#460 Dysphagia Following Anterior Cervical Discetomy and Fusion: National Incidence and Risk Factors
Cervical Therapies and Outcomes
Poster Presented by: S. Yang
K.M. Bianco (1)
S. Yang (1)
S.P. Maier (1)
P. Passias (1)
M.C. Gerling (1)
(1) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
Introduction: A common complication following anterior cervical surgery, dysphagia can be defined as the decreased ability to swallow food or liquid. The incidence of dysphagia is thought to be underreported, which leads to significant morbidity, mortality, and associated costs. This study examines the incidence, risk factors, and related costs of dysphagia after anterior cervical discectomy and fusion (ACDF) procedures utilizing the National Inpatient Sample (NIS) database.
Methods: The NIS database was queried for patients undergoing ACDF procedures between 2003 and 2010 using corresponding ICD-9 diagnosis and procedure codes. Univariate and multivariate analyses were carried out to correlate the incidence of dysphagia with risk factors including number of surgical levels, mortality rates, length of hospital stay (LOS), medical expenses, and hospital characteristics of patients who developed dysphagia versus those that did not develop dysphagia. Multiple logistic regression controlled for age, gender, race/ethnicity, and Deyo comorbidity index to quantify the odds ratio (OR) for associated risk factors. Statistical significance was defined by p< 0.001, due to the large sample size.
Results: There were 71,852 ACDF procedures identified between the years of 2003 and 2010 in the NIS database, of which 87.3% had a 1-2 level fusion and 12.7% had 3 or more levels fused. The overall incidence of dysphagia for all ACDF procedures was 1.8%. The incidence of dysphagia was significantly higher for patients who received an ACDF on 3 or more levels vs. 1-2 levels (3.4% vs. 1.6%, p< 0.001, OR: 2.12). The incidence of dysphagia was significantly higher in teaching hospitals than non-teaching hospitals (p< 0.001, OR=1.11). The incidence of dysphagia varied between small, medium, and large hospital sizes (p< 0.001) and large hospitals had an increased risk dysphagia (OR=1.30). The incidence of dysphagia also varied according to hospital region (p< 0.001) and patients who received surgery in the midwest, south, or west had an increased risk of dysphagia compared to the northeast (OR=1.34, 1.12, 1.80). Patients with dysphagia had a longer LOS than those without dysphagia (5.9 vs. 2.4 days, p< 0.001). Furthermore, patients with dysphagia had higher total charges than patients without dysphagia ($59,550 vs. $37,097, p< 0.001). Patients who developed dysphagia had a higher incidence of mortality than those that did not develop dysphagia (0.4% vs. 0.2%, p< 0.001, OR: 2.37).
Discussion and Conclusion: The incidence of dysphagia following ACDF procedures is statistically correlated with the number of levels fused, increased hospital volume, and teaching hospitals. Furthermore, there is significant variability in dysphagia rates based on site geography. The incidence of dysphagia was statistically correlated with longer LOS and higher total hospital charges. It is important to note that patients who suffered from dysphagia had an increased risk of mortality, likely due to the increased risk of aspiration. The results indicate much lower dysphagia rates in ACDF procedures in the NIS database as compared to previously reported literature, which may be due to a reporting bias. The current analysis of the NIS database reveals that dysphagia is associated with longer LOS, increased costs, and increased risk of mortality; thus, improved reporting methods and increased awareness of dysphagia following ACDF procedures is imperative.