University of Connecticut School of Medicine, UConn Health, Farmington, CT.
Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT.
Spine (Phila Pa 1976). 2019 Dec 1;44(23):E1379-E1387. doi: 10.1097/BRS.0000000000003167.
Retrospective cohort study.
The aim of this study was to determine the differences in 30-day readmission, reoperation, and morbidity for patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) or single and multilevel anterior cervical corpectomy and fusion (ACCF).
Despite increasing rates of surgical treatment of cervical spine disease, few studies have compared outcomes by surgical technique. To the best of our knowledge, this is the only large-scale administrative database study that directly evaluates early outcomes between multilevel ACDF and single and multilevel ACCF.
Patients who underwent ACDF and ACCF were identified using the NSQIP database. Multivariate regression was utilized to compare rates of readmission, reoperation, morbidity, and specific complications between surgical techniques, and to evaluate for predictors of primary outcomes.
We identified 15,600 patients. ACCF independently predicted (P < 0.001) greater reoperation (odds ratio [OR] = 1.876) and morbidity (OR = 1.700), but not readmission, on multivariate analysis. ACCF was also associated with greater rates of transfusion (OR = 3.273, P < 0.001) and DVT/thrombophlebitis (OR = 2.852, P = 0.001). ACCF had significantly (P < 0.001) greater operative time and length of stay. In the cohort, increasing age (P < 0.001), diabetes (P = 0.025), chronic obstructive pulmonary disease (P = 0.027), disseminated cancer (P = 0.009), and American Society of Anesthesiologists (ASA) class ≥3 (P < 0.001) predicted readmission. Age (P = 0.011), female sex (P = 0.001), heart failure (P = 0.002), ASA class ≥3 (P < 0.001), and increased creatinine (P = 0.044), white cell count (P = 0.033), and length of stay (P < 0.001) predicted reoperation. Age (P < 0.001), female sex (P = 0.002), disseminated cancer (P = 0.010), ASA class ≥3 (P < 0.001), increased white cell count (P = 0.036) and length of stay (P < 0.001), and decreased hematocrit (P < 0.001) predicted morbidity. Within ACDF, three or more levels treated compared to two levels did not predict poorer 30-day outcomes.
Compared to multilevel ACDF, ACCF was associated with an 88% increased odds of reoperation and 70% increased odds of morbidity; readmission was similar between techniques. Older age, higher ASA class, and specific comorbidities predicted poorer 30-day outcomes. These findings can guide surgical solution given specific factors.
回顾性队列研究。
本研究旨在确定行多节段前路颈椎间盘切除融合术（ACDF）与单节段和多节段前路颈椎椎体切除术和融合术（ACCF）的患者在 30 天内再入院、再次手术和发病率方面的差异。
尽管颈椎疾病的手术治疗率不断上升，但很少有研究比较手术技术的结果。据我们所知，这是唯一一项直接评估多节段 ACDF 和单节段及多节段 ACCF 之间早期结果的大规模行政数据库研究。
使用 NSQIP 数据库确定行 ACDF 和 ACCF 的患者。采用多变量回归比较手术技术之间的再入院率、再次手术率、发病率和特定并发症发生率，并评估主要结局的预测因素。
我们共确定了 15600 名患者。ACCF 独立预测（P＜0.001）更高的再次手术（比值比[OR]＝1.876）和发病率（OR＝1.700），但多变量分析显示与再入院无关。ACCF 还与更高的输血率（OR＝3.273，P＜0.001）和 DVT/血栓性静脉炎（OR＝2.852，P＝0.001）相关。ACCF 还与更长的手术时间和住院时间有关（P＜0.001）。在该队列中，年龄增长（P＜0.001）、糖尿病（P＝0.025）、慢性阻塞性肺疾病（P＝0.027）、转移性癌症（P＝0.009）和美国麻醉医师协会（ASA）分级≥3（P＜0.001）预测再入院。年龄（P＝0.011）、女性（P＝0.001）、心力衰竭（P＝0.002）、ASA 分级≥3（P＜0.001）和肌酐升高（P＝0.044）、白细胞计数升高（P＝0.033）和住院时间延长（P＜0.001）预测再次手术。年龄（P＜0.001）、女性（P＝0.002）、转移性癌症（P＝0.010）、ASA 分级≥3（P＜0.001）、白细胞计数升高（P＝0.036）和住院时间延长（P＜0.001）以及血细胞比容降低（P＜0.001）预测发病率。在 ACDF 中，与处理两个节段相比，处理三个或更多节段并不预示 30 天内结局较差。
与多节段 ACDF 相比，ACCF 与再次手术的可能性增加 88%和发病率增加 70%相关；两种技术的再入院率相似。年龄较大、ASA 分级较高和特定合并症预测 30 天内结局较差。这些发现可以根据特定因素指导手术治疗方案。
3 级。
