TY - JOUR
T1 - Perioperative Neurological Complications Following Anterior Cervical Discectomy and Fusion
T2 - Clinical Impact on 317,789 Patients from the National Inpatient Sample
AU - Kashkoush, A.
AU - Mehta, Amol
AU - Agarwal, N.
AU - Nwachuku, Enyinna L.
AU - Fields, Daryl P.
AU - Alan, Nima
AU - Kanter, Adam S.
AU - Okonkwo, David O.
AU - Hamilton, David K.
AU - Thirumala, Parthasarathy D.
N1 - Publisher Copyright:
© 2019
PY - 2019/8
Y1 - 2019/8
N2 - Background: Perioperative neurologic complication after an anterior cervical discectomy and fusion (ACDF) is uncommon but may have significant clinical consequences. Objective: We aim to estimate the incidence of perioperative neurologic complications, identify their risk factors, and evaluate their impact on morbidity and mortality after ACDF. Methods: ACDF cases (n = 317,789 patients) were extracted from the National Inpatient Sample between 1999 and 2011. Based on their Elixhauser-van Walraven score (VWR), patients were classified as low (VWR < 5), moderate (5–14), or high risk (>14) for surgery. The primary outcome was perioperative neurologic complications. Secondary outcomes included morbidity (hospital length of stay >14 days or discharge disposition to a location other than home) and in-hospital mortality. Results: The rate of perioperative neurologic complications, morbidity, and mortality after ACDF was 0.4%, 8.4%, and 0.1%, respectively. Perioperative neurologic complications were highly associated with in-house morbidity (odds ratio [OR], 3.7 [3.1–4.4]) and mortality (OR, 8.0 [4.1–15.5]). The strongest predictors for perioperative neurologic complications were moderate- (OR, 3.1 [2.6–3.7]) and high-risk VWR (OR, 5.4 [3.3–8.9]), postoperative hematoma/seroma formation (OR, 5.4 [3.9–7.4]), and obesity (OR, 1.9 [1.6–2.3]). The rate of perioperative neurologic complications increased from 0.2% to 0.7% from 1999 to 2011, which was temporally associated with the rise in moderate- (P = 0.002) and high-risk patients (P = 0.001) undergoing ACDF. Conclusions: Perioperative neurologic complications are independent predictors of in-hospital morbidity and mortality after ACDF. Both morbidity and perioperative neurologic complications have increased between 1999 and 2011, which may be due, in part, to increasing numbers of moderate- and high-risk patients undergoing ACDF.
AB - Background: Perioperative neurologic complication after an anterior cervical discectomy and fusion (ACDF) is uncommon but may have significant clinical consequences. Objective: We aim to estimate the incidence of perioperative neurologic complications, identify their risk factors, and evaluate their impact on morbidity and mortality after ACDF. Methods: ACDF cases (n = 317,789 patients) were extracted from the National Inpatient Sample between 1999 and 2011. Based on their Elixhauser-van Walraven score (VWR), patients were classified as low (VWR < 5), moderate (5–14), or high risk (>14) for surgery. The primary outcome was perioperative neurologic complications. Secondary outcomes included morbidity (hospital length of stay >14 days or discharge disposition to a location other than home) and in-hospital mortality. Results: The rate of perioperative neurologic complications, morbidity, and mortality after ACDF was 0.4%, 8.4%, and 0.1%, respectively. Perioperative neurologic complications were highly associated with in-house morbidity (odds ratio [OR], 3.7 [3.1–4.4]) and mortality (OR, 8.0 [4.1–15.5]). The strongest predictors for perioperative neurologic complications were moderate- (OR, 3.1 [2.6–3.7]) and high-risk VWR (OR, 5.4 [3.3–8.9]), postoperative hematoma/seroma formation (OR, 5.4 [3.9–7.4]), and obesity (OR, 1.9 [1.6–2.3]). The rate of perioperative neurologic complications increased from 0.2% to 0.7% from 1999 to 2011, which was temporally associated with the rise in moderate- (P = 0.002) and high-risk patients (P = 0.001) undergoing ACDF. Conclusions: Perioperative neurologic complications are independent predictors of in-hospital morbidity and mortality after ACDF. Both morbidity and perioperative neurologic complications have increased between 1999 and 2011, which may be due, in part, to increasing numbers of moderate- and high-risk patients undergoing ACDF.
KW - Anterior cervical discectomy and fusion
KW - In-hospital outcomes
KW - Intraoperative neuromonitoring
KW - Mortality
KW - Perioperative neurologic complications
UR - http://www.scopus.com/inward/record.url?scp=85066237380&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2019.04.037
DO - 10.1016/j.wneu.2019.04.037
M3 - Article
C2 - 30980979
AN - SCOPUS:85066237380
SN - 1878-8750
VL - 128
SP - e107-e115
JO - World Neurosurgery
JF - World Neurosurgery
ER -