Revision Anterior Cervical Discectomy and Fusion and Revision Cervical Arthroplasty Are Associated with Similar Outcomes: Real-World Analysis from a National Quality Registry.

Abstract

To utilize a national surgical quality registry to compare 30-day quality outcomes between repeat anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). The National Surgical Quality Improvement Project (NSQIP) Participant User Files (PUF) for the years 2005-2018 were queried for patients undergoing repeat ACDF and CDA using current procedural terminology (CPT) and International Classification of Disease (ICD)-9th version codes. We compared demographic and baseline clinical characteristics, operative characteristics, 30-day readmissions, reoperations, and complications between the two groups. We also performed multivariable analyses to assess the impact of the type of repeat procedure on outcomes of interest. A total of 3,957 patients were identified, of which 182 underwent revision/removal of arthroplasty, while 3,775 underwent revision or removal of fusion. Up to 4.6% of patients (n=179) in the repeat ACDF group had a complication, compared to 0.5% (n=1) in the CDA group. The 30-day readmission rate was found to be similar between the two groups (repeat-ACDF, 3.8% (n=145), vs. repeat-CDA, 2.2% (n=4); p=0.23). Similarly, 30-day reoperation rate was also not found to be different between the two groups (repeat-ACDF, 3.9% (n=149) vs. repeat-CDA, 2.7% (n=5); p=0.39). On multivariable analysis, removal or revision ACDF was found to be only significantly associated with an increased risk of 30-day complications (OR, 8.00; 95% CI, 1.07-59.79; p=0.04). Repeat ACDF or repeat CDA can be performed safely and are associated with optimal 30-day outcomes, comparable to those of index procedures. However, patients undergoing revision ACDF may be slightly more likely to have complications than those undergoing revision CDA.