P112. 30-day postoperative morbidity and readmissions following revision anterior cervical discectomy and fusion (ACDF)

Abstract

BACKGROUND CONTEXT Despite a 48% national increase in the incidence of revision anterior cervical fusions from 2007 to 2010, as well as higher inpatient costs and longer hospital length of stay as compared to primary ACDFs, current literature remains limited to with regard to how revision ACDF patients fare in the acute 30-day postoperative period. PURPOSE Utilizing a national surgical database, the current study was designed to understand the incidence and risk factors for adverse outcomes and re-admissions following a revision ACDF. Furthermore, as a secondary objective, the study evaluated the causes of re-admissions and re-operations in these patients. STUDY DESIGN/SETTING Retrospective cohort study performed using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. PATIENT SAMPLE The 2012-2016 ACS-NSQIP database files were queried using Current Procedural Terminology codes for ACDF (22551, 22554 and 63075) combined with Current Procedural Terminology codes 22830 (exploration of spinal fusion) or 22855 (removal of anterior instrumentation) to identify revision cases. Patients undergoing concurrent posterior cervical fusion and/or decompression (laminectomies/laminotomies) were excluded from the study. In addition, patients undergoing posterior segmental/non-segmental instrumentation and/or corpectomies were also excluded. OUTCOME MEASURES Thirty-day outcomes were categorized into severe adverse events (SAEs) and minor adverse events (MAEs). SAEs included the following – deep surgical site infection (SSI), organ/space SSI, wound disruption/dehiscence, unplanned intubation, postoperative ventilator use >48 hours, pulmonary embolism, deep venous thrombosis, myocardial infarction, cardiac arrest, stroke, acute renal failure, sepsis, septic shock, re-operation and death. MAEs included the occurrence of urinary tract infections, bleeding requiring transfusions, pneumonia, progressive renal insufficiency and superficial SSI. An additional variable defined as “any adverse event” or “AAE” recorded the presence of at least one SAE or MAE. METHODS Multi-variate logistic regression analyses were used to identify significant risk factors associated with experiencing adverse 30-day outcomes following revision ACDFs. Descriptive analyses were used to report the causes of readmissions and re-operations in these patients. RESULTS Out of a total of 1,140 patients, 51 (4.5%) experienced at least one adverse event (AAE), with 40 (3.5%) experiencing a severe adverse event (SAE) and 17 (1.5%) experiencing a minor adverse event (MAE). On multivariate analysis, AAEs were significantly associated with male gender (OR 1.98; p=0.023), 2-level vs 1-level fusion (OR 2.05; p=0.019) and a LOS>1 day (OR 7.70; p 1 day (OR 7.28; p 1 day was the only significant factor associated with a MAE (OR 14.65; p CONCLUSIONS In conclusion, 4.5 % of patients experience an adverse event following a revision ACDF with up to 3.4% experiencing a re-admission. The study is the also the first of its kind to analyze the risk factors for experiencing an adverse event following a revision ACDF. Providers should utilize these data to enhance the dissemination of knowledge regarding postoperative outcomes following a revision ACDF among hospital staff and/or patients to improve shared decision-making, reduce fragmentation of services and increase the quality of care to improve outcomes and curb costs in these high-risk patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.