1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
J Neurosurg Spine. 2021 Oct 29;36(4):575-584. doi: 10.3171/2021.7.SPINE21478. Print 2022 Apr 1.
Hybrid surgery (HS) is the combination of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) at different levels in the same operation. The aim of this study was to investigate perioperative variables, 30-day postoperative outcomes, and complications of HS in comparison with those of CDA and ACDF.
The authors queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry for patients who underwent multilevel primary HS, CDA, and ACDF for degenerative disc disease from 2015 to 2019. The authors compared these three operations in terms of 30-day postoperative outcomes, specifically readmission and reoperation rates, discharge destination, and complications.
This analysis included 439 patients who underwent HS, 976 patients who underwent CDA, and 27,460 patients who underwent ACDF. Patients in the HS and CDA groups were younger, had fewer comorbidities, and myelopathy was less often the indication for surgery compared with patients who underwent ACDF. For the HS group, the unplanned readmission rate was 0.7%, index surgery-related reoperation rate was 0.3%, and nonroutine discharge rate was 2.1%. Major and minor complications were also rare, with rates of 0.2% for each. The mean length of stay in the HS group was 1.5 days. The association of HS with better outcomes in univariate analysis was not evident after adjustment for confounding factors.
The authors found that HS was noninferior to ACDF and CDA in terms of early postoperative outcomes among patients treated for degenerative disc disease.
杂交手术（HS）是在同一手术中对不同节段的前路颈椎间盘切除术和融合术（ACDF）与颈椎间盘置换术（CDA）进行联合。本研究旨在比较 HS 与 CDA 和 ACDF 的围手术期变量、术后 30 天结局和并发症。
作者在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）登记处查询了 2015 年至 2019 年因退行性椎间盘疾病接受多节段原发性 HS、CDA 和 ACDF 的患者。作者比较了这三种手术在术后 30 天结局（特别是再入院率和再次手术率、出院去向和并发症）方面的差异。
本分析纳入了 439 例接受 HS、976 例接受 CDA 和 27460 例接受 ACDF 的患者。HS 和 CDA 组的患者年龄较小，合并症较少，且与接受 ACDF 的患者相比，脊髓病作为手术指征的情况较少。HS 组的非计划再入院率为 0.7%，指数相关再次手术率为 0.3%，非常规出院率为 2.1%。主要和次要并发症也很少见，发生率均为 0.2%。HS 组的平均住院时间为 1.5 天。在调整混杂因素后，HS 与更好的单变量结果之间的关联并不明显。
作者发现，对于退行性椎间盘疾病患者，HS 在术后早期结局方面与 ACDF 和 CDA 相比不劣。
