#112 Trends in Complications after Cervical Spine Surgery from 2002-2009

Oral Posters: Cervical Arthroplasty

Presented by: K. Singh

Author(s):

M. Pelton (1)
S.J. Fineberg (1)
M. Oglesby (1)
K. Singh (1)
A. Patel (2)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, USA
(2) Northwestern University Feinberg School of Medicine, Orthopaedic Surgery, Chicago, IL, USA

Abstract

Introduction: The frequency of cervical spine surgery has increased in the United States. How this increasing surgical trend relates to the occurrence of complications after anterior cervical fusions (ACF), posterior cervical fusions (PCF) and posterior cervical decompressions (PCD) without instrumentation is largely unknown. The purpose of this study was to analyze a population-based database and describe national complication trends of these three procedures.

Methods: Data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project was obtained for each year from 2002-2009. Patients undergoing ACF, PCF, and PCD were identified. Ten categories of complications were tabulated between the three groups using corresponding ICD-9 codes. Patient demographics, co-morbidities, hospitalization duration, costs, and major complications were assessed. SPSS v.20 was used for statistical analysis using the χ2 test for categorical data. Spearman's Rank Order Correlation was used to assess the strength and direction of this 8-year trend. A p-value of 0.01 was used to denote statistical significance.

Results: A total of 273,396 cervical procedures were identified in the NIS database between 2002-2009. Patients undergoing PCF had greater co-morbidities, complication rates, longer hospitalizations, mortalities, and costs at all time points compared to ACF and PCD groups. Overall 8-year trends demonstrated increases in age, co-morbidities, and costs from 2002-2009 (p< 0.0005). Specifically, ACF and PCF had statistically significant increases in age, co-morbidity, overall complication rates, and hospital costs during this 8-year period. Total complications and total DVTs showed statistically significant increases spanning this time period. There was a significant increase in infections following ACF during this 8-year period (p=0.004). PCD-treated patients had a statistically significant increase in cardiac complications during this time period (p=0.004). ACF, PCF and PCD did not demonstrate statistically significant increases with respect to mortality rates or hospitalization durations from 2002-2009.

Discussion: The present findings demonstrate that across all time points, PCF patients had higher rates of cardiac complications, infections, overall post-operative complications, and hospital costs when compared to ACF and PCD. Our results suggest that the reason for these increases is the shifting trend of older patients with more comorbidities undergoing posterior cervical fusion. Despite trends of increasing age and comorbidities of ACF and PCF groups, respective mortality rates and lengths of stay did not statistically increase from 2002-2009. The increases in age and co-morbidities of all patients demonstrate the increasing challenges and complexity of spine surgery during this decade.

Table 1