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Postoperative complications in patients with sickle cell disease undergoing single-level anterior cervical discectomy
Gwyneth C Maloy1, Rushabh H Doshi1, Wesley Day1,2
1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, United States.
Insights
Patients with sickle cell disease (SCD) face significantly higher risks of complications, including adverse events and readmissions, after anterior cervical discectomy and fusion (ACDF) surgery compared to those without SCD.
Area of Science:
- Orthopedic Surgery
- Hematology
- Patient Safety
Background:
- Sickle cell disease (SCD) is a prevalent genetic disorder with increasing life expectancy.
- Individuals with SCD may develop accelerated degenerative disc disease, necessitating surgical consideration for anterior cervical discectomy and fusion (ACDF).
- Limited data exists on postoperative outcomes for SCD patients undergoing ACDF.
Purpose of the Study:
- To characterize 90-day postoperative outcomes in patients with sickle cell disease (SCD) undergoing anterior cervical discectomy and fusion (ACDF).
- To compare adverse events, readmissions, and emergency department visits between SCD patients and matched controls after ACDF.
Main Methods:
- A retrospective analysis of adult patients undergoing single-level ACDF from 2010 to 2021 was conducted using the PearlDiver database.
- Patients with SCD were matched 1:4 to controls based on age, sex, and Elixhauser Comorbidity Index (ECI).
- Ninety-day postoperative adverse events, readmissions, and emergency department visits were assessed and compared using statistical analyses, including multivariable logistic regression.
Main Results:
- The study identified 82 SCD patients and 324 matched controls.
- SCD patients exhibited significantly higher odds of any 90-day adverse events (OR 3.06), serious adverse events (OR 2.91), minor adverse events (OR 3.62), readmissions (OR 3.50), and emergency department visits (OR 3.64) (p < 0.05 for all).
- Specific complications with higher odds in SCD patients included pneumonia (OR 10.41), acute kidney injury (OR 6.65), deep vein thrombosis (OR 6.73), and sepsis (OR 5.30).
Conclusions:
- Patients with sickle cell disease (SCD) undergoing anterior cervical discectomy and fusion (ACDF) face substantially increased risks of postoperative complications.
- These findings highlight the need for enhanced perioperative care and monitoring for SCD patients undergoing ACDF.
- Further research is warranted to develop optimized management strategies for this high-risk surgical population.
Background:
Sickle cell disease (SCD) is the most common genetic disorder in the United States, affecting approximately 300,000 infants worldwide annually. As advancements in treatment have led to increased life expectancy for individuals with SCD, this population may be considered for anterior cervical discectomy and fusion (ACDF) due to potentially accelerated degenerative disc disease. The current study sought to characterize 90-day postoperative outcomes among SCD patients undergoing ACDF using matched cohorts.
Methods:
Adult patients undergoing single-level ACDF were identified from the 2010 to 2021 Q1 M151 PearlDiver database. Those with SCD were matched 1:4 to controls based on age, sex, and Elixhauser Comorbidity Index (ECI). The occurrence of 90-day postoperative adverse events, readmissions, and emergency department (ED) visits were assessed. Patient characteristics and postoperative outcomes were compared using Student's t-tests and chi-square tests. Multivariable logistic regression was performed to compare outcomes between the matched cohorts. p < 0.05 was considered statistically significant.
Results:
After matching, 82 SCD patients and 324 controls were identified. Patients with SCD had significantly higher odds of adverse events including: any 90-day adverse events (OR 3.06), serious adverse events (OR 2.91), minor adverse events (OR 3.62), readmissions (OR 3.50), and ED visits (OR 3.64) (p < 0.05 for all). In terms of individual adverse events, in decreasing OR order patients with SCD had higher odds of: pneumonia (OR 10.41), acute kidney injury (OR 6.65), deep vein thrombosis (OR 6.73), sepsis (OR 5.30), urinary tract infections (OR 3.43) (p < 0.05 for all).
Conclusions:
SCD patients undergoing single-level ACDF were found to have significantly higher odds of multiple postoperative complications compared to matched controls. These findings suggest that SCD patients may require more intensive perioperative care and monitoring to minimize such adverse outcomes. Further research is needed to optimize management strategies for this high-risk population.
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