Study design: Retrospective Study. Objective: To identify the spectrum of immediate post-operative complications after complex anterior cervical reconstruction surgery, and the risk factors associated with their occurrence. Summary of background data: Complex anterior cervical reconstruction surgery can be lengthy with more extensive exposure and greater soft tissue disturbance, putting patients at higher risk for immediate complications. Multi-level anterior cervical cases may be associated with a greater number of risks and complications compared to singlelevel anterior cervical discectomy and fusion (ACDF) cases. Methods: A retrospective study of 155 patients between 1996 and 2009 who had undergone complex anterior cervical reconstruction surgery at a single institution by one of three fellowship-trained surgeons. Complex anterior cervical reconstruction surgery cases were defined as: ACDF of 3 or more levels (with or without posterior instrumentation). Hospital charts and operative reports were reviewed for procedurerelated peri-operative complications. Results: Reported complications included dysphagia 41/155 (26.4%), dysphonia 15/155 (9.6%), new nerve palsy 1/155 (0.6%), worsening of preoperative radiculopathy 2/155 (1.3%), post-operative hematoma requiring evacuation 2/155 (1.3%), emergent re-intubation 2/155 (1.3%), and dural tear 1/155 (0.6%). Females (aOR: 2.91, 95% CI: 0.81, 10.49) and fusion of the C3-C4 level (aOR: 3.49, 95% CI: 0.89, 13.29) were found to be predictive characteristics for the onset of dysphagia. Anxiety disorder (aOR: 4.94, 95% CI: 1.06, 22.94) was found to have increased risk of post-operative dysphonia. Increasing Nurick grade, however, was found to have a protective effect on the development of dysphagia (aOR: 0.43, 95% CI: 0.23, 0.80) and dysphonia (aOR: 0.47, 95% CI: 0.26, 0.85). Conclusion: Female gender, fusion of C3-4, and anxiety disorder, were associated with a higher rate of immediate post-operative complications following complex anterior cervical reconstruction surgery. Higher nurick grade was found to have a protective effect on the development of dysphagia and dysphonia.