Comparing Predictors of Complications After Anterior Cervical Diskectomy and Fusion, Total Disk Arthroplasty, and Combined Anterior Cervical Diskectomy and Fusion-Total Disk Arthroplasty With a Minimum 2-Year Follow-Up

Shah, Neil V.; Jain, Ishaan; Moattari, Cameron R.; Beyer, George A.; Kelly, John J.; Hollern, Douglas A.; Newman, Jared M.; Stroud, Sarah; Challier, Vincent; Post, Nicholas H.; Lafage, Renaud; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie; Paulino, Carl B.; Diebo, Bassel G.

doi:10.5435/jaaos-d-19-00666

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…The most important feature for model performance is patient sex. Patient sex has been previously shown to be predictive of major complications and readmission in those undergoing anterior cervical fusion 36–38. We also show that comorbidities such as COPD, metastatic cancer, and protein-calorie malnutrition are important contributors to the accuracy of our ensemble model.…”

Section: Discussionmentioning

confidence: 53%

“…Patient sex has been previously shown to be predictive of major complications and readmission in those undergoing anterior cervical fusion. [36][37][38] We also show that comorbidities such as COPD, metastatic cancer, and protein-calorie malnutrition are important contributors to the accuracy of our ensemble model. In patients undergoing anterior cervical fusion, COPD has been implicated as a predictor of unplanned readmission and postoperative complications such as pneumonia.…”

Section: Discussionmentioning

confidence: 70%

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Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion

Shah¹,

Devana²,

Lee³

et al. 2022

Spine

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Study Design. A retrospective, case-control study. Objective. We aim to build a risk calculator predicting major perioperative complications after anterior cervical fusion. In addition, we aim to externally validate this calculator with an institutional cohort of patients who underwent anterior cervical discectomy and fusion (ACDF). Summary of Background Data. The average age and proportion of patients with at least one comorbidity undergoing ACDF have increased in recent years. Given the increased morbidity and cost associated with perioperative complications and unplanned readmission, accurate risk stratification of patients undergoing ACDF is of great clinical utility. Methods. This is a retrospective cohort study of adults who underwent anterior cervical fusion at any nonfederal California hospital between 2015 and 2017. The primary outcome was major perioperative complication or 30-day readmission. We built standard and ensemble machine learning models for risk prediction, assessing discrimination, and calibration. The best-performing model was validated on an external cohort comprised of consecutive adult patients who underwent ACDF at our institution between 2013 and 2020. Results. A total of 23,184 patients were included in this study; there were 1886 cases of major complication or readmissions. The ensemble model was well calibrated and demonstrated an area under the receiver operating characteristic curve of 0.728. The variables most important for the ensemble model include male sex, medical comorbidities, history of complications, and teaching hospital status. The ensemble model was evaluated on the validation cohort (n = 260) with an area under the receiver operating characteristic curve of 0.802. The ensemble algorithm was used to build a web-based risk calculator. Conclusion. We report derivation and external validation of an ensemble algorithm for prediction of major perioperative complications and 30-day readmission after anterior cervical fusion. This model has excellent discrimination and is well calibrated when tested on a contemporaneous external cohort of ACDF cases.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 70%

Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion

Shah¹,

Devana²,

Lee³

et al. 2022

Spine

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“…Multiple randomized controlled trials have compared the efficacy, complications, and patient reported outcomes following anterior cervical discectomy and fusion (ACDF) vs CDA. [7][8][9][10][11][12][13][14][15] As spine surgeons become more comfortable utilizing CDA within their practices, the annual healthcare utilization is impacted. Studies assessing primary and revision CDA procedural volume and complications are largely outdated and limited to periods prior to 2015.…”

Section: Introductionmentioning

confidence: 99%

Primary Cervical Disc Arthroplasty Among Medicare Beneficiaries Versus Alternative Payers: Is It Time to Consider Nationwide Coverage?

Gordon

Golub

Lam

et al. 2022

Global Spine Journal

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Study Design Retrospective cohort study. Objectives As of 2022, the Centers for Medicare and Medicaid Services does not provide nationwide coverage for cervical disc arthroplasty (CDA). The aim was to determine whether Medicare beneficiaries have differences in: (1) lengths of stay (LOS); (2) complications; (3) readmissions; and (4) costs of care. Methods Using the 2010 to 2020 PearlDiver database, we queried patients undergoing primary CDA for degenerative disc pathology. Study groups patients were those undergoing CDA with Medicare coverage (n = 1467); patients without Medicare coverage were the comparison cohort (n = 15,389). Endpoints were to compare demographics and comorbidities within the Elixhauser comorbidity index (ECI), LOS, 90-day complications, 90-day readmissions, and 90-day reimbursements. A multivariate logistic regression was used to calculate odds (OR) of medical complications and readmissions within 90-days. A P-value less than .003 was significant. Results Patients with Medicare coverage undergoing CDA had higher mean ECI compared to alternative payers (5.24 vs 3.26; P < .0001). Mean LOS was significantly higher for Medicare beneficiaries (2.20 vs 1.76 days; P < .010). There was no significant differences in odds of all medical complications (OR: 1.19, 95% CI: .98-1.44; P = .069) or readmission rates (1.77% vs 1.33%, OR:0.82, 95% CI: .50-1.29; P = .417) within 90-days following the index procedure among Medicare beneficiaries vs alternative payers. Non-Medicare beneficiaries had higher 90-day reimbursements compared to Medicare beneficiaries ($6,700 vs $7,086, P < .001). Conclusions Medicare beneficiaries despite having slightly longer lengths of stay did not have higher rates of medical complications or readmissions. Surgeons and policy makers may use this data to consider alternative treatments in Medicare patients.

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“…8 Likewise, Shah et al conducted a retrospective study of 16,510 patients from a state database and found that those who had undergone 1-or 2-level CDA had an increased risk for 2-year surgical complications, overall complications, and revisions compared to ACDF patients. 9 Furthermore, a systematic review by Xu et al found that rates for dysphagia/dysphonia ranged from 1.3% to 27.2%, rates for cervical wound infection ranged from 1.2% to 22.5%, rates for vascular compromise ranged from 1.1% to 2.4%, and rates for cerebrospinal fluid leak ranged from .8% to 7.1%. 10 There is a need to better identify risk factors for complications and worse outcomes in order to improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Influence of Surgeon Specialty on 30-day Outcomes Following Single-Level Cervical Disc Arthroplasty: A Propensity-Matched Analysis

Gupta

Hassan

Thomas

et al. 2022

Global Spine Journal

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Study Design Retrospective, propensity-matched analysis Objectives Cervical disc arthroplasty (CDA) is being increasingly utilized for cervical disc generation. Surgeon specialty has been shown to influence the risk for postoperative complications in spine surgery, but this has not yet been explored for CDA. Thus, the purpose of this study is to determine whether there is any difference in 30-day complications between patients undergoing single-level CDA by neurosurgeons vs by orthopaedic surgeons. Methods A retrospective, 1:1 propensity score matched analysis was performed using the NSQIP database from 2015 to 2020. Patient demographics, operative characteristics, and postoperative complications were recorded. Independent multivariate logistic regression models were constructed using the propensity-matched dataset to assess surgical specialty influence on any complication, any site complication, any operative infection, and any medical complications. Results 3179 single-level CDAs (28.8% orthopaedic surgery patients, 71.2% neurosurgery patients) were identified that met the inclusion criteria. Well-matched cohorts of 916 patients each were generated. After controlling for all possible confounders, orthopedic surgery specialty was not associated with a higher odds for any complication (OR: .87, 95% CI: .35 – 2.20, P = .7696), any site complication (OR: .32, 95% CI: .08 – 1.32, P = .1359), any operative infection (OR: .31, 95% CI: .07 – 1.34), P = .1172), nor any medical complication (OR: 2.11, 95% CI: .62 – 7.20, P = .2311) vs neurosurgery. Conclusion This is the first propensity-matched analysis to show that spine surgeon specialty does not influence the risk for any complication, any site complication, any operative infection, nor any medical complication following single-level CDA within the first 30 days after surgery.

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Comparing Predictors of Complications After Anterior Cervical Diskectomy and Fusion, Total Disk Arthroplasty, and Combined Anterior Cervical Diskectomy and Fusion-Total Disk Arthroplasty With a Minimum 2-Year Follow-Up

Cited by 8 publications

References 28 publications

Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion

Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion

Primary Cervical Disc Arthroplasty Among Medicare Beneficiaries Versus Alternative Payers: Is It Time to Consider Nationwide Coverage?

Influence of Surgeon Specialty on 30-day Outcomes Following Single-Level Cervical Disc Arthroplasty: A Propensity-Matched Analysis

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