Nandyala Sreeharsha V, Marquez-Lara Alejandro, Fineberg Steven J, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA.
Spine J. 2014 Dec 1;14(12):2841-6. doi: 10.1016/j.spinee.2014.03.037. Epub 2014 Apr 3.
Cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) provide comparable outcomes for degenerative cervical pathology. However, revisions of these procedures are not well characterized.
The purpose of this study is to examine the rates, epidemiology, perioperative complications, and costs between the revision procedures and to compare these outcomes with those of primary cases.
This study is a retrospective database analysis.
A total of 3,792 revision and 183,430 primary cases from the Nationwide Inpatient Sample (NIS) database from 2002 to 2011 were included.
Incidence of revision cases, patient demographics, length of stay (LOS), in-hospital costs, mortality, and perioperative complications.
Patients who underwent revision for either one- to two-level cervical TDR or ACDF were identified. SPSS v.20 was used for statistical analysis with χ(2) test for categorical data and independent sample t test for continuous data. The relative risk for perioperative complications with revisions was calculated in comparison with primary cases using a 95% confidence interval. An alpha level of less than 0.05 denoted statistical significance.
There were 3,536 revision one- to two-level ACDFs and 256 revision cervical TDRs recorded in the NIS database from 2002 to 2011. The revision cervical TDR cohort demonstrated a significantly greater LOS (3.18 vs. 2.25, p<.001), cost ($16,998 vs. $15,222, p=.03), and incidence of perioperative wound infections (13.6 vs. 5.3 per 1,000, p<.001) compared with the ACDF revision cohort (p<.001). There were no differences in mortality between the revision surgical cohorts. Compared with primary cases, both revision cohorts demonstrated a significantly greater LOS and cost. Furthermore, patients who underwent revision demonstrated a greater incidence and risk for perioperative wound infections, hematomas, dysphagia, and neurologic complications relative to the primary procedures.
This study demonstrated a significantly greater incidence of perioperative wound infection, LOS, and costs associated with a TDR revision compared with a revision ACDF. We propose that these differences are by virtue of the inherently more invasive nature of revising TDRs. In addition, compared with primary cases, revision procedures are associated with greater costs, LOS, and complications including wound infections, dysphagia, hematomas, and neurologic events. These additional risks must be considered before opting for a revision procedure.
颈椎全椎间盘置换术（TDR）和颈椎前路椎间盘切除融合术（ACDF）在治疗颈椎退行性病变方面疗效相当。然而，这些手术的翻修情况尚无充分描述。
本研究旨在探讨翻修手术的发生率、流行病学特征、围手术期并发症及费用，并将这些结果与初次手术病例进行比较。
本研究为回顾性数据库分析。
纳入了2002年至2011年全国住院患者样本（NIS）数据库中的3792例翻修病例和183430例初次手术病例。
翻修病例的发生率、患者人口统计学特征、住院时间（LOS）、住院费用、死亡率及围手术期并发症。
确定接受一至两节段颈椎TDR或ACDF翻修手术的患者。使用SPSS v.20软件进行统计分析，分类数据采用χ²检验，连续数据采用独立样本t检验。与初次手术病例相比，计算翻修手术围手术期并发症的相对风险，并给出95%置信区间。α水平小于0.05表示具有统计学意义。
2002年至2011年NIS数据库中记录了3536例一至两节段ACDF翻修病例和256例颈椎TDR翻修病例。与ACDF翻修队列相比，颈椎TDR翻修队列的住院时间显著更长（3.18天对2.25天，p<0.001）、费用更高（16998美元对15222美元，p=0.03）以及围手术期伤口感染发生率更高（每1000例中13.6例对5.3例，p<0.001）（p<0.001）。两个翻修手术队列的死亡率无差异。与初次手术病例相比，两个翻修队列的住院时间和费用均显著更高。此外，接受翻修手术的患者相对于初次手术，围手术期伤口感染、血肿、吞咽困难及神经并发症的发生率和风险更高。
本研究表明，与ACDF翻修术相比，TDR翻修术围手术期伤口感染的发生率、住院时间和费用显著更高。我们认为这些差异是由于TDR翻修术本质上具有更强的侵入性。此外，与初次手术病例相比，翻修手术与更高的费用、住院时间以及包括伤口感染、吞咽困难、血肿和神经事件在内的并发症相关。在选择翻修手术之前，必须考虑这些额外的风险。
