title: Incidence and risk factors for dysphagia after anterior cervical fusion.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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 χ 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and †Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
authors.forename: Alejandro
authors.initials: A
authors.lastname: Marquez-Lara
authors.forename: Sreeharsha V
authors.initials: SV
authors.lastname: Nandyala
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fineberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000196:embryology / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011843:Radiculopathy / Q000601:surgery; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019485:Bone Morphogenetic Proteins