Turkish Neurosurgery 2021 , Vol 31 , Num 6
Revision Anterior Cervical Discectomy and Fusion and Revision Cervical Arthroplasty Are Associated with Similar Outcomes: Real-World Analysis from a National Quality Registry
Sung Huang LAURENT TSAI1,Mohammed Ali ALVI3,Saema TAZYEEN4,Yagiz YOLCU3,Saad JAVEED3,Arjun SEBASTIAN5,Brett A. FREEDMAN5,Mohamad BYDON3,Benjamin D. ELDER3
1Chang Gung Memorial Hospital at Keelung, Department of Orthopedic Surgery, Keelung, Taiwan and Chang Gung University, School of Medicine, Taoyuan, Taiwan
2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3Mayo Clinic, Department of Neurologic Surgery, Rochester, MN, USA
4Dubai Medical University, Dubai, United Arab Emirates
5Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
DOI : 10.5137/1019-5149.JTN.33270-20.4 AIM: To utilize a national surgical quality registry to compare 30-day quality outcomes between repeat anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA).

MATERIAL and METHODS: The National Surgical Quality Improvement Project (NSQIP) Participant User Files (PUF) for the years 2005-2018 were queried for patients undergoing repeat ACDF and CDA using current procedural terminology (CPT) and International Classification of Disease (ICD)-9th version codes. We compared demographic and baseline clinical characteristics, operative characteristics, 30-day readmissions, reoperations, and complications between the two groups. We also performed multivariable analyses to assess the impact of the type of repeat procedure on outcomes of interest.

RESULTS: A total of 3,957 patients were identified, of which 182 underwent revision/removal of arthroplasty, while 3,775 underwent revision or removal of fusion. Up to 4.6% of patients (n=179) in the repeat ACDF group had a complication, compared to 0.5% (n=1) in the CDA group. The 30-day readmission rate was found to be similar between the two groups (repeat-ACDF, 3.8% (n=145), vs. repeat-CDA, 2.2% (n=4); p=0.23). Similarly, 30-day reoperation rate was also not found to be different between the two groups (repeat-ACDF, 3.9% (n=149) vs. repeat-CDA, 2.7% (n=5); p=0.39). On multivariable analysis, removal or revision ACDF was found to be only significantly associated with an increased risk of 30-day complications (OR, 8.00; 95% CI, 1.07-59.79; p=0.04).

CONCLUSION: Repeat ACDF or repeat CDA can be performed safely and are associated with optimal 30-day outcomes, comparable to those of index procedures. However, patients undergoing revision ACDF may be slightly more likely to have complications than those undergoing revision CDA. Keywords : repeat ACDF, CDA, Cervical fusion, Cervical spine, Spine, Outcomes, NSQIP, 30-day outcomes, Cervical disc replacement, Cervical disc arthroplasty

Corresponding author : Benjamin D. ELDER, Elder.Benjamin@mayo.edu