Anterior Cervical Discectomy and Fusion Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to Posterior Cervical Decompression and Fusion: A Propensity-Matched Analysis.

Autor: Ezzat B; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: bahie.ezzat@icahn.mssm.edu., Bhanot P; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Kalagara R; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Elkersh Y; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Ali M; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Laurore C; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Carr MT; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Schüpper AJ; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Qureshi HM; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA., Hrabarchuk E; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Quinones A; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Gal J; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Choudhri TF; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Nov 25. Date of Electronic Publication: 2024 Nov 25.
DOI: 10.1016/j.wneu.2024.10.145
Abstrakt: Introduction: Cervical disc herniation often necessitates surgery in elderly patients when nonoperative treatments fail. This study compares discharge outcomes of anterior cervical discectomy and fusion (ACDF) vs. posterior cervical decompression and fusion (PCDF) in geriatric patients.
Methods: A retrospective analysis of 8622 spine surgery patients (January 2008-December 2020) was performed. Geriatric patients (age ≥65) undergoing primary 2-4 level ACDF or PCDF were included. Propensity score matching (1:1) based on age, sex, ethnicity, body mass index, insurance, American Society of Anesthesiologists classification, Elixhauser comorbidity index, preoperative diagnosis, fusion levels, estimated blood loss, intraoperative transfusion, and procedure length was used. Discharge outcomes were dichotomized to home or nonhome.
Results: After matching, 122 patients (ACDF = 61, PCDF = 61) were analyzed. A larger proportion of ACDF patients were discharged home compared to PCDF (84% vs. 64%, P = 0.02). On binary logistic regression, younger age (OR = 0.88 [0.79, 0.98], P = 0.02), male sex (OR = 2.04 [1.79, 3.28], P = 0.001), lower estimated blood loss (OR = 0.99 [0.99, 0.99], P = 0.001), intraoperative transfusion (OR = 0.43 [0.22, 0.92], P = 0.03), and ACDF approach (OR = 4.34 [1.91, 6.77], P = 0.01) were significant predictors of home discharge.
Conclusions: ACDF in geriatric patients with cervical disc herniation was associated with higher rates of home discharge compared to PCDF. Tailored surgical approaches based on patient demographics may improve recovery outcomes.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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