Department of Neurosurgery, Park Nicollet, Methodist Hospital, St. Louis Park, Minnesota, USA; Health Partners Institute, Bloomington, Minnesota, USA.
Health Partners Institute, Bloomington, Minnesota, USA.
World Neurosurg. 2023 Feb;170:e79-e114. doi: 10.1016/j.wneu.2022.10.072. Epub 2022 Oct 22.
OBJECTIVE: American College of Surgeons National Surgical Quality Improvement Program Participant Use File data from 2014 through 2019 were used to compare 1- and 2-level anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (cTDR) with respect to: patient demographics, comorbidities, adverse events, and 30-day morbidity rates. METHODS: One- and 2-level ACDF and cTDR patients were identified by current procedural terminology codes. Demographics, comorbidities, and adverse events were summarized. Unmatched cohorts were compared using Wilcoxon Rank Sum test for continuous variables, Pearson χ test for categorical variables, and 30-day morbidity using inverse probability of treatment weighted log-binomial regression. RESULTS: American College of Surgeons National Surgical Quality Improvement Program 2014 through 2019 Participant Use File datasets represent 4,862,497 unique patients, identifying 13,347 1-level, 6933 2-level ACDF, 3114 1-level, and 862 2-level cTDR patient cohorts. Statistically significant differences between cohorts are extensive: age, sex, race, admission status, patient origin, discharge disposition, emergent surgery, surgical specialty, American Society of Anesthesiologists classification, wound class, operative time, hospital LOS, BMI, functional status, smoking, diabetes, dyspnea, chronic obstructive pulmonary disease, congestive heart failure, hypertension, renal failure, dialysis, cancer, steroid use, anemia, bleeding disorders, systemic sepsis, and number of concurrent comorbid conditions. Inverse probability of treatment weighted log-binomial models, demonstrated increased risk of deep venous thrombosis/thrombophlebitis, pulmonary embolism, deep incisional surgical site infection, pneumonia, and unplanned return to operating room associated with ACDF while increased risk of cerebral vascular accident/stroke with neurological deficit and myocardial infarction associated with cTDR. The composite complications outcome favors cTDR over ACDF for 30-day morbidity. No mortalities occurred within the cTDR cohort. CONCLUSIONS: Adjusting for demographics and comorbidities; ACDF has a higher average risk of adverse event. When ACDF and cTDR are equipoise, consideration for cTDR may be indicated in populations with higher rates of comorbid conditions.
目的：利用美国外科医师学会国家外科质量改进计划参与者使用文件中 2014 年至 2019 年的数据，比较 1 级和 2 级颈椎前路椎间盘切除融合术（ACDF）和颈椎全椎间盘置换术（cTDR）在以下方面的差异：患者人口统计学特征、合并症、不良事件和 30 天发病率。
方法：通过当前程序术语代码识别 1 级和 2 级 ACDF 和 cTDR 患者。总结人口统计学特征、合并症和不良事件。使用 Wilcoxon 秩和检验比较非匹配队列的连续变量，使用 Pearson χ 检验比较分类变量，使用逆概率治疗加权对数二项回归比较 30 天发病率。
结果：美国外科医师学会国家外科质量改进计划 2014 年至 2019 年参与者使用文件数据集代表了 4862477 个独特的患者，确定了 13347 例 1 级、6933 例 2 级 ACDF、3114 例 1 级和 862 例 2 级 cTDR 患者队列。队列之间存在广泛的统计学差异：年龄、性别、种族、入院状态、患者来源、出院处置、紧急手术、手术专业、美国麻醉师协会分类、伤口分级、手术时间、住院时间、BMI、功能状态、吸烟、糖尿病、呼吸困难、慢性阻塞性肺疾病、充血性心力衰竭、高血压、肾衰竭、透析、癌症、类固醇使用、贫血、出血性疾病、全身败血症和同时存在的合并症数量。逆概率治疗加权对数二项模型表明，ACDF 与深静脉血栓形成/血栓性静脉炎、肺栓塞、深部切口手术部位感染、肺炎和计划外返回手术室的风险增加相关，而 cTDR 与中风和神经功能缺损以及心肌梗死的风险增加相关。30 天发病率的综合并发症结果有利于 cTDR 优于 ACDF。cTDR 队列中未发生死亡。
结论：在调整人口统计学特征和合并症后；ACDF 的不良事件平均风险更高。当 ACDF 和 cTDR 势均力敌时，在合并症发生率较高的人群中，考虑使用 cTDR 可能是合理的。
Spine (Phila Pa 1976). 2019-5-1
N Am Spine Soc J. 2024-3-6
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