122. Variation in 90-day neurological complications across increasing fusion levels for posterior cervical fusion: a five-year analysis

Abstract

BACKGROUND CONTEXT While neurological complications are known to occur following cervical fusions, few studies with sufficient power have quantified the difference in neurological outcomes as posterior cervical fusion (PCF) surgical invasiveness increases. PURPOSE Compare longer vs shorter PCF complication rates. STUDY DESIGN/SETTING Retrospective review of the New York State Statewide Planning and Research Cooperative System (SPARCS) database. PATIENT SAMPLE All patients undergoing ≥2 level PCF. OUTCOME MEASURES Ninety-day neurological or medical complications status post short-cervical (SC), long-cervical (LC), or long cervicothoracic (LCT). METHODS From the NYS Statewide Planning and Research Cooperative System (SPARCS) database, retrospective review of all patients who underwent ≥2 level PCF from 2009-13 with ≤ 90-day follow-up were identified and stratified by levels fused: 2-3 (SC), 4-8 (LC), and ≥ 9 (LCT). Data on demographics, hospital-related parameters, and 90-day neurological and other complications, readmissions, and revisions were collected. Regression analysis identified independent predictors of neurologic and overall complications. RESULTS A total of 6,981 patients were included (SC, n=2,964, LC, n=3,899, LCT, n=118). LC patients were older than SC and LCT (60.8 vs 58.2 and 56.1), while LCT patients were more often female (59.3% vs LC 42.1% and SC 44%) and had higher total charges ($187,996 vs LC $99,020 and SC $82,239) and LOS (12.4 vs 6.1 and 6.9 days), all p CONCLUSIONS Compared to 2-3 levels, longer PCF had higher C5-C7 nerve palsy rates (3.3%) and 70% increased odds of sustaining ≥1 neurological complication. Longer PCF was also associated with increased rates of medical and total complications. This data can improve the ability to counsel patients regarding the risks and expectations of potential adverse outcomes preceding cervical fusion via posterior or combined anterior-posterior approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.