Abstract
Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan–Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p < 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.
Highlights
Since 1958, when Cloward invented his approach for anterior cervical discectomy and fusion (ACDF), this surgery has become widely accepted for the management of medically refractory cervical myelopathy, as well as for radiculopathy [1,2,3,4,5]
A total of 6271 patients who underwent ACDF surgery between July 2011 and June 2013 were identified in the National Health Insurance Research Database (NHIRD) (Figure 1)
When looking into the details, re-admissions related to cervical spinal problems and those who required re-operations were not statistically different between the two groups
Summary
Since 1958, when Cloward invented his approach for anterior cervical discectomy and fusion (ACDF), this surgery has become widely accepted for the management of medically refractory cervical myelopathy, as well as for radiculopathy [1,2,3,4,5]. For patients who have received one- or two-level ACDF, there have been very high rates of satisfaction and low incidences of complications [6,7,8]. ACDF has gained popularity within recent decades owing to the advances made in biologics and instrumentation [9,10,11]. ACDF has become one of the most commonly performed surgeries in regular neurosurgical practice and has frequently resulted in excellent clinical outcomes.
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