Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The goal of this study was to compare 30-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) versus those after cervical disc replacement (CDR).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors used the 2013–2014 American College of Surgeons National Surgical Quality Improvement Program database. Included were adult patients who underwent first-time single-level ACDF or CDR for cervical spondylosis or disc herniation. Primary outcome measures were readmission and/or reoperation within 30 days of the original surgery. Logistic regression analysis was used to assess the independent effect of the procedure (ACDF or CDR) on outcome, and results are presented as odds ratios with 95% confidence intervals.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 6077 patients met the inclusion criteria; 5590 (92.0%) patients underwent single-level ACDF, and 487 (8.0%) patients underwent CDR. The readmission rates were 2.6% for ACDF and 0.4% for CDR (p = 0.003). When stratified according to age groups, only patients between the ages of 41 and 60 years who underwent ACDF had a significantly higher readmission rate than those who underwent CDR (2.5% vs 0.7%, respectively; p = 0.028). After controlling for patient age, sex, body mass index, smoking status, history of chronic obstructive pulmonary disease (COPD), diabetes, hypertension, steroid use, and American Society of Anesthesiologists (ASA) class, patients who underwent CDR were significantly less likely to undergo readmission within 30 days than patients who underwent ACDF (OR 0.23 [95% CI 0.06–0.95]; p = 0.041). Patients with a history of COPD (OR 1.97 [95% CI 1.08–3.57]; p = 0.026) or hypertension (OR 1.62 [95% CI 1.10–2.38]; p = 0.013) and those at ASA Class IV (OR 14.6 [95% CI 1.69–125.75]; p = 0.015) were significantly more likely to require readmission within 30 days. The reoperation rates were 1.2% for ACDF and 0.4% for CDR (p = 0.086), and multivariate analysis revealed that CDR was not associated with lower odds of reoperation (OR 0.60 [95% CI 0.14–2.55]; p = 0.492). However, increasing age was associated with a higher risk (OR 1.02 [95% CI 1.00–1.05]; p = 0.031) of reoperation; a 2% increase in risk per year of age was found.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patients who underwent single-level ACDF had a higher readmission rate than those who underwent single-level CDR in this study. When stratified according to age, this effect was seen only in the 41- to 60-year age group. No significant difference in the 30-day single-level ACDF and single-level CDR reoperation rates was found. Although patients in the ACDF group were older and sicker, other unmeasured covariates might have accounted for the increased rate of readmission in this group, and further investigation is encouraged.</jats:p></jats:sec>

Cervical Disc Replacement: Trends, Costs, and Complications

“…This may be due to the differing nature of the databases being used. The highest percentage of patients who underwent CDR were between ages 40 to 54 years old and approximately 50% were female, similar to other large database studies [18][19][20]. The most common complication (found in 12.3% of patients) in the first postoperative year after CDR was mechanical and/or bone-related, which included malpositioning of the implant, heterotrophic ossification, and adjacent disc degeneration.…”

Age Stratification of 30-Day Postoperative Outcomes Following Excisional Laminectomy for Extradural Cervical and Thoracic Tumors

“…When comparing reoperation rates among different types of spinal surgery, studies have found similar 30-day reoperation rates for adult deformity spinal surgery (5%), 47 but lower rates for ACDF (1.2%) and cervical disc arthroplasty (0.4%). 48 Age has been shown to be predictive of a higher risk of reoperation following ACDF. 48 Unplanned reoperation is taxing on a patient’s health and also drives increasing health care costs.…”

“… 48 Age has been shown to be predictive of a higher risk of reoperation following ACDF. 48 Unplanned reoperation is taxing on a patient’s health and also drives increasing health care costs. Under the Affordable Care Act, any cost associated with patient readmission up to 30 days following discharge becomes the financial burden of the hospital.…”

Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature

“…[21][22][23]29 Similarly, Bhashyam et al reported no significant differences with reoperation rates between ACDF and CDA. 30 However, the authors did find a higher readmission rate after ACDF that they attributed to the difference in age groups of each cohort. 30 In contrast, Skeppholmm et al reported higher rates of reoperation after CDA compared to ACDF, likely due to implant migration as both groups had no significant difference in reoperation due to adjacent segment disease.…”

“…10,28 In terms of revision and readmission rates, CDA appears to perform similarly, if not better, than ACDF. 17,[21][22][23][24]26,29,30 While some studies have demonstrated decreased rates of reoperation at the adjacent level after CDA, Kelly and colleagues noted no significant difference in secondary surgery when comparing arthroplasty to ACDF up to 5-year follow-up. [21][22][23]29 Similarly, Bhashyam et al reported no significant differences with reoperation rates between ACDF and CDA.…”