Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases
Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases
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DOI：
10.1007/s00586-018-5570-8
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发表时间：
2018-06-01
影响因子：
2.8
通讯作者：
SooHoo, Nelson F.
中科院分区：
文献类型：
--
作者：
Kelly, Michael P.;Eliasberg, Claire D.;SooHoo, Nelson F.
本研究的目的是分析接受前路颈椎间盘切除融合术 (ACDF) 治疗颈椎退行性椎间盘疾病的患者和接受人工颈椎间盘置换术 (ACDA) 治疗长达 5 年随访的患者的围手术期并发症和随后的颈椎手术发生率。对加州全州卫生规划和发展办公室出院数据库进行了分析，分析了 2003 年至 2003 年间接受单级 ACDF 或 ACDA 的 18-65 岁患者。 2010 年。医疗合并症通过 CMS 病症类别进行识别。确定因手术短期并发症而再次入院的情况，并在 90 天以及 1 年、3 年和 5 年随访时计算随后的宫颈手术率。使用多变量回归模型来确定与并发症和随后的宫颈手术之间的关联，以纠正患者和提供者的特征。总共确定了 52,395 例符合条件的病例：50,926 例 ACDF 和 1469 例 ACDA。 ACDA 组再入院的情况较少见（OR：0.69，95% CI：0.48-1.0，p = 0.048）。随后的颈椎手术在 ACDF 组中在围手术期（手术后 90 天内）更为常见（ACDF 3.35% vs. ACDA 2.04%，OR：0.63，95% CI：0.44-0.92，p = 0.015）。术后 1 年、3 年和 5 年，两个队列之间的后续宫颈手术率相似。在迄今为止检查的最大的一组患者中，经过长达 5 年的随访，我们发现 ACDA 与 ACDF 对于单节段疾病没有保护作用。两个队列中的早期并发症都很罕见，这强调了大型队列研究对于研究罕见事件的危险因素的价值。这些幻灯片可以在电子补充材料下检索。[图形]。
The aim of this study was to analyze rates of perioperative complications and subsequent cervical surgeries in patients treated for cervical degenerative disc disease with anterior cervical discectomy and fusion (ACDF) and those treated with artificial cervical disc arthroplasty (ACDA) for up to 5-year follow-up.California's Office of Statewide Health Planning and Development discharge database was analyzed for patients aged 18-65 years undergoing single-level ACDF or ACDA between 2003 and 2010. Medical comorbidities were identified with CMS-Condition Categories. Readmissions for short-term complications of the procedure were identified and rates of subsequent cervical surgeries were calculated at 90-day and 1-, 3-, and 5-year follow-up. Multivariate regression modeling was used to identify associations with complications and subsequent cervical surgeries correcting for patient and provider characteristics.A total of 52,395 eligible cases were identified: 50,926 ACDF and 1469 ACDA. Readmission was less common in the ACDA group (OR: 0.69, 95% CI: 0.48-1.0, p = 0.048). Subsequent cervical spine surgery was more common in the ACDF group in the immediate perioperative period (within 90 days of surgery) (ACDF 3.35% vs. ACDA 2.04%, OR: 0.63, 95% CI: 0.44-0.92, p = 0.015). At 1-, 3-, and 5-year postoperatively, rates of subsequent cervical surgeries were similar between the two cohorts.We found no protective benefit for ACDA versus ACDF for single-level disease at up to 5-year follow-up in the largest cohort of patients examined to date. Early complications were rare in both cohorts stressing the value of large cohort studies to study risk factors for rare events.These slides can be retrieved under Electronic Supplementary Material.[GRAPHICS].