Cervical spondylotic myelopathy: complications and outcomes after spinal fusion

There is little information about in-hospital complication rates, adverse outcomes, and mortality after spinal fusion for cervical spondylotic myelopathy (CSM). The aim of this study was to report inpatient mortality, complications, and outcomes on a national level.

We used the National Inpatient Sample to identify 58,115 admissions of patients with CSM who underwent spinal fusion in the United States from 1993 to 2002. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on outcomes such as mortality, complications, discharge disposition, and length of stay.

A total of 58,115 patients with CSM underwent spinal fusion with an average mortality rate of 0.6%, a complication rate of 13.4%, and a mean length of stay of 4 days. Pulmonary (3.6%) and postoperative hemorrhages or hematomas (2.3%) were the most common complications reported. One postoperative complication led to a 4-day increase in mean length of stay, increased the mortality rate 20-fold, and added more than $10,000 to hospital charges. Multivariate analysis identified age, comorbidity, and admission type as the main predictors of mortality, complication rate, and adverse outcome. Patients aged > or =85 or 65 to 84 years had respective 44- and 14-fold increases in mortality, compared with patients in the 18- to 44-year age group. Patients older than 84 years had a 40-fold increase in adverse outcomes and a 5-fold likelihood of medical complications. Patients with three or more comorbidities had an increased risk of medical complications (odds ratio [OR], 1.98), adverse discharge (OR, 2.17), and in-hospital mortality (OR, 2.36). Elective admissions were associated with much lower rates of mortality (OR, 0.28), complication (OR, 0.68), and adverse outcome (OR, 0.26). Complications were greater for posterior fusion (16.4%) versus anterior fusion (11.9%) procedures. Anterior fusions were associated with a greater incidence of dysphagia (3%) and hoarseness (0.21%). Cervical spondylosis patients who presented without myelopathy had a much lower incidence of complications (6.3%).

We provide a national estimate of inpatient complications and outcomes after spinal fusion for CSM patients in the United States. We demonstrate the impacts of age, complications, and medical comorbidities on the outcome of surgery for patients with this common disorder. We provide complication rates stratified by age and medical comorbidities for elderly patients who present with CSM who need spinal fusion.