Study Design: 

Retrospective cohort.

Objective: 

The largest published cohort of anterior cervical discectomy and fusion (ACDF) patients was queried to better characterize demographic and operative factors that predict 90-day complication and 2-year reoperation risk.

Summary of Background Data: 

The MarketScan Database was queried from 2007 to 2016 to identify adult patients until 65 years, who underwent an ACDF procedure using International Classification of Diseases 9th Version (ICD-9) and Current Procedural Terminology (CPT) codes. MarketScan is a national insurance claims database that contains millions of patient records across all 50 states.

Methods: 

Multivariate logistic regression was used to identify factors associated with complications until 90 days and reoperations until 2 years.

Results: 

Of 138,839 ACDF procedures, 8500 patients (6.1%) experienced a complication within 90 days of the ACDF, and 7433 (5.4%) underwent surgical revision by 2 years. While the use of anterior cervical plating did not predict 2-year reoperation, it was associated with dramatically reduced 90-day complication risk (adjusted odds ratio [aOR]: 0.32; 95% confidence interval [CI]: 0.30–0.34; P<0.001). Upon multivariate analysis, female sex (aOR: 0.83; 95% CI: 0.79–0.87; P<0.001) was associated with decreased risk of 2-year reoperation, while depression predicted a 50% increase in reoperation risk (aOR: 1.51; 95% CI: 1.43–1.59; P<0.001). The single largest factor associated with reoperation risk, however, was the presence of a 90-day postoperative complication (aOR: 1.79; 95% CI: 1.66–1.94; P<0.001).

Conclusion: 

Increased patient comorbidities and the use of bone morphogenic protein were found to increase the risk for postoperative complications, while cervical plating was associated with a strong decline in this risk. In addition, poor patient mental health outweighed the adverse of impact of other comorbidities on 2-year revision risk. The presence of a postoperative complication was the key modifiable risk factor associated with reoperation risk. Conclusions from this study may help surgeons better identify high-risk ACDF patients for more careful patient selection, counseling, informed consent, and management.

中文翻译：

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预测非老年成人人群颈椎前路椎间盘切除术和融合手术不良后果的因素

学习规划： 

回顾性队列。

客观的： 

对最大的已发表的颈椎前路椎间盘切除融合术 (ACDF) 患者队列进行了调查，以更好地描述预测 90 天并发症和 2 年再次手术风险的人口统计学和手术因素。

背景数据摘要： 

从 2007 年到 2016 年，对 MarketScan 数据库进行了查询，以识别 65 岁之前使用国际疾病分类第 9 版 (ICD-9) 和现行程序术语 (CPT) 代码接受 ACDF 程序的成年患者。MarketScan 是一个国家保险理赔数据库，包含全美 50 个州的数百万条患者记录。

方法： 

使用多变量逻辑回归来确定与 90 天前并发症和 2 年后再次手术相关的因素。

结果： 

在 138,839 例 ACDF 手术中，8500 名患者 (6.1%) 在 ACDF 后 90 天内出现并发症，7433 名患者 (5.4%) 在 2 年后接受了手术修复。虽然颈椎前路钢板的使用并不能预测 2 年再次手术，但它与显着降低的 90 天并发症风险相关（调整后比值比 [aOR]：0.32；95% 置信区间 [CI]：0.30–0.34；P < 0.001）。多变量分析显示，女性（aOR：0.83；95% CI：0.79-0.87；P <0.001）与 2 年再手术风险降低相关，而抑郁症则预示着再手术风险增加 50%（aOR：1.51；95） % CI：1.43–1.59；P <0.001）。然而，与再次手术风险相关的最大因素是术后 90 天并发症的存在（aOR：1.79；95% CI：1.66–1.94；P <0.001）。

结论： 

研究发现，患者合并症的增加和骨形态发生蛋白的使用会增加术后并发症的风险，而宫颈钢板则与这种风险的大幅下降相关。此外，患者心理健康状况不佳超过了其他合并症对 2 年翻修风险的不利影响。术后并发症的存在是与再次手术风险相关的关键可改变危险因素。这项研究的结论可能有助于外科医生更好地识别高危 ACDF 患者，以便更仔细地选择患者、提供咨询、知情同意和管理。