Abstract
BACKGROUND CONTEXT Outcomes following Anterior Cervical Discectomy and Fusion (ACDF) and Total Disc Replacement (TDR) procedures are known to be satisfactory; however, following ACDF, morbidity may be as high as 19%, and reoperation rates for TDR as high as 3%. Factors that may predict risks of developing complications are under-reported, with limited existing data. PURPOSE Therefore, this study sought to determine how complications varied among ACDF, TDR, and combined ACDF-TDR as well as what variables significantly impacted development of postoperative complications. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients who underwent ACDF and/or TDR from 2009 to 2011 with minimum 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 20,487 patients were included. OUTCOME MEASURES Demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) was used to identify all patients who underwent ACDF or TDR from 2009 to 2011 with minimum 2-year follow-up surveillance, and three cohorts were formed: ACDF, TDR, or combined ACDF-TDR. Primary data points collected included patient demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). Multivariate logistic regression models identified independent predictors of these outcomes. RESULTS A total of 20,487 patients identified, 19,808 underwent ACDF only, 449 underwent TDR, and 230 underwent a combined ACDF and TDR. There was a significant difference in age across the cohorts, the youngest of which was TDR (44.1 vs. ACDF 51.3 and ACDF-TDR 48.46 years, p CONCLUSIONS There were significant differences in the patient cohorts that underwent ACDF, TDR, or both procedures, where TDR patients were younger but incurred the least amount of hospital charges. Total Disc Replacement patients could expect increased rates of surgical complications and revisions in comparison to the other cohorts, and the procedure was found to predict surgical complications. This study of a large cohort of patients can provide surgeons and their patients with evidence to better individualize and optimize procedure choice for each patient.
Published Version
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