Perez-Roman Roberto J, Luther Evan M, McCarthy David, Lugo-Pico Julian G, Leon-Correa Roberto, Vanni Steven, Wang Michael Y
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA.
Neurospine. 2021 Mar;18(1):147-154. doi: 10.14245/ns.2040452.226. Epub 2021 Mar 31.
Anterior cervical discectomy and fusion (ACDF) is the most common performed surgery in the cervical spine. Dysphagia is one of the most frequent complications following ACDF. Several studies have identified certain demographic and perioperative risk factors associated with increased dysphagia rates, but few have reported recent trends. Our study aims to report current trends and factors associated with the development of inpatient postoperative dysphagia after ACDF.
The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were selected. Time trend series plots were created for the yearly treatment trends for each fusion level by dysphagia outcome. Separate univariable followed by multivariable logistic regression analyses were performed to evaluate predictors of dysphagia.
A total of 1,212,475 ACDFs were identified in which 3.3% experienced postoperative dysphagia. A significant increase in annual dysphagia rates was observed from 2004-2014. Frailty, intraoperative neuromonitoring, 4 or more level fusions, African American race, fluid/electrolyte disorders, blood loss, and coagulopathy were all identified as significant independent risk factors for the development of postoperative dysphagia following ACDF.
Postoperative dysphagia is a well-known postsurgical complication associated with ACDF. Our cohort showed a significant increase in the annual dysphagia rates independent of levels fused. We identified several risk factors associated with the development of postoperative dysphagia after ACDF.
颈椎前路椎间盘切除融合术（ACDF）是颈椎最常施行的手术。吞咽困难是ACDF术后最常见的并发症之一。多项研究已确定了一些与吞咽困难发生率增加相关的人口统计学和围手术期风险因素，但很少有研究报告近期趋势。我们的研究旨在报告ACDF术后住院患者吞咽困难发生的当前趋势及相关因素。
对2004年至2014年的全国住院患者样本进行评估，选择具有国际疾病分类手术编码表明为ACDF的出院病例。根据吞咽困难结果，为每个融合节段的年度治疗趋势绘制时间趋势序列图。进行单变量分析，随后进行多变量逻辑回归分析，以评估吞咽困难的预测因素。
共识别出1,212,475例ACDF手术，其中3.3%的患者术后出现吞咽困难。2004年至2014年期间，吞咽困难的年发生率显著增加。虚弱、术中神经监测、4个或更多节段融合、非裔美国人种族、液体/电解质紊乱、失血和凝血障碍均被确定为ACDF术后吞咽困难发生的显著独立危险因素。
术后吞咽困难是与ACDF相关的一种众所周知的术后并发症。我们的队列显示，无论融合节段如何，吞咽困难的年发生率均显著增加。我们确定了一些与ACDF术后吞咽困难发生相关的危险因素。
