Anterior cervical discectomy and fusion in patients with preexisting dementia: Increased medical complications, costs, and 90-day readmissions

Abstract

Study designRetrospective-Cohort IntroductionDementia is among the most common health concerns for the aging population, characterized by steep cognitive decline and subsequent loss of independence. Limited orthopedic literature examines the influence that dementia has on patients undergoing elective spinal surgeries. MethodsEmploying the PearlDriver Database, a study population consisting of patients who underwent primary elective ACDF with a prior diagnosis of dementia were selected using Internal Classification Disease-9 (ICD) and ICD-10 codes. Patients with a history of trauma, infection, or malignancy were excluded. Patients with dementia were compared to matched controls via logistical regression accounting for patient demographics, medical comorbidities and levels operated on. Patients were assessed for 90-day outcomes including medical complications, emergency department visits, readmissions, one-year reoperation, hospital length of stay (LOS) and total operative hospitalization costs, and 90-day postoperative cost. ResultsThere were 4104 patients in the dementia group and 20,269 patients in the matched control group who underwent primary ACDF. Multivariate analysis showed that patients with dementia undergoing ACDF were associated with increased 90-day major and minor medical complications (p < 0.001). Patients with dementia were also associated with an increased risk of dysphagia (p < 0.001), 90-day ER visits(p < 0.001), 90-day readmissions(p < 0.001), and increased LOS(p < 0.001) following ACDF compared to the control group. Additionally, both total hospitalization costs and 90-day postoperative costs were higher in the dementia cohort(p < 0.001). ConclusionPreoperative dementia diagnosis in patients undergoing ACDF is associated with increased number of readmissions, hospitalization and 90-day costs, and postoperative medical complications. Level of evidence3