General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons’ Perceptions and Reported Data for Rates and Risk Factors

Abstract

Study Design:Survey study and retrospective review of prospective data.Objectives:To contrast surgeons’ perceptions and reported national data regarding the rates of postoperative adverse events following anterior cervical discectomy and fusion (ACDF) and to assess the accuracy of surgeons in predicting the impact of patient factors on such outcomes.Methods:A survey investigating perceived rates of perioperative complications and the perceived effect of patient risk factors on the occurrence of complications following ACDF was distributed to spine surgeons at the Cervical Spine Research Society (CSRS) 2015 Annual Meeting. The equivalent reported rates of adverse events and impacts of patient risk factors on such complications were assessed in patients undergoing elective ACDF from the National Surgical Quality Improvement Program (NSQIP).Results:There were 110 completed surveys from attending physicians at CSRS (response rate = 44%). There were 18 019 patients who met inclusion criteria in NSQIP years 2011 to 2014. The rates of 11 out of 17 (65%) postoperative adverse events were mildly overestimated by surgeons responding to the CSRS questionnaire in comparison to reported NSQIP data (overestimates ranged from 0.24% to 1.50%). The rates of 2 out of 17 (12%) postoperative adverse events were mildly underestimated by surgeons (range = 0.08% to 1.2%). The impacts of 5 out of 10 (50%) patient factors were overestimated by surgeons (range relative risk = 0.56 to 1.48).Conclusions:Surgeon estimates of risk factors for and rates of adverse events following ACDF procedures were reasonably nearer to national data. Despite an overall tendency toward overestimation, surgeons’ assessments are roughly appropriate for surgical planning, expectation setting, and quality improvement initiatives.

The Impact of Diabetes on Outcomes and Health Care Costs Following Anterior Cervical Discectomy and Fusion

“…Multiple limitations arise in this study due to the nature of ACDF procedures as well as having a limited sample size from a single institution. ACDF is known to have very low complication rates, 1 , 3 and thus a lack of significant differences between in-hospital complication rates between diabetic and nondiabetic patients may be a product of sample size limitations as opposed to a lack of differences. Additionally, the present results only account for adverse events occurring during the index hospital stay, and therefore may underestimate delayed complications, such as pseudoarthrosis.…”

“…Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed procedures for patients suffering from a wide spectrum of cervical spine pathologies, 1 including degenerative disc disease, myelopathy, radiculopathy, trauma, and infection. 2 , 3 Advantages to the procedure include low postoperative complication rates, 4 consistent good results, and relative procedural ease, thereby making it a popular surgical strategy for patients with maladies of the cervical spine.…”

Comparison of postoperative outcomes in patients with and without osteoporosis undergoing single-level anterior cervical discectomy and fusion

“…Anterior cervical decompression and fusion (ACDF) is commonly considered to address degenerative conditions of the cervical spine [1] , [2] , [3] , [4] , [5] , [6] . Noting that osteoporosis may be present in those being considered for ACDF [ 7 , 8 ], the correlation of osteoporosis with ACDF short- and longer-term outcomes is of interest as it may be associated with graft subsidence, bony union, and stresses on adjacent segments [9] , [10] , [11] .…”