National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

Abstract

Anterior cervical discectomy and fusion (ACDF) is the most common performed surgery in the cervical spine. Dysphagia is one of the most frequent complications following ACDF. Several studies have identified certain demographic and perioperative risk factors associated with increased dysphagia rates, but few have reported recent trends. Our study aims to report current trends and factors associated with the development of inpatient postoperative dysphagia after ACDF. Methods: The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were selected. Time trend series plots were created for the yearly treatment trends for each fusion level by dysphagia outcome. Separate univariable followed by multivariable logistic regression analyses were performed to evaluate predictors of dysphagia. Results: A total of 1,212,475 ACDFs were identified in which 3.3% experienced postoperative dysphagia. A significant increase in annual dysphagia rates was observed from 2004-2014. Frailty, intraoperative neuromonitoring, 4 or more level fusions, African American race, fluid/electrolyte disorders, blood loss, and coagulopathy were all identified as significant independent risk factors for the development of postoperative dysphagia following ACDF. Conclusion:Postoperative dysphagia is a well-known postsurgical complication associated with ACDF. Our cohort showed a significant increase in the annual dysphagia rates independent of levels fused. We identified several risk factors associated with the development of postoperative dysphagia after ACDF.

Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

“…In the present study, we found a significantly higher incidence of complications in patients who underwent ACDF compared with those who underwent LAMP and LF, especially for dysphagia and pseudoarthrosis. Transient dysphagia was one of the most common postoperative complications following the ACDF procedure ( 23 ), a part of which was self-healing, whereas the others may suffer for a long time, severely impacting patients’ living quality. Because the site of operation and fixation with plate and graft were adjacent to the esophagus, patients who underwent the anterior cervical procedure were predisposed to suffer from dysphagia postoperatively, and this tendency was more evident as the operative segments increased ( 21 ).…”

Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery

“…However, the secondary data lacked clinical and radiological information; hence, a detailed investigation and interpretation was not possible. Usually, reoperation and complication rates as well as incurred costs were used as a indicator for outcomes 32 , 33 , 37 , 46 , 59 . Morishita et al 2 analyzed nationwide inpatient data in Japan to compare anterior and posterior decompression and fusion.…”

A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion

“… 111 According to a recent study, 1,212,475 ACDFs were performed in the United States between 2004 and 2014, accounting for more than 80% of cervical spine procedures. 118 The United States still dominated the institution publications: 11 of the 15 most productive institutions were affiliated to the United States ( Table 3 ), explaining why the United States leads the world in total publications.…”