Introduction An anterior approach to lumbar interbody fusion is a widely utilized method of access to the lumbar spine. Due to the potential for vascular complications with spine exposure, vascular surgeons are frequently included in the care of these patients as part of a team-based approach. Identifying risk factors for such complications is difficult and not well-defined in the literature. In this investigation, we evaluate the potential risk factors for complications during anterior lumbar inter-body fusion (ALIF). Methods This is a retrospective review of 106 patients who underwent ALIF at a single institution between May 1, 2007, and April 30, 2017. Patients were identified through operating room case logs and Current Procedural Terminology (CPT) codes correlating with ALIF. Vascular surgeons performed all anterior exposures. Patient demographics and data regarding their surgical care and postoperative course were obtained from a review of operative and progress notes in the electronic medical record. Statistical methods employed included a t-test for normally distributed data and the Wilcoxon rank-sum test for non-normally distributed data. Categorical variables were compared using Fisher’s exact and chi-square tests. A logistic regression model was applied to predict complications by controlling other significant covariates. Results Of the 106 patients included in this analysis, 16 patients experienced a defined complication, giving an overall complication rate of 15%. Patients with complications were more likely to be of male gender (n=11, P=0.016), with older average age (54.6, P=0.017), with higher estimated blood loss, with higher use of blood products, and with higher use of cell-saver. A venous injury was the most common complication (n=11, 10.4%); ileus and nerve injury were the next most common (n=3, 2.8%). The 30-day mortality was 0%. Male gender demonstrated an odds ratio of 3.78 (P=0 .034) in a logistic regression model after adjusting for age and blood products. Conclusions Overall complication rates were comparable to those in the published literature and male gender was identified as a predictor for risk of complications in those undergoing ALIF. This is the first study to identify male sex as a risk factor for complications following ALIF. The results of this study will hopefully guide future studies in gaining more insight into the predictors of complications in larger series.

Objective: Multiple societal guidelines recommend medical optimization and exercise therapy for patients with claudication before lower extremity revascularization (LER). However, the application of those guidelines in practice remains unknown. Our hypothesis is that vascular surgeons (VSs) are more adherent to guidelines compared with other specialists (OSs) treating claudication.Methods: The records of patients undergoing LER for claudication in a single center were reviewed, and adherence to guidelines before LER was assessed. Patients received minimal medical management if the impact of claudication on quality of life was documented, ankle-brachial index (ABI) was obtained, and patients were treated with at least 3 months of walking exercises and smoking cessation when indicated.Results: There were 187 patients treated for claudication (VSs, 65; OSs, 122). Patients treated by VSs were younger (P ¼ .006) and more likely to be African American (P ¼ .04). Patients treated by OSs were more likely to have hypertension (P < .001), hyperlipidemia (P ¼ .001), coronary artery disease (P < .001), congestive heart failure (P ¼ .025), and smoking (P ¼ .017) but less likely to have prior LER (P ¼ .009). VSs were more likely to assess pattern of symptoms (P < .001), but there was no difference in documentation of the effect on quality of life. VSs obtained more ABI (P ¼ .001) and computed tomography angiography (P < .001) compared with OSs, but the mean ABIs were similar. VSs were more likely to prescribe walking exercises and smoking cessation before LER. Even though walking exercises were recommended to 70.8% and 31.1% of patients treated by VSs and OSs, respectively, only 33.8% and 18% were given a period of 3 months to benefit from it before LER. Minimal medical management was significantly higher among VSs compared with OSs but was overall low (VSs, 12.3%; OSs, 3.3%; P ¼ .016). After 3 years, there was no difference in mortality or major amputation (Table ).Conclusions: The medical management of vascular claudication before LER is overall poor, but VSs have better adherence to practice guidelines compared with OSs. Institutional protocols and guidelines in appropriateness across specialties are needed to reinforce the application of the established standards of care.