title: Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies.
abstract: BACKGROUND
  Few studies have provided nationwide estimates of patient characteristics and procedure-related complications, or examined postsurgical outcomes for patients with cervical spondylotic myelopathy (CSM) comparatively with respect to surgical approach. The objective of this study is to identify patients at risk for morbidity and mortality directly related with the selected approach, report an overall nation-wide complication rate for each approach against which surgeons can compare themselves, and direct future research to improve patient outcomes.
  
  
  METHODS
  Patients surgically treated for CSM were retrospectively identified using ICD-9-CM codes from the Nationwide Inpatient Sample (NIS) database. Four cohorts were compared for demographics and hospital system-related data: anterior (ACDF, ACCF), posterior decompression without fusion, decompression with posterior fusion, and combined anterior-posterior. Multivariate analysis was also used to determine the odds ratio of morbidity and mortality among the cohorts.
  
  
  RESULTS
  54,416 discharges were identified between 2001 and 2010: 34,400 anterior, 9,014 decompression procedures without fusion, 8,741 decompression procedures with posterior fusion, and 2,261 combined anterior-posterior. Groups were statistically different with respect to age, length of hospital stay, mortality, and complications. Groups were statistically different for Deyo score except between posterior decompression only and combined approaches. Using multivariate analysis and adjusting for covariates, the combined (2.74[2.18-3.44]) and laminectomy (1.22[1.04-1.44]) cohorts had an increased risk of mortality when compared to anterior alone.
  
  
  CONCLUSIONS
  These findings are the first to determine the rates and odds of perioperative risks directly related to combined anterior-posterior procedures. This study provides clinically useful data for surgeons to educate patients and direct future research to improve patient outcomes.
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Angel
authors.initials: A
authors.lastname: Macagno
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Shian
authors.initials: S
authors.lastname: Liu
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Marascalchi
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Sun
authors.initials: S
authors.lastname: Yang
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Boniello
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: John A
authors.initials: JA
authors.lastname: Bendo
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Virginie C
authors.initials: VC
authors.lastname: Lafage
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, New York City, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
keywords: Anterior; Cervical spondylotic myelopathy; Laminectomy; combined; laminoplasty; nation-wide trends; procedure-related complications