Patient factors outweigh procedure extent in infection risk after cervical disc arthroplasty

To determine the 90-day incidence of surgical site infection (SSI) after cervical disc arthroplasty (CDA), compare single versus multilevel procedures, and identify independent predictors of SSI.

We identified adult patients undergoing single- or multilevel cervical disc arthroplasty for elective/degenerative indications. Patients with malignancy, spinal infection, metastatic disease, or acute trauma were excluded, and continuous claims data for 1 year preoperatively and 90 days postoperatively were required. Demographics, comorbidities, and procedural extent were compared between patients with and without 90-day SSI. Multivariable logistic regression identified independent predictors of SSI after adjustment for demographic, procedural, and comorbidity variables. Significance was set at P < 0.001.

The overall 90-day SSI incidence was 1.9% (554/29,588). Rates were 2.0% after single-level CDA (390/19,483) and 1.6% after multilevel CDA (164/10,105). Multilevel CDA did not increase infection risk compared with single-level (OR 0.82, P = 0.035). Independent predictors included obesity (OR 1.90, P < 0.001), substance-related disorders (OR 1.74, P < 0.001), fluid and electrolyte disorders (OR 1.69, P < 0.001), coagulopathy or hemorrhagic disorders (OR 1.65, P < 0.001), and anemia (OR 1.52, P < 0.001).

CDA was associated with a low 90-day SSI rate. Infection risk appeared more closely related to patient comorbidity burden than to procedural extent. In this national cohort of patients selected for CDA, multilevel arthroplasty did not demonstrate increased adjusted odds of SSI, supporting preoperative optimization and risk-stratified counseling in appropriately selected patients.