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Given the deidentified nature of claims data, this study was exempt from institutional review board approval. We accessed data from the Optum De-identified Clinformatics Database, which contains data on more than 100 million commercially insured and Medicare Advantage beneficiaries from 2003 to 2017. Men undergoing surgery of the lumbar spine, including but not limited to anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF) and posterior  [https://zindi.africa/users/nizagara-tablets nizagara official website] lumbar fusion (PLF), were identified using Current Procedure Terminology (CPT) codes (Supplemental Table 1).<br><br>Development of DE related to lumbar surgery was assessed by examining for the appropriate diagnosis code within 2 years after their lumbar surgery. The primary outcome was the occurrence of delayed ejaculation using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9/ICD-10) diagnosis codes (Supplemental Table 1). We examined other postoperative entities after spinal surgery including deep vein thrombosis (DVT), pulmonary embolism (PE), urinary retention, retrograde ejaculation, and erectile dysfunction using ICD-9 codes (Supplemental Table 1).<br><br>Patients were excluded if they were younger than 18 years or developed DE prior to their index lumbar surgery.