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Incidence and Risk Factors for Dysphagia After Anterior Cervical Fusion

Singh, Kern MD*; Marquez-Lara, Alejandro MD*; Nandyala, Sreeharsha V. BA*; Patel, Alpesh A. MD, FACS; Fineberg, Steven J. MD*

doi: 10.1097/BRS.0b013e3182a3dbda
Cervical Spine

Study Design. Retrospective database analysis.

Objective. To determine the national incidence, mortality, and risk factors for dysphagia associated with anterior cervical spinal fusion surgery in the United States.

Summary of Background Data. Dysphagia is a known complication associated with anterior cervical fusion (ACF). A population-based database was analyzed to characterize the incidence of dysphagia in terms of demographics, mortality, and risk factors associated with ACF.

Methods. Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project were obtained from 2002 to 2009. Patients undergoing ACF for cervical myelopathy and/or radiculopathy were identified and separated into cohorts (1- to 2-level and 3+-level fusions), and incidences of dysphagia were identified. Demographics, length of stay, costs, mortality, and use of bone morphogenetic proteins (BMPs) were assessed. Statistical data were analyzed in SPSS (version 20), using the Student t test for discrete variables and the χ2 test for categorical data. Binomial logistic regression was used to identify independent predictors of dysphagia. A P value of less than 0.001 was used to denote significance.

Results. A total of 159,590 ACF cases were identified of which 139,434 were 1- to 2-level ACF and 20,156 were 3+-level ACF. The incidence of dysphagia in the 3+-level ACF group was double that of the 1- to 2-level ACF group (44.8 vs. 22.4 per 1000; P < 0.001). Patients with dysphagia were significantly older than patients without dysphagia (P < 0.001). Dysphagia was more common in males undergoing 1- to 2-level ACF (P < 0.001). BMP was used more frequently for patients with dysphagia in the 1- to 2-level ACF group (9.4% vs. 7.2% of cases; P < 0.001). Logistic regression analysis demonstrated that independent predictors for dysphagia included age (≥65 yr), male sex, 3+-level fusion, BMP use, and preoperative patient comorbidities.

Conclusion. Dysphagia occurs twice as often after 3+-level ACF compared with 1- to 2-level ACF. Utilization of BMP was also linked to an increased incidence of dysphagia in the 1- to 2-level ACF group. Regardless of the number of levels fused, patients experiencing dysphagia had increased age, comorbid risk factors, hospitalizations, and costs.

Level of Evidence: 3

A large population-based database retrospective analysis of 159,590 anterior cervical spinal fusion cases demonstrated a 2.5% incidence of postoperative dysphagia risk factors include 3+ level fusion, utilization of recombinant human bone morphogenetic protein, male sex, and preoperative patient comorbidities.

*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and

Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Ste #300, Chicago, IL 60612; E-mail:

Acknowledgment date: May 15, 2013. Acceptance date: June 30, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties, and stock/stock options.

© 2013 by Lippincott Williams & Wilkins