Factors Affecting Outcomes in Anterior Cervical Spine Surgery

To evaluate procedure-related complications after ACSS and identify key influential factors that increase or decrease the risk of perioperative complications.

This single institution retrospective cohort study included 3401 patients who underwent ACSS by spine-surgeons at a single institution from January 2015 to August 2023. Our main outcome of interest was perioperative complications after ACSS, divided into objective and subjective outcomes. Covariates included patient, procedure, surgeon, and institutional factors. Univariable and multivariable logistic regression were used to identify factors associated with complications.

Our cohort included 3401 patients averaging 55 ± 12 years and 50% (n = 1689) were male. The objective complication rate was 4.44% (n = 151) and subjective complications were 6.70% (n = 228). Otolaryngologists were involved in 17% (n = 591) of cases. On multivariable logistic regression, high volume (≥ 15 annual cases) surgeons (OR: 0.58, 95% Cl: 0.35-0.95, p = 0.030), and otolaryngologist involvement in revision surgeries (OR: 0.31, 95% Cl: 0.12-0.77, p = 0.011) were independent predictors of decreased odds of objective complications. Advanced age (OR: 1.04, 95% Cl: 1.02-1.05, p < 0.001) and surgeries involving multiple (≥ 3) spinal levels (OR: 1.70, 95% Cl: 1.23-2.34, p = 0.001) independently predicted an increased odd of subjective complications. Otolaryngologist involvement in upper (C1-4) cervical spinal cases (OR: 0.28, 95% Cl: 0.08-0.96, p = 0.042) independently decreased odds of subjective complications.

Adopting a multidisciplinary approach with otolaryngologists as co-surgeons in complex procedures and increasing surgeons' case volume may improve surgical outcomes, decrease complication rates, and improve quality of care.