P = 0.011), intraoperative transfusion (aOR: 4.43, P < 0.001), and incision and drainage (aOR: 7.45, [1.75-31.62], P < 0.01).ConclusionVenous laceration occurred in 16.61% of ALIF cases, with independent risk factors including age, CKD, L4-5 ALIF, and two-level ALIF. These injuries were associated with prolonged operative times and a markedly elevated risk of DVT. Future research should focus on developing risk reduction strategies for high-risk patients and developing evidence-based VTE prophylaxis protocols tailored to patients with venous injuries.