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Published on: August 6, 2019
Postoperative adverse events following 2-level hybrid cervical construct relative to 2-level anterior cervical
Philip P Ratnasamy1, Sahir S Jabbouri1, Michael J Gouzoulis1
1Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
Background Context:
ACDF has been the mainstay for managing degenerative cervical spine pathology and CDA has emerged as a possible alternative. Limited research exists comparing postoperative adverse events between 2-level hybrid constructs and 2-level ACDF.
Purpose:
To evaluate postoperative adverse events, readmissions, and 5-year survival to reoperation for patients undergoing 2-level cervical hybrid construct (anterior cervical discectomy at 1 level and fusion [ACDF] and cervical disc arthroplasty [CDA] at an adjacent level) relative to 2-level ACDF.
Study Design/Setting:
Retrospective database study.
Patient Sample:
Patients undergoing 2-level cervical hybrid constructs or 2-level ACDF were isolated from the PearlDiver M165Ortho 2010-2021 database, a large national billing claims database containing deidentified health information across all payer types and sites of care in the US.
Outcome Measures:
Incidence of 90-day postoperative adverse events in 2-level cervical hybrid construct patients and 2-level ACDF patients. Relative odds of 90-day adverse events for hybrid construct patients relative to ACDF patients. 5-year survival to reoperation.
Methods:
Two-level cervical hybrid construct and 2-level ACDF patients were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) scores. Odds of 90-day postoperative adverse events were compared between the 2 groups using multivariable analysis. Five-year survival to cervical spine reoperation was then assessed.
Results:
After matching, there were 1,417 patients in the hybrid construct group and 5,664 in the ACDF group. No significant differences were identified for 90-day individual adverse events, aggregated any adverse events, or readmissions. Further, no significant difference was identified for 5-year survival to reoperation.
Conclusions:
While consideration may be given to 2-level cervical hybrid constructs or 2-level ACDF, the current large-cohort comparison study could not determine differences in 90-day complications or 5-year reoperations between these surgical options to support 1 procedure over the other.
