P114. Incidence and predictors of prolonged length of stay and readmissions following cervical disc arthroplasty

Abstract

BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) has emerged as a viable alternative to discectomy and fusion in the treatment of degenerative disc disease, offering advantages in range of motion and more rapid return to work. While the number of disc replacements has rapidly increased in recent years, little is known regarding the rates and predictors of suboptimal postoperative outcomes. PURPOSE The purpose of this study was to identify the incidence and specific causes of readmissions and prolonged length of stay (LOS) following CDA. STUDY DESIGN/SETTING Analysis of prospectively collected registry data. PATIENT SAMPLE Patients undergoing cervical disc arthroplasty. OUTCOME MEASURES Postoperative complications, prolonged LOS, and 30-day readmissions. METHODS The 2012-2017 National Surgical Quality Improvement Program (NSQIP) database was employed to identify all patients undergoing cervical disc arthroplasty. A variety of variables, including demographics, comorbidities, operative characteristics, postoperative complications, LOS and 30-day readmissions were collected. Patients were considered to experience a prolonged LOS if they remained in the hospital for 2 or more days (>90th percentile). Bivariate statistical analysis followed by multivariable regression modeling was employed to identify significant predictors of readmissions and prolonged LOS. Specific causes of readmissions were identified for all patients who were readmitted within 30 days following surgery. RESULTS A total of 3,221 patients undergoing CDA were identified. Of these, 472 (14.7%) experienced a prolonged LOS. A total of 36 (1.1%) patients were readmitted within 30 days following surgery. The most common causes of readmission were infectious complications (n=4), followed by orthopedic adverse events, such as vertebral fracture (n=1), displacement of the prosthesis (n=1) and neck pain (n=2). Postoperative superficial wound infection (OR=73.8; p CONCLUSIONS Wound complications, including superficial wound infection and dehiscence, were significantly associated with prolonged LOS and were among the most common causes of readmission following CDA. Meticulous infection prophylaxis, which has been adopted in other areas of orthopedics such as hip and knee arthroplasty, may be beneficial in improving outcomes in this patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.