General Session: MIS - Hall F
Presented by: J. Guntin
B. Haws(1), B. Khechen(1), A. Narain(1), F. Hijji(1), K. Cardinal(1), J. Guntin(1), K. Singh(1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
Introduction: Anterior cervical discectomy and fusion (ACDF) is a common and effective surgical therapy for symptoms associated with cervical radiculopathy and myelopathy. Postoperative complications after ACDF procedures can have a significant impact on clinical outcomes, patient satisfaction, and costs of healthcare utilization. Identifying predictive factors for complications after surgical procedures may allow for the modification of preoperative and postoperative care protocols to mitigate complication risk. Therefore, the objective of this study is to determine potential risk factors for the incidence of medical and surgical complications up to 2-years postoperatively after ACDF procedures.
Methods: Patients who underwent primary, 1-2 level ACDF were retrospectively reviewed. The incidence of medical and surgical complications up to 2-years postoperatively was determined for each patient. Patients were classified according to demographic, comorbidity, and procedural characteristics. Bivariate Poisson regression with robust error variance was utilized to determine if an association existed between the incidence of medical or surgical complications and patient demographic, comorbidity, and procedural characteristics. A final multivariate model including all patient and procedural characteristics as controls was created using backwards, stepwise regression until only those variables with p< 0.05 remained.
Results: 310 patients were included in this analysis. Upon bivariate analysis, age > 50 years was identified as a risk factor for medical complications up to 2-years after an ACDF procedure (Relative risk [RR] = 3.5, 95% Confidence Interval [CI] = 1.45-8.51, p=0.005). Additionally, bivariate analysis identified 2-level procedures as a risk factor for surgical complications up to 2-years after an ACDF procedure (RR = 3.2, 95% CI = 1.01-9.87, p=0.048). Upon multivariate analysis, age > 50 years was identified as an independent risk factor for medical complications (RR = 3.2, 95% CI = 1.50-6.96, p=0.003), while 2-level procedures were identified as an independent risk factor for surgical complications after an ACDF procedure (RR = 3.2, 95% CI = 1.02-9.98, p=0.046).
Conclusions: The results of this study demonstrate that older patient age and 2-level operations were independent risk factors for medical and surgical complications, respectively, following ACDF procedures. Patients with these risk factors should be counseled regarding the increased risk of postoperative complications. Additionally, those patients should undergo more vigilant monitoring during the intraoperative and postoperative period to aid in the prevention of these complications.