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Dysphagia Risk After Single vs Multi-level Anterior Cervical Discectomy and Fusion in Octogenarians: A Propensity
Christopher D Hamad1, Joshua Wiener1,2,3, Tim Gutierrez4
1Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA.
Study Design:
Retrospective cohort study.
Objective:
To evaluate the independent associations of operative extent and advanced age with postoperative dysphagia after anterior cervical discectomy and fusion (ACDF).
Summary Of Background Data:
Dysphagia is common after ACDF and may be especially consequential in octogenarians. The relative contributions of multi-level surgery and advanced age to dysphagia risk after adjustment for comorbidity remain unclear.
Methods:
We performed a retrospective cohort study using the TriNetX Research Network to identify patients aged 80 to 89 years undergoing ACDF from 2015 to 2023. Single-level ACDF was defined as CPT 22551 without 22552 and multi-level ACDF as CPT 22551 plus 22552. Cohorts were propensity score matched 1:1 on demographics and comorbidities. The primary outcome was new onset dysphagia at 0 to 2 weeks, 6 to 24 weeks, and 1 to 2 years. Secondary outcomes included aspiration pneumonia, reoperation, readmission, and mortality. Additional matched analyses compared octogenarians with younger patients aged 50 to 69 years stratified by operative extent.
Results:
After matching, 993 octogenarians remained in each operative extent cohort. Dysphagia was more frequent after multi-level versus single-level ACDF at 0 to 2 weeks (11.5% vs 8.0%; RR 1.44, 95% CI 1.10 to 1.90; P =0.008), but did not differ at later timepoints. Other major postoperative complications did not differ by operative extent. In age stratified analyses, octogenarians had higher dysphagia rates than younger patients at 0 to 2 weeks after both single-level ACDF (7.7% vs. 4.5%; RR 1.71, 95% CI 1.23 to 2.39; P =0.001) and multi-level ACDF (11.6% vs. 8.0%; RR 1.45, 95% CI 1.13 to 1.85; P =0.003), with differences resolving by 6 to 24 weeks.
Conclusions:
Multi-level ACDF in octogenarians is associated with higher acute dysphagia risk than single-level ACDF. Advanced age is associated with increased early dysphagia after both procedures, supporting focused counseling and early dysphagia mitigation strategies.
Level Of Evidence:
III.
