Do Patients With High ASA Grades Benefit From CSM Surgery?: A Report From the Quality Outcomes Database.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Health Services Research

Background:

• Cervical spondylotic myelopathy (CSM) is a degenerative spinal condition affecting the neck.
• The impact of severe systemic illness on surgical outcomes for CSM is not well understood.
• Assessing surgical benefit in patients with comorbidities is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate if systemic illness severity influences surgical outcomes in patients with cervical spondylotic myelopathy (CSM).
• To compare patient-reported outcomes (PROs) and readmission rates between CSM patients with and without severe systemic illness.

Main Methods:

• Analysis of prospectively collected data from the Quality Outcomes Database CSM cohort.
• Utilized the American Association of Anesthesiology (ASA) grade to categorize patients into mild (ASA 1-2) and severe (ASA 3-4) systemic illness groups.
• Compared 90-day readmission rates and 24-month minimal clinically important differences (MCID) for PROs, including pain, disability, and quality of life.

Main Results:

• Patients with severe systemic illness (ASA 3-4) were older, had higher BMI, more comorbidities, and worse baseline PROs.
• The severe illness group experienced longer hospitalizations and higher rates of nonhome discharge and 90-day readmissions.
• Despite baseline differences and higher readmissions, both groups achieved similar rates of MCID for mJOA, pain, disability, and quality of life at 24 months.

Conclusions:

• Severe systemic illness in CSM patients is associated with poorer baseline function and increased perioperative complications, including higher 90-day readmission rates.
• Surgical intervention for CSM yields comparable long-term functional improvements and quality of life gains, regardless of systemic illness severity.
• These findings suggest that CSM patients with severe systemic illness can still benefit significantly from surgical treatment.