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Patient factors rather than surgical approach are associated with readmission and reoperation for cervical
Gabrielle Santangelo1,2, Christopher Sollenberger1, Connor Wathen1
1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Background:
The prevalence of cervical spondylotic myelopathy (CSM) is increasing annually and represents a large burden of disability. Anterior cervical discectomy and fusion (ACDF), posterior cervical decompression (PCD), and PCD and fusion (PCDF) are commonly used surgical approaches to address this pathology. This single-institution retrospective cohort of ACDFs, PCDFs, and PCDs compares readmission rates and the incidence/indication for reoperation at 90-day, 1-year, and 2-year follow-up.
Methods:
Patients undergoing ACDF, PCD, or PCDF between 2013 and 2019 were identified using CPT codes. Charts were reviewed for demographics, surgical characteristics, and reoperations. Statistical analysis included t-tests for continuous variables and χ2 testing for categorical variables.
Results:
A total of 366 patients undergoing 175 ACDFs, 86 PCDFs, and 105 PCDs were included. Initial analysis of complications by surgical approach showed that the rate of reoperation was significantly higher in the PCDF group at 30-day and 1-year (P<0.001, P=0.003) with no difference at 2-year. Overall readmission rate over 1 year was 30.6%, and there was no significant difference between groups. Subsequent analyses demonstrated that patients undergoing PCDF or PCD had significantly higher Charleston Comorbidity Indices (CCI) than ACDF patients (P<0.001). Upon controlling for CCI in regression analyses, neither reoperation nor readmission rates varied significantly by surgical approach.
Conclusions:
In our cohort, we observe advantages and limitations for each surgical approach. On examination of patient factors, patients undergoing PCDF and PCD tended to have a higher burden of comorbidities compared to those treated via an anterior approach. Upon controlling for comorbidity index, the observed difference in reoperation rates was no longer apparent. Thus, patient comorbidities, rather than surgical approach, may be the major driver for postoperative complications for treatment of CSM.
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