Jiang Sam Han, Nie James W, Chaudhry Nauman Shaukat, Patel Saavan, Ansari Darius, Ganesh Ashwin, Nie Jeffrey Z, Patel Jaimin, Mehta Ankit Indravadan
Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
Department of Neurosurgery, University of South Florida, Lakeland, FL, USA.
Asian Spine J. 2025 Jun;19(3):389-398. doi: 10.31616/asj.2024.0321. Epub 2025 Mar 4.
A retrospective case-control study.
To understand the risk factors for prolonged hospitalization following anterior cervical discectomy and fusion (ACDF) to reduce postoperative complications and better identify optimal candidates for elective ACDF.
Despite the proven safety of ACDF, many patients may experience prolonged postoperative hospitalization.
Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset spanning 2017-2019. The primary outcome of interest was the length of stay (LOS). The study population was divided into two cohorts: those with LOS ≤1 day and those with LOS >1 day. Univariate and multivariate analyses were performed to identify predictors of LOS >1 day. Propensity score matching and group comparisons were used to evaluate pre- and post-discharge complication rates between the cohorts.
A total of 12,906 patients with ACDF were identified in the database and considered eligible for the study. Of these patients, 69.5% had LOS ≤1 day and 30.5% had LOS >1 day. Factors associated with LOS >1 day included age ≥65 years, female sex, non-White race, American Society of Anesthesiologists classification 3, dependent functional status, and operation length of 120-150 minutes and >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative or postoperative blood transfusions (0.1% vs. 0.7%, p<0.001), unplanned reoperations (0% vs. 1.7%, p<0.001), and develop pneumonia during hospitalization (0% vs. 0.7%, p<0.001). These patients were also more likely to be readmitted (2.7% vs. 4.3%, p<0.001).
Older patients, those with poorer functional status, and those who undergo longer operative times are more likely to experience prolonged postoperative hospitalization. These patients are also at increased risk of complications such as pneumonia, blood transfusions, reoperation, and readmission. Careful patient selection for ACDF is essential to reduce the risk of prolonged hospitalization and associated complications.
一项回顾性病例对照研究。
了解颈椎前路椎间盘切除融合术（ACDF）后住院时间延长的危险因素，以减少术后并发症，并更好地确定择期ACDF的最佳候选者。
尽管ACDF已被证明具有安全性，但许多患者术后住院时间可能延长。
从美国外科医师学会国家外科质量改进计划数据集中收集2017 - 2019年的数据。主要关注的结果是住院时间（LOS）。研究人群分为两个队列：住院时间≤1天的患者和住院时间>1天的患者。进行单因素和多因素分析以确定住院时间>1天的预测因素。倾向评分匹配和组间比较用于评估队列之间出院前和出院后的并发症发生率。
数据库中总共识别出12906例接受ACDF的患者，并认为他们符合研究条件。在这些患者中，69.5%的患者住院时间≤1天，30.5%的患者住院时间>1天。与住院时间>1天相关的因素包括年龄≥65岁、女性、非白人种族、美国麻醉医师协会分级3级、依赖性功能状态以及手术时间为120 - 150分钟和>150分钟。住院时间>1天的患者更有可能接受术中或术后输血（0.1%对0.7%，p<0.001）、非计划再次手术（0%对1.7%，p<0.001），并在住院期间发生肺炎（0%对0.7%，p<0.001）。这些患者也更有可能再次入院（2.7%对4.3%，p<0.001）。
老年患者、功能状态较差的患者以及手术时间较长的患者术后住院时间延长的可能性更大。这些患者发生肺炎、输血、再次手术和再次入院等并发症的风险也增加。仔细选择ACDF患者对于降低住院时间延长及相关并发症的风险至关重要。
