Increased In-hospital Complications After Primary Posterior versus Primary Anterior Cervical Fusion
- First Online:
- 347 Downloads
Although anterior (ACDF) and posterior cervical fusion (PCDF) are relatively common procedures and both are associated with certain complications, the relative frequency and severity of these complications is unclear. Since for some patients either approach might be reasonable it is important to know the relative perioperative risks for decision-making.
The purposes of this study were to: (1) characterize the patient population undergoing ACDF and PCDF; (2) compare perioperative complication rates; (3) determine independent risk factors for adverse perioperative events; and (4) aid in surgical decision-making in cases in which clinical equipoise exists between anterior and posterior cervical fusion procedures.
The National Inpatient Sample was used and entries for ACDF and PCDF between 1998 and 2006 were analyzed. Demographics and complication rates were determined and regression analysis was performed to identify independent risk factors for mortality after ACDF and PCDF.
ACDF had a shorter length of stay and their procedures were more frequently performed at nonteaching institutions. The incidence of complications and mortality was 4.14% and 0.26% among patients undergoing ACDF and 15.35% and 1.44% for patients undergoing PCDF, respectively. When controlling for overall comorbidity burden and other demographic variables, PCDF was associated with a twofold increased risk of a fatal outcome compared with ACDF. Pulmonary, circulatory, and renal disease were associated with the highest odds for in-hospital mortality.
PCDF procedures were associated with higher perioperative rates of complications and mortality compared with ACDF surgeries. Despite limitations, these data should be considered in cases in which clinical equipoise exists between both approaches.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- 3.Browne JA, Cook C, Pietrobon R, Bethel MA, Richardson WJ. Diabetes and early postoperative outcomes following lumbar fusion. Spine (Phila Pa 1976). 2007;32:2214–2219.Google Scholar
- 11.Ghogawala Z, Comans JV, Benzel EC, Stabile LM, Barker FG 2nd. Ventral versus dorsal decompression for cervical spondylotic myelopathy: surgeons’ assessment of eligibility for randomization in a proposed randomized controlled trial: results of a survey of the Cervical Spine Research Society. Spine (Phila Pa 1976). 2007;32:429–436.Google Scholar
- 13.HCUP Comorbidity Software. Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; April 2009. Available at: www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Last modified April 24, 2009. Accessed May 14, 2009.
- 14.HCUP Databases. Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; July 2008. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Last modified July 11, 2008. Accessed May 14, 2009.
- 16.Introduction to the HCUP National Inpatient Sample (NIS) 2006. May 2008 Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP). Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/2006NIS_INTRODUCTION.pdf. Last modified May 14, 2008. Accessed May 14, 2009.
- 17.Kalanithi PS, Patil CG, Boakye M. National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine (Phila Pa 1976). 2009;34:1963–1969.Google Scholar
- 20.Marawar S, Girardi FP, Sama AA, Ma Y, Gaber-Baylis LK, Besculides MC, Memtsoudis SG. National trends in anterior cervical fusion procedures. Spine (Phila Pa 1976). 2010 Mar 5 [Epub ahead of print].Google Scholar
- 24.Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP Jr. Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine (Phila Pa 1976). 2006;31:897–902.Google Scholar
- 26.Publications from the HCUP Databases. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP). Available at: http://www.ahrq.gov/data/hcup/hcupref.htm. Accessed May 14, 2009.
- 27.Pull ter Gunne AF, Cohen DB. Incidence, prevalence and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976). 2009;34:1422–1428.Google Scholar
- 30.Veeravagu A, Patil CG, Lad SP, Boakye M. Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976). 2009;34:1869–1872.Google Scholar