Comparing Predictors of Complications After Anterior Cervical Diskectomy and Fusion, Total Disk Arthroplasty, and Combined Anterior Cervical Diskectomy and Fusion-Total Disk Arthroplasty With a Minimum 2-Year Follow-Up
| Autor: | Sarah G Stroud, Cameron R. Moattari, Bassel G. Diebo, Jared M. Newman, Vincent Challier, Douglas A. Hollern, Virginie Lafage, George A. Beyer, John J. Kelly, Frank J. Schwab, Carl B. Paulino, Nicholas H. Post, Peter G. Passias, Ishaan Jain, Neil V. Shah, Renaud Lafage |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Reoperation Total Disc Replacement medicine.medical_specialty Time Factors Heart Diseases medicine.medical_treatment Logistic regression Patient Readmission Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine Cervical diskectomy medicine Humans Internal fixation Orthopedics and Sports Medicine 030222 orthopedics business.industry 030229 sport sciences Middle Aged medicine.disease Prosthesis Failure Pulmonary embolism Surgery Spinal Fusion medicine.anatomical_structure Cervical Vertebrae Female Implant Pulmonary Embolism Complication business Negative Results Diskectomy Follow-Up Studies Cohort study Cervical vertebrae |
| Zdroj: | Journal of the American Academy of Orthopaedic Surgeons. 28:e759-e765 |
| ISSN: | 1940-5480 1067-151X |
| DOI: | 10.5435/jaaos-d-19-00666 |
| Popis: | INTRODUCTION Outcomes after anterior cervical diskectomy and fusion (ACDF) and cervical total disk arthroplasty (TDA) are satisfactory, but related morbidity and revision surgery rates are notable. This study sought to determine complication variations among ACDF, TDA, and combined ACDF-TDA as well as predictors of postoperative complications. METHODS Patients undergoing 1- to 2-level ACDF and/or TDA with at least a 2-year follow-up from 2009 to 2011 were identified from the Statewide Planning and Research Cooperative System database. Patient demographics, hospital-related parameters, mortality, and postoperative outcomes were compared, and their predictors were identified using multivariate logistic regression. RESULTS A total of 16,510 and 449 individuals underwent ACDF and cervical TDA, respectively, and 201 underwent ACDF-TDA. ACDF-TDA patients had the highest rates of cardiac complications and pulmonary embolism (PE) (P ≤ 0.006), whereas TDA patients had higher individual surgical and device/implant/internal fixation complications (P ≤ 0.025). ACDF-TDA patients experienced the lowest rate of revisions. Cervical TDA increased the odds of any surgical complications (OR = 2.5, P = 0.002), overall complications (OR = 1.57, P = 0.034), and revisions (OR = 2.29, P < 0.001). Deyo index predicted any medical/surgical complications (OR = 1.43 and 1.19, respectively). Female sex was associated with increased odds of readmission (OR 1.30, P < 0.001) but was protective against medical complications (OR = 0.81, P = 0.013). DISCUSSION Combined ACDF-TDA procedures were not associated with increases in 2-year individual or overall complications, readmissions, or revisions. LEVEL OF EVIDENCE Level 3-Therapeutic study. |
| Databáze: | OpenAIRE |
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