Study Design: A retrospective database study. Objectives: The purpose of the current study was to investigate the impact of hyperlipidemia (HLD) on the incidence of perioperative complications associated with posterior cervical spine fusion (PCF). Background: HLD is a very common disease that leads to atherosclerosis. Therefore, it can cause fatal diseases as well as lifestyle-related diseases. The possible impact of HLD on outcomes after PCF has not yet been investigated. Methods: Patients with cervical degeneration underwent initial PCF from 2010 through the third quarter of 2020 using the MSpine subset of the PearlDiver Patient Record Database. The incidence of perioperative complications was queried using relevant ICD-9, 10, and CPT codes. χ2 analysis was performed in age-, sex-, and Charlson Comorbidity Index (CCI)-matched populations to compare between non-HLD and HLD patients in each single-level and multilevel PCF. Results: Through propensity score matching, 1600 patients each in the HLD and non-HLD groups were analyzed in the single-level PCF, 6855 patients were analyzed in the multilevel PCF were analyzed. The comorbidity of HLD significantly decreased the incidence of respiratory failure in single-level PCF (OR=0.58, P<0.01). In the multilevel PCF, the presence of HLD increased the incidence of cervicalgia (OR=1.26, P=0.030). On the contrary, the incident of spinal cord injury (OR=0.72, P<0.01), dysphagia (OR=0.81, P=0.023), respiratory failure (OR=0.85, P=0.030), pneumonia (OR=0.70, P=0.045), neurological bladder (OR=0.84, P=0.041), and urinary tract infection (OR=0.85, P=0.021) in the HLD group were significantly lower than those in non-HLD group. Conclusions: In the current study, the presence of HLD significantly increased the incidence of postoperative cervicalgia in multilevel PCF. On the other hand, the incidence of some complications was significantly decreased with HLD. Further studies are needed taking into account other factors such as the treatment of HLD, its efficacy, and intraoperative events. Level of Evidence: Level III.

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