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Comparative and Predictor Analysis of 30-day Readmission, Reoperation, and Morbidity in Patients Undergoing Multilevel ACDF Versus Single and Multilevel ACCF Using the ACS-NSQIP Dataset

Katz, Austen David MD; Mancini, Nickolas BS; Karukonda, Teja MD; Cote, Mark PT, DPT, MS, CTR; Moss, Isaac L. MD, MASc, FRCSC

doi: 10.1097/BRS.0000000000003167

Study Design. Retrospective cohort study.

Objective. The aim of this study was to determine the differences in 30-day readmission, reoperation, and morbidity for patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) or single and multilevel anterior cervical corpectomy and fusion (ACCF).

Summary of Background Data. Despite increasing rates of surgical treatment of cervical spine disease, few studies have compared outcomes by surgical technique. To the best of our knowledge, this is the only large-scale administrative database study that directly evaluates early outcomes between multilevel ACDF and single and multilevel ACCF.

Methods. Patients who underwent ACDF and ACCF were identified using the NSQIP database. Multivariate regression was utilized to compare rates of readmission, reoperation, morbidity, and specific complications between surgical techniques, and to evaluate for predictors of primary outcomes.

Results. We identified 15,600 patients. ACCF independently predicted (P < 0.001) greater reoperation (odds ratio [OR] = 1.876) and morbidity (OR = 1.700), but not readmission, on multivariate analysis. ACCF was also associated with greater rates of transfusion (OR = 3.273, P < 0.001) and DVT/thrombophlebitis (OR = 2.852, P = 0.001). ACCF had significantly (P < 0.001) greater operative time and length of stay. In the cohort, increasing age (P < 0.001), diabetes (P = 0.025), chronic obstructive pulmonary disease (P = 0.027), disseminated cancer (P = 0.009), and American Society of Anesthesiologists (ASA) class ≥3 (P < 0.001) predicted readmission. Age (P = 0.011), female sex (P = 0.001), heart failure (P = 0.002), ASA class ≥3 (P < 0.001), and increased creatinine (P = 0.044), white cell count (P = 0.033), and length of stay (P < 0.001) predicted reoperation. Age (P < 0.001), female sex (P = 0.002), disseminated cancer (P = 0.010), ASA class ≥3 (P < 0.001), increased white cell count (P = 0.036) and length of stay (P < 0.001), and decreased hematocrit (P < 0.001) predicted morbidity. Within ACDF, three or more levels treated compared to two levels did not predict poorer 30-day outcomes.

Conclusion. Compared to multilevel ACDF, ACCF was associated with an 88% increased odds of reoperation and 70% increased odds of morbidity; readmission was similar between techniques. Older age, higher ASA class, and specific comorbidities predicted poorer 30-day outcomes. These findings can guide surgical solution given specific factors.

Level of Evidence: 3

We compared 30-day readmission, reoperation, and morbidity rates between multilevel anterior cervical discectomy and fusion and single and multilevel anterior cervical corpectomy and fusion (ACCF) in 15,600 patients. ACCF independently predicted (P < 0.001) greater reoperation (odds ratio [OR] = 1.876) and morbidity (OR = 1.700) on multivariate analysis. ACCF also had greater rates of transfusion (P < 0.001) and DVT/thrombophlebitis (P = 0.001), operative time (P < 0.001), and hospital stay (P < 0.001).

University of Connecticut School of Medicine, UConn Health, Farmington, CT

Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT.

Address correspondence and reprint requests to Isaac L. Moss, MD, MASc, FRCSC, Department of Orthopedic Surgery, UConn Musculoskeletal Institute, Comprehensive Spine Center, 263 Farmington Avenue, Farmington, CT 06030-5353; E-mail:

Received 11 February, 2019

Revised 14 May, 2019

Accepted 10 June, 2019

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: consultancy, stocks, royalties, personal fees.

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