Background: 

Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are attractive targets for transition to the outpatient setting. We assessed the prevalence of rapid responses and major complications in the inpatient setting following 1 or 2-level ACDFs and CDAs. We evaluated factors that may place patients at greater risk for a rapid response or a postoperative complication.

Methods: 

This was an institutional review board-approved, retrospective cohort study of adults undergoing 1 or 2-level ACDF or CDA at 1 hospital over a 2-year period (2018 and 2019). Data on patient demographic characteristics, surgical procedures, and comorbidities were collected. Rapid response events were identified by hospital floor staff and involved acute changes in a patient’s clinical condition. Complications were events that were life-threatening, required an intervention, or led to delayed hospital discharge.

Results: 

In this study, 1,040 patients were included: 888 underwent ACDF and 152 underwent CDA. Thirty-six patients (3.5%) experienced a rapid response event; 22% occurred >24 hours after extubation. Patients having a rapid response event had a significantly higher risk of developing a complication (risk ratio, 10; p < 0.01) and had a significantly longer hospital stay. Twenty-four patients (2.3%) experienced acute complications; 71% occurred >6 hours after extubation. Patients with a complication were older and more likely to be current or former smokers, have chronic obstructive pulmonary disease, have asthma, and have an American Society of Anesthesiologists (ASA) score of >2. The length of the surgical procedure was significantly longer in patients who developed a complication. All patients who developed dysphagia had a surgical procedure involving C4-C5 or more cephalad. Patients with a rapid response event or complication were more commonly undergoing revision surgical procedures.

Conclusions: 

Rapid response and complications are uncommon following 1 or 2-level ACDFs or CDAs but portend a longer hospital stay and increased morbidity. Revision surgical procedures place patients at higher risk for rapid responses and complications. Additionally, older patients, patients with chronic obstructive pulmonary disease or asthma, patients who are current or former smokers, and patients who have an ASA score of ≥3 are at increased risk for postoperative complications.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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明智地选择：基于住院患者早期并发症的门诊颈前路手术候选人的手术选择

背景： 

前路颈椎间盘切除融合术 (ACDF) 和颈椎间盘置换术 (CDA) 是过渡到门诊环境的有吸引力的目标。我们评估了 1 级或 2 级 ACDF 和 CDA 后住院环境中快速反应和主要并发症的发生率。我们评估了可能使患者面临快速反应或术后并发症风险更大的因素。

方法： 

这是一项机构审查委员会批准的回顾性队列研究，研究对象是在 2 年期间（2018 年和 2019 年）在 1 家医院接受 1 级或 2 级 ACDF 或 CDA 的成年人。收集了有关患者人口统计学特征、外科手术和合并症的数据。快速反应事件由医院工作人员确定，涉及患者临床状况的急剧变化。并发症是危及生命、需要干预或导致延迟出院的事件。

结果： 

在这项研究中，包括 1,040 名患者：888 名接受了 ACDF，152 名接受了 CDA。36 名患者 (3.5%) 经历了快速反应事件；22% 发生在拔管后 >24 小时。发生快速反应事件的患者发生并发症的风险明显更高（风险比 10；p < 0.01），住院时间也明显延长。24 名患者 (2.3%) 出现急性并发症；71% 发生在拔管后 >6 小时。出现并发症的患者年龄较大，更有可能是目前或曾经吸烟者、患有慢性阻塞性肺病、患有哮喘，并且美国麻醉医师协会 (ASA) 评分 > 2。发生并发症的患者的手术时间明显更长。所有发生吞咽困难的患者都接受过涉及 C4-C5 或更多头侧的外科手术。发生快速反应事件或并发症的患者更常接受翻修手术。

结论： 

1 级或 2 级 ACDFs 或 CDAs 后的快速反应和并发症并不常见，但预示着更长的住院时间和更高的发病率。翻修手术使患者面临快速反应和并发症的更高风险。此外，老年患者、患有慢性阻塞性肺疾病或哮喘的患者、现在或以前吸烟的患者以及 ASA 评分≥3 的患者发生术后并发症的风险增加。

证据等级： 

预后三级。有关证据等级的完整描述，请参阅作者须知。