Daniel-Diaz Aguilar1, Harsimran S Brara2, Shayan Rahman2, Jessica Harris3, Heather A Prentice3, Kern H Guppy4. 1. David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States. 2. Department of Neurosurgery, Kaiser Permanente, 4867 W Sunset Blvd., Los Angeles, CA, 90027, United States. 3. Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, San Diego, CA, 92108, United States. 4. Department of Neurosurgery, Kaiser Permanente Medical Group, 2025 Morse Ave., Sacramento, CA, 95825, United States. Electronic address: kern.h.guppy@kp.org.
Abstract
OBJECTIVES: Reported incidence of dysphagia after ACDFs has been as high as 79%. There, however, have been no studies that have specifically looked at developing a criteria for reducing the incidence of dysphagia for outpatient ACDFs. The aim of this study was to determine the risks factors for significant dysphagia that will exclude patients from outpatient single-level anterior cervical discectomy and fusions (ACDFs). PATIENTS AND METHODS: Using the Kaiser Permanente Spine registry database, between January 2009 and September 2013, we identified all inpatients (there were no outpatients) who underwent primary elective one-level ACDFs. A cohort of patients were identified with in-hospital length of stay (LOS) > 48 h in which the reason for continued admission was primarily significant dysphagia (DG). Patient's demographics and intraoperative data (ACDF levels (upper [C2-3, C3-4], middle [C4-5, C5-6], lower [C6-7, C7-T1]), and operative times (<100, 100-199, ≥ 200, minutes)) was used to determine risk factors for dysphagia. RESULTS: We found 747 single-level ACDF cases with a cohort of 239 (32.0%) who met the criteria for dysphagia (DG) with > 48 h admission. The DG group and non-dysphagia group (NDG) had similar demographics. Diabetes was excluded from regression analysis due to the low frequency. Compared to the lower spine level (C5-6, C7-T1), the upper spine level (C2-3, C3-4) ACDF had a higher likelihood for dysphagia (OR = 2.23, 95% CI = 1.35-3.68, p = 0.0016); no difference was found for middle spine level (C4-5, C5-6) ACDF. CONCLUSION: Single-level ACDF at the upper cervical spine (C2-3, C3-4) was found to be the only risk factor for dysphagia with LOS > 48 h based on inpatient data from a spine registry. Age, BMI category, gender, ASA classification, smoking, and operative time were not predictive factors. These findings should be used for excluding patients who undergo outpatient single-level ACDF surgery to reduce significant postoperative dysphagia.
OBJECTIVES: Reported incidence of dysphagia after ACDFs has been as high as 79%. There, however, have been no studies that have specifically looked at developing a criteria for reducing the incidence of dysphagia for outpatient ACDFs. The aim of this study was to determine the risks factors for significant dysphagia that will exclude patients from outpatient single-level anterior cervical discectomy and fusions (ACDFs). PATIENTS AND METHODS: Using the Kaiser Permanente Spine registry database, between January 2009 and September 2013, we identified all inpatients (there were no outpatients) who underwent primary elective one-level ACDFs. A cohort of patients were identified with in-hospital length of stay (LOS) > 48 h in which the reason for continued admission was primarily significant dysphagia (DG). Patient's demographics and intraoperative data (ACDF levels (upper [C2-3, C3-4], middle [C4-5, C5-6], lower [C6-7, C7-T1]), and operative times (<100, 100-199, ≥ 200, minutes)) was used to determine risk factors for dysphagia. RESULTS: We found 747 single-level ACDF cases with a cohort of 239 (32.0%) who met the criteria for dysphagia (DG) with > 48 h admission. The DG group and non-dysphagia group (NDG) had similar demographics. Diabetes was excluded from regression analysis due to the low frequency. Compared to the lower spine level (C5-6, C7-T1), the upper spine level (C2-3, C3-4) ACDF had a higher likelihood for dysphagia (OR = 2.23, 95% CI = 1.35-3.68, p = 0.0016); no difference was found for middle spine level (C4-5, C5-6) ACDF. CONCLUSION: Single-level ACDF at the upper cervical spine (C2-3, C3-4) was found to be the only risk factor for dysphagia with LOS > 48 h based on inpatient data from a spine registry. Age, BMI category, gender, ASA classification, smoking, and operative time were not predictive factors. These findings should be used for excluding patients who undergo outpatient single-level ACDF surgery to reduce significant postoperative dysphagia.