Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The authors performed a population-based analysis of national trends, costs, and outcomes associated with cervical spondylotic myelopathy (CSM) in the United States. They assessed postoperative complications, resource utilization, and predictors of costs, in this surgically treated CSM population.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>MarketScan data (2006–2010) were used to retrospectively analyze the complications and costs of different spine surgeries for CSM. The authors determined outcomes following anterior cervical discectomy and fusion (ACDF), posterior fusion, combined anterior/posterior fusion, and laminoplasty procedures.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The authors identified 35,962 CSM patients, comprising 5154 elderly (age ≥ 65 years) patients (mean 72.2 years, 54.9% male) and 30,808 nonelderly patients (mean 51.1 years, 49.3% male). They found an overall complication rate of 15.6% after ACDF, 29.2% after posterior fusion, 41.1% after combined anterior and posterior fusion, and 22.4% after laminoplasty. Following ACDF and posterior fusion, a significantly higher risk of complication was seen in the elderly compared with the nonelderly (reference group). The fusion level and comorbidity-adjusted ORs with 95% CIs for these groups were 1.54 (1.40–1.68) and 1.25 (1.06–1.46), respectively. In contrast, the elderly population had lower 30-day readmission rates in all 4 surgical cohorts (ACDF, 2.6%; posterior fusion, 5.3%; anterior/posterior fusion, 3.4%; and laminoplasty, 3.6%). The fusion level and comorbidity-adjusted odds ratios for 30-day readmissions for ACDF, posterior fusion, combined anterior and posterior fusion, and laminoplasty were 0.54 (0.44–0.68), 0.32 (0.24–0.44), 0.17 (0.08–0.38), and 0.39 (0.18–0.85), respectively.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors' analysis of the MarketScan database suggests a higher complication rate in the surgical treatment of CSM than previous national estimates. They found that elderly age (≥ 65 years) significantly increased complication risk following ACDF and posterior fusion. Elderly patients were less likely to experience a readmission within 30 days of surgery. Postoperative complication occurrence, and 30-day readmission were significant drivers of total cost within 90 days of the index surgical procedure.</jats:p></jats:sec>

National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy

“…Prior studies have observed similar trends in surgical approaches. 2,22,28 Broadly, we found the trends seen in all cervical fusions held true for ACF and PCF. The ACF and PCF cohorts grew older and presented with a greater comorbidity burden over time, while outcomes improved and charges increased.…”

“…[3][4][5] Prior studies have assessed epidemiological trends, 6 compared the effectiveness of different surgical approaches, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and estimated the cost of the surgical management of CSM. 22,23 In 2005, an estimated 45 cervical fusions were performed per 100 000 Medicare beneficiaries, and CSM was the most common diagnosis made prior to these procedures. 2 While Wang et al quantified the rate of cervical fusions overall, it is currently unknown how national trends in cervical fusion for CSM specifically evolved over the last decade.…”

Efficacy and Safety of Surgery for Mild Degenerative Cervical Myelopathy: Results of the AOSpine North America and International Prospective Multicenter Studies

“…Although this rate of complication appears high, this is consistent with the contemporary literature, with reported complication rates ranging from 16% to 41% depending on surgical approach. 32 Further, studies have demonstrated the complication rate varies significantly with age, with elderly age being associated with significantly greater complication risk. 32 , 33 Although we had no mortalities in our cohort, postoperative complications in the setting of DCM have previously been shown to increase length of stay, mortality rate, and hospitalization costs.…”

Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65–74 Years) and Middle-Old Patients (Over 75 Years)

“…Bernstein et al 3 found that patients > 75 years old undergoing laminectomy or laminotomy were at higher risk of complication and mortality than younger patients. Veeravagu et al 18 found that older patients ( ≥ 65 years) had a significantly increased complication risk following ACDF and posterior fusion.…”