Shillingford Jamal, Laratta Joseph, Hardy Nathan, Saifi Comron, Lombardi Joseph, Pugely Andrew J, Lehman Ronald A, Riew K Daniel
The Spine Hospital at Columbia University Medical Center, New York, NY, USA.
J Spine Surg. 2017 Dec;3(4):641-649. doi: 10.21037/jss.2017.12.04.
To compare the differences in the thirty-day postoperative outcomes between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF).
Patients undergoing primary single-level ACDF and CDA from 2010-2014 were identified by unique Current Procedural Terminology (CPT) codes within the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) database. Primary outcomes included surgical and medical complications, length of hospital stay (LOS), unplanned readmission, return to operating room, and mortality all occurring within 30 days of the initial procedure. Patients were propensity score-matched to reduce selection bias and differences in preoperative characteristics. Multivariate logistic regression models were utilized to determine associations between covariates and primary outcomes of interest.
Propensity score-matching produced a cohort of 1,305 patients with 652 (50.0%) ACDF and 653 (50.0%) CDA patients. There were no statistically significant differences in the development of major surgical or medical complications between the groups. ACDF patients experienced a significantly longer LOS (2.3±14.8 1.1±1.0 days, P=0.034) and unplanned hospital readmission (1.8% 0.2%, P=0.002). For ACDF patients, increased LOS [odds ratios (OR), 4.21; 95% confidence interval (CI), 1.29-13.73; P=0.017] and increased readmission (OR, 12.17; 95% CI, 1.16-127.23; P=0.037) persisted in the multivariate model. Elevated ASA classification, preoperative anemia and elevated white blood cell count (WBC) were also associated with a significantly increased LOS.
Although ACDF and CDA can be indicated for similar cervical pathologies, the latter can be performed safely and effectively with comparable perioperative risk of major complications. The increased readmission rate and LOS for patients undergoing ACDF may have significant impact on patient cost and outcomes.
比较颈椎间盘置换术（CDA）与颈椎前路椎间盘切除融合术（ACDF）术后30天的结果差异。
通过美国外科医师学会国家外科质量改进计划（NSQIP）数据库中的独特现行手术操作术语（CPT）编码，识别2010年至2014年接受初次单节段ACDF和CDA的患者。主要结局包括手术和医疗并发症、住院时间（LOS）、非计划再入院、返回手术室以及初次手术后30天内发生的死亡率。对患者进行倾向评分匹配以减少选择偏倚和术前特征差异。使用多变量逻辑回归模型来确定协变量与感兴趣的主要结局之间的关联。
倾向评分匹配产生了一个由1305名患者组成的队列，其中652名（50.0%）为ACDF患者，653名（50.0%）为CDA患者。两组之间主要手术或医疗并发症的发生没有统计学上的显著差异。ACDF患者的住院时间明显更长（2.3±14.8对1.1±1.0天，P = 0.034），非计划住院再入院率更高（1.8%对0.2%，P = 0.002）。在多变量模型中，ACDF患者住院时间延长[比值比（OR），4.21；95%置信区间（CI），1.29 - 13.73；P = 0.017]和再入院率增加（OR，12.17；95% CI，1.16 - 127.23；P = 0.037）仍然存在。美国麻醉医师协会（ASA）分级升高、术前贫血和白细胞计数（WBC）升高也与住院时间显著延长相关。
尽管ACDF和CDA可用于治疗相似的颈椎疾病，但后者可以安全有效地进行，且主要并发症的围手术期风险相当。ACDF患者再入院率和住院时间的增加可能对患者成本和结局产生重大影响。
