Airway Compromise in Adults Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Postoperative airway compromise is a rare but significant complication following anterior cervical discectomy and fusion (ACDF). This systematic review and meta-analysis aims to determine the incidence of airway compromise in ACDF patients and identify associated risk factors to guide otolaryngologists in optimizing the airway.

Following PRISMA guidelines, CINAHL, Cochrane Library, PubMed, and Scopus were searched from inception to July 10, 2024.

Articles reporting the incidence of airway complications following ACDF were included. Primary outcome measures included proportions (%) and odds ratios (OR) with 95% confidence intervals (CI).

Of 449 abstracts identified, 42 studies (N = 960,092) were included. Among ACDF patients, the incidence of airway compromise was 0.78% [95% CI: 0.59-0.99], with unplanned reintubation occurring in 0.45% [95% CI: 0.35-0.57], delayed extubation in 1.5% [95% CI: 0.90-2.1], and tracheotomy in 0.54% [95% CI: 0.05-1.5] of patients. Patients who experienced airway compromise following ACDF demonstrated increased odds of having diabetes mellitus (OR: 2.05 [95% CI: 1.61-2.60]; p < 0.00001), pulmonary disease (OR: 3.44 [95% CI: 2.41-4.93]; p < 0.00001), and bleeding disorders or anticoagulant use at the time of surgery (OR: 3.06 [95% CI: 2.54-3.69]; p < 0.00001). ASA class 3 or 4 (OR: 4.55 [95% CI: 3.28-6.31]; p < 0.00001) and multilevel fusion (OR: 2.33 [95% CI: 1.41-3.84]; p = 0.001) were more common among those who experienced airway compromise.

Postoperative airway compromise is a rare but potentially lethal complication of ACDF. Preoperative identification of patient risk factors allows for tailored perioperative management by otolaryngologists and spine surgeons, minimizing the occurrence of airway compromise.