Elderly Age as a Risk Factor for 30-Day Postoperative Outcomes Following Elective Anterior Cervical Discectomy and Fusion

Capua, John Di; Somani, Sulaiman; Kim, Jun; Phan, Kevin; Lee, Nathan J.; Kothari, Parth; Cho, Samuel K.

doi:10.1177/2192568217699383

Cited by 38 publications

(33 citation statements)

References 25 publications

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“…Increased age has been reported as a risk factor for extended LOS, hospital readmissions, and adverse events following ACDF. 14,16,20,[22][23][24]30 The average age in our extended LOS group was greater than 60 years of age, and the average age in our normal LOS group was 55 years old. Age 65 was independently associated with extended LOS; however, it was not associated with 90-day readmission rates.…”

Section: Discussionmentioning

confidence: 79%

“…Risk factors previously associated with extended LOS or hospital readmissions include advanced age, gender, race, insurance status, medical comorbidities, preoperative opioid use, preoperative anemia, and multiple-level surgery. [13][14][15][16][17][18][19][20][21][22][23][24][25] The purpose of our study was to identify independent risk factors for extended LOS and 90-day readmission rates following ACDF surgery.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Dial

Esposito

Danilkowicz

et al. 2019

Global Spine Journal

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Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Dial

Esposito

Danilkowicz

et al. 2019

Global Spine Journal

View full text Add to dashboard Cite

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“…There was one study which utilized the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database to analyze the complications after ACDF. It demonstrated that, by multivariate logistic regression, aging was associated with pulmonary complications, UTI, cardiac complication, and sepsis [ 32 ]. There was also another large cohort study that revealed similar findings for older patients undergoing ACDF [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Radiological and clinical outcomes of cervical disc arthroplasty for the elderly: a comparison with young patients

Chang

Huang

et al. 2019

BMC Musculoskelet Disord

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BackgroundThis study aimed to investigate whether cervical disc arthroplasty (CDA) would be equally effective in elderly patients as in the young. The inclusion criteria of published clinical trials for CDA-enrolled patients covered the ages from 18 to 78 years. However, there was a paucity of data addressing the differences of outcomes between older and the younger patients.MethodsA series of consecutive patients who underwent one- or two-level CDA were retrospectively reviewed. Patients at the two extreme ends of the age distribution (≥65 and ≤ 40 years) were selected for comparison. Clinical outcome parameters included visual analog scale (VAS) of neck and arm pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiographic outcomes included range of motion (ROM) at the indexed level and evaluation of heterotopic ossification (HO) by computed tomography (CT). Complication profiles were also investigated.ResultsThere were 24 patients in the elderly group (≥65 years old) and 47 patients in the young group (≤40 years old) with an overall mean follow-up of 28.0 ± 21.97 months. The elderly group had more two-level CDA, and thus the mean operative time was longer (239 vs. 179 min, p < 0.05) than the young group. Both groups had similarly significant improvement in clinical outcomes at the final follow-up. All the replaced disc segments remained mobile on post-operative lateral flexion and extension radiographs. However, the elderly group had a slight decrease in mean ROM (− 0.32° ± 3.93°) at the index level after CDA when compared to that of pre-operation. In contrast, the young group had an increase in mean ROM (+ 0.68° ± 3.60°). The complication profiles were not different, though a trend toward dysphagia was noted in the elderly group (p = 0.073). The incidence or severity (grading) of HO was similar between the two groups.ConclusionsDuring the follow-up of two years, CDA was equally effective for patients over 65 years old and those under 40 years in clinical improvement. Although the elderly group demonstrated a small reduction of mean ROM after CDA, in contrast to the young group which had a small increase, the segmental mobility was well preserved at every indexed level for each group.

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“…Increasing age has been shown to be associated increased risk of 30-day postoperative complications and also is an independent risk factor for increased morbidity and increased stay in hospital. [13141516] Males are more prone to develop cervical degenerative disc disease. [1718192021222324] Higher incidence of spondylosis changes in population with increasing age and in males was reported by Sasaki et al .…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation and outcome after anterior cervical discectomy and fusion for degenerative cervical disc disease

Srikhande

Kiran

Ghosh

et al. 2019

J Craniovert Jun Spine

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Background: Anterior cervical discectomy and fusion (ACDF) is a well-described surgical approach for symptomatic degenerative cervical disc disease which does not respond to conservative management. In the present study, we assessed clinical presentation and outcomes of ACDF. Materials and Methods: The present study was conducted from October 1, 2015, to October 31, 2017, in the Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, among 100 consecutive adult patients who underwent single- or two-level ACDF for degenerative cervical disc disease. Results: The mean age was 47.2 ± 12.8 years (range: 20–74 years). Majority of the patients were male (86/100). Presenting symptoms were neck pain (77%), limb weakness (73%), paresthesias (53%), radicular pain (49%), stiffness in limbs (16%), and bladder involvement (13%). Fusion was done with stand-alone titanium cage/bone graft or titanium cage/bone graft with anterior cervical plate. At the time of discharge, significant improvement in preoperative symptoms (neck pain [47/77-61%], radicular pain [31/49-63%], limb weakness [53/73-72.6%], paresthesias [44/53-83%], stiffness in limbs [13/16-81%], and bladder symptoms [8/13-61%]) was reported by majority of these patients. Majority of these patients also reported improvement in preoperative sensory deficits at the time of discharge. Postoperative complications were hoarseness of voice (22%), dysphagia (16%), deterioration of motor power (8%), and postoperative hematoma (7%). Conclusions: A significant proportion of patients with degenerative cervical disc disease show remarkable recovery after ACDF.

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Elderly Age as a Risk Factor for 30-Day Postoperative Outcomes Following Elective Anterior Cervical Discectomy and Fusion

Cited by 38 publications

References 25 publications

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Radiological and clinical outcomes of cervical disc arthroplasty for the elderly: a comparison with young patients

Clinical presentation and outcome after anterior cervical discectomy and fusion for degenerative cervical disc disease

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