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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery
The Spine Journal 18 (2018) S70 S128 CONCLUSIONS: Our results suggest that ACDF is associated with a substantial reduction in axial neck pain. These findings may inform future controlled randomized trials of the safety and efficacy of ACDF as a treatment option for patients with herniated cervical disc with axial neck pain without radiculopathy or myelopathy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.423
159. Comparing predictors of complications following anterior cervical discectomy and fusion (ACDF), total disc replacement (TDR), and combined ACDF-TDR with minimum 2-year follow-up Neil V. Shah, MD, MS1, Ishaan Jain, BS2, Cameron R. Moattari, BS2, George A. Beyer, MS1, John J. Kelly, BA3, Sarah Stroud, BA1, Jared M. Newman, MD1, Vincent Challier, MD4, Hiroyuki Yoshihara, MD, PhD1, Peter G. Passias, MD5, Frank J. Schwab, MD6, Virginie Lafage, PhD6, Carl B. Paulino, MD1, Bassel G. Diebo, MD7; 1 SUNY Downstate Medical Center, Brooklyn, NY, USA; 2 Brooklyn, NY, USA; 3 St. George’s University School of Medicine, New York, NY, USA; 4 Spine Unit, Clinique Francheville, Perigueux, France; 5 NY Spine Institute, NYU Langone Health, New York, NY, USA; 6 Hospital for Special Surgery, New York, NY, USA; 7 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA BACKGROUND CONTEXT: Outcomes following anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) procedures are known to be satisfactory; however, following ACDF, morbidity may be as high as 19%, and reoperation rates for TDR as high as 3%. Factors that may predict risks of developing complications are under-reported, with limited existing data. PURPOSE: Therefore, this study sought to determine how complications varied among ACDF, TDR, and combined ACDF-TDR as well as what variables significantly impacted development of postoperative complications. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: All patients who underwent ACDF and/or TDR from 2009 to 2011 with minimum 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 20,487 patients were included. OUTCOME MEASURES: Demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). METHODS: The New York Statewide Planning and Research Cooperative System (SPARCS) was used to identify all patients who underwent ACDF or TDR from 2009 to 2011 with minimum 2-year follow-up surveillance, and three cohorts were formed: ACDF, TDR, or combined ACDFTDR. Primary data points collected included patient demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). Multivariate logistic regression models identified independent predictors of these outcomes. RESULTS: A total of 20,487 patients identified, 19,808 underwent ACDF only, 449 underwent TDR, and 230 underwent a combined ACDF and TDR. There was a significant difference in age across the cohorts, the youngest of which was TDR (44.1 vs. ACDF 51.3 and ACDF-TDR 48.46 years, p<.001). Total hospital charges also varied significantly across the cohorts, with TDR as the least expensive ($36,205.43 vs. ACDF $42,941.44 and ACDF-TDR $46,488.85, p=.002). No differences were found with length of stay, race, and gender. All procedures had comparably low mortality rates, with a 0.2% mortality rate associated with ACDF, while both TDR and ACDF-TDR had 0% mortality rates. Rates of complications significantly differed across the cohorts. ACDF-TDR patients had the highest rates of cardiac complications (1.3% vs. 0.4% ACDF and 0.9% TDR) and pulmonary embolism (0.4% vs. 0% for ACDF and ACDF-TDR) (both p<.05), while TDR had the most individual surgical complications (2.4% vs. 1.7% ACDF-TDR and 1.4% ACDF) as well as the highest rates of complications related to the device, internal fixation, and prosthesis (1.8%, 1.8%, and 0.2%, all p≤.014). Revision rates differed as well, with
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ACDF-TDR patients experiencing the lowest rate (5.2% vs. 6.4% ACDF and TDR 10.9%). Total disc replacement associated with increased odds of developing any surgical complications (OR 1.9, p=.03). Deyo Index was found to predict any medical or surgical complications (OR 1.4 and 1.2, respectively), while black race was found to predict any medical and total complications (OR 1.5 and 1.3) (all p<.004). Female gender was associated with increased odds of readmission (OR 1.2) but was the only significant protective factor against readmission (OR 0.9) (both p≤.002). CONCLUSIONS: There were significant differences in the patient cohorts who underwent ACDF, TDR, or both procedures, where TDR patients were younger but incurred the least amount of hospital charges. Total disc replacement patients could expect increased rates of surgical complications and revisions in comparison to the other cohorts, and the procedure was found to predict surgical complications. This study of a large cohort of patients can provide surgeons and their patients with evidence to better individualize and optimize procedure choice for each patient. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.424
160. Obstructive sleep apnea increases the risk of postoperative pulmonary complications following one- or two-level cervical fusion: a retrospective database review study Blake G. Formanek, BA1, Christopher Wang, BS1, Jeffrey C. Wang, MD2, Zorica Buser, PhD3; 1 Los Angeles, CA, USA; 2 USC Spine Center, Los Angeles, CA, USA; 3 Norris Research Tower, Keck School of Medicine, USC, Los Angeles, CA, USA BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) are surgical techniques for the treatment of degenerative disc disease with established efficacy and safety. However, patients with obstructive sleep apnea (OSA) present with additional risk due to preexisting airway obstruction. Pulmonary complications of patients with OSA who undergo cervical fusion have not been well studied. PURPOSE: This study aims to review rates of pulmonary complications following one- or two-level cervical fusion within patients with preexisting OSA. STUDY DESIGN/SETTING: Retrospective database study. PATIENT SAMPLE: Patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDF or one- or two-level PCF. OUTCOME MEASURES: Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia. METHODS: The PearlDiver insurance database was queried for Humana patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDF (CPT-22548, CPT-22551, CPT-22552, CPT22554, CPT-22585) or one- or two-level PCF (CPT-22590, CPT-22595, CPT-22600, CPT-22614) between 2005 and 2015. The search resulted in 3,748 patients who had OSA prior to ACDF, 24,838 patients who did not have OSA prior to ACDF, 543 patients who had OSA prior to PCF, and 4,034 patients who did not have OSA prior to PCF. Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia were then compared between the four groups. RESULTS: Patients who were diagnosed with OSA within 1 year prior to undergoing cervical fusion were at a significantly greater risk for developing postoperative pulmonary complications. Patients with OSA who underwent ACDF showed greater rates of chronic airway obstruction 17.4% versus 8.9% (odds ratio [OR]=2.163, p<.001), bronchitis 7.6% versus 3.9% (OR=2.059, p<.001), dyspnea 16.1% versus 9.7% (OR=2.004, p<.001), lung diseases 8.1% versus 5.5% (OR=1.534, p<.001), and pneumonia 3.9% versus 2.7% (OR=1.476, p<.001). Patients with OSA who underwent PCF also showed greater risk of developing chronic airway
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
159. Comparing predictors of complications following anterior cervical discectomy and fusion (ACDF), total disc replacement (TDR), and combined ACDF-TDR with minimum 2-year follow-up Neil V. Shah, MD, MS1, Ishaan Jain, BS2, Cameron R. Moattari, BS2, George A. Beyer, MS1, John J. Kelly, BA3, Sarah Stroud, BA1, Jared M. Newman, MD1, Vincent Challier, MD4, Hiroyuki Yoshihara, MD, PhD1, Peter G. Passias, MD5, Frank J. Schwab, MD6, Virginie Lafage, PhD6, Carl B. Paulino, MD1, Bassel G. Diebo, MD7; 1 SUNY Downstate Medical Center, Brooklyn, NY, USA; 2 Brooklyn, NY, USA; 3 St. George’s University School of Medicine, New York, NY, USA; 4 Spine Unit, Clinique Francheville, Perigueux, France; 5 NY Spine Institute, NYU Langone Health, New York, NY, USA; 6 Hospital for Special Surgery, New York, NY, USA; 7 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA BACKGROUND CONTEXT: Outcomes following anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) procedures are known to be satisfactory; however, following ACDF, morbidity may be as high as 19%, and reoperation rates for TDR as high as 3%. Factors that may predict risks of developing complications are under-reported, with limited existing data. PURPOSE: Therefore, this study sought to determine how complications varied among ACDF, TDR, and combined ACDF-TDR as well as what variables significantly impacted development of postoperative complications. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: All patients who underwent ACDF and/or TDR from 2009 to 2011 with minimum 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 20,487 patients were included. OUTCOME MEASURES: Demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). METHODS: The New York Statewide Planning and Research Cooperative System (SPARCS) was used to identify all patients who underwent ACDF or TDR from 2009 to 2011 with minimum 2-year follow-up surveillance, and three cohorts were formed: ACDF, TDR, or combined ACDFTDR. Primary data points collected included patient demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). Multivariate logistic regression models identified independent predictors of these outcomes. RESULTS: A total of 20,487 patients identified, 19,808 underwent ACDF only, 449 underwent TDR, and 230 underwent a combined ACDF and TDR. There was a significant difference in age across the cohorts, the youngest of which was TDR (44.1 vs. ACDF 51.3 and ACDF-TDR 48.46 years, p<.001). Total hospital charges also varied significantly across the cohorts, with TDR as the least expensive ($36,205.43 vs. ACDF $42,941.44 and ACDF-TDR $46,488.85, p=.002). No differences were found with length of stay, race, and gender. All procedures had comparably low mortality rates, with a 0.2% mortality rate associated with ACDF, while both TDR and ACDF-TDR had 0% mortality rates. Rates of complications significantly differed across the cohorts. ACDF-TDR patients had the highest rates of cardiac complications (1.3% vs. 0.4% ACDF and 0.9% TDR) and pulmonary embolism (0.4% vs. 0% for ACDF and ACDF-TDR) (both p<.05), while TDR had the most individual surgical complications (2.4% vs. 1.7% ACDF-TDR and 1.4% ACDF) as well as the highest rates of complications related to the device, internal fixation, and prosthesis (1.8%, 1.8%, and 0.2%, all p≤.014). Revision rates differed as well, with
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ACDF-TDR patients experiencing the lowest rate (5.2% vs. 6.4% ACDF and TDR 10.9%). Total disc replacement associated with increased odds of developing any surgical complications (OR 1.9, p=.03). Deyo Index was found to predict any medical or surgical complications (OR 1.4 and 1.2, respectively), while black race was found to predict any medical and total complications (OR 1.5 and 1.3) (all p<.004). Female gender was associated with increased odds of readmission (OR 1.2) but was the only significant protective factor against readmission (OR 0.9) (both p≤.002). CONCLUSIONS: There were significant differences in the patient cohorts who underwent ACDF, TDR, or both procedures, where TDR patients were younger but incurred the least amount of hospital charges. Total disc replacement patients could expect increased rates of surgical complications and revisions in comparison to the other cohorts, and the procedure was found to predict surgical complications. This study of a large cohort of patients can provide surgeons and their patients with evidence to better individualize and optimize procedure choice for each patient. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.424
160. Obstructive sleep apnea increases the risk of postoperative pulmonary complications following one- or two-level cervical fusion: a retrospective database review study Blake G. Formanek, BA1, Christopher Wang, BS1, Jeffrey C. Wang, MD2, Zorica Buser, PhD3; 1 Los Angeles, CA, USA; 2 USC Spine Center, Los Angeles, CA, USA; 3 Norris Research Tower, Keck School of Medicine, USC, Los Angeles, CA, USA BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) are surgical techniques for the treatment of degenerative disc disease with established efficacy and safety. However, patients with obstructive sleep apnea (OSA) present with additional risk due to preexisting airway obstruction. Pulmonary complications of patients with OSA who undergo cervical fusion have not been well studied. PURPOSE: This study aims to review rates of pulmonary complications following one- or two-level cervical fusion within patients with preexisting OSA. STUDY DESIGN/SETTING: Retrospective database study. PATIENT SAMPLE: Patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDF or one- or two-level PCF. OUTCOME MEASURES: Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia. METHODS: The PearlDiver insurance database was queried for Humana patients who were diagnosed with OSA within 1 year prior to undergoing one- or two-level ACDF (CPT-22548, CPT-22551, CPT-22552, CPT22554, CPT-22585) or one- or two-level PCF (CPT-22590, CPT-22595, CPT-22600, CPT-22614) between 2005 and 2015. The search resulted in 3,748 patients who had OSA prior to ACDF, 24,838 patients who did not have OSA prior to ACDF, 543 patients who had OSA prior to PCF, and 4,034 patients who did not have OSA prior to PCF. Postoperative pulmonary complications that developed within three months following surgery, including: bronchitis, bronchiectasis, chronic airway obstruction, lung diseases, dyspnea, respiratory complications, and pneumonia were then compared between the four groups. RESULTS: Patients who were diagnosed with OSA within 1 year prior to undergoing cervical fusion were at a significantly greater risk for developing postoperative pulmonary complications. Patients with OSA who underwent ACDF showed greater rates of chronic airway obstruction 17.4% versus 8.9% (odds ratio [OR]=2.163, p<.001), bronchitis 7.6% versus 3.9% (OR=2.059, p<.001), dyspnea 16.1% versus 9.7% (OR=2.004, p<.001), lung diseases 8.1% versus 5.5% (OR=1.534, p<.001), and pneumonia 3.9% versus 2.7% (OR=1.476, p<.001). Patients with OSA who underwent PCF also showed greater risk of developing chronic airway
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.