title: Surgical Morbidity and Mortality Associated With Transoral Approach to the Cervical Spine.
abstract: METHODS
  A retrospective cohort analysis of prospectively collected data.
  
  
  OBJECTIVE
  The aim of this study was to analyze morbidity and mortality in adult patients undergoing transoral approach using a large national database.
  
  
  BACKGROUND
  The transoral approach to the anterior skull base and atlanto-axial cervical spine provides a direct corridor to the lower clivus, C1, C2, and occasionally C3. Due to the rarity of this approach and the unfamiliar anatomy, there is potential for significant morbidity and mortality.
  
  
  METHODS
  Adult patients undergoing transoral approach to the cervical spine from 2008 to 2012 were identified by the Current Procedural Terminology (CPT) code 22548 in the ACS NSQIP database. Cases with missing preoperative information were excluded. Univariate and multivariate analyses were performed to assess associated morbidity and mortality.
  
  
  RESULTS
  One hundred twenty-six patients underwent cervical spine and clival surgery via the transoral approach. There were a total of 27 (21.4%) postoperative complications with three (2.4%) mortalities. On multivariate analysis, there was an increased risk of complications with operative time >4 hours [odds ratio (OR) 7.8, 95% confidence interval (95% CI) 1.8-33.1, P = 0.0054] and total length of stay >5 days (OR 7.5, 95% CI 2.4-23.4, P = 0.0006).
  
  
  CONCLUSIONS
  The transoral approach carries significant risks of morbidity and mortality. Maintaining operative time <4 hours and LOS <5 days may decrease morbidity and mortality.
  
  
  METHODS
  4.
authors.affiliation: *Department of Neurosurgery†Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York‡Department of Orthopaedic Surgery, SUNY Health Science Center at Brooklyn, NY.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Steinberger
authors.forename: Branko
authors.initials: B
authors.lastname: Skovrlj
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Lee
authors.forename: Parth
authors.initials: P
authors.lastname: Kothari
authors.forename: Dante M
authors.initials: DM
authors.lastname: Leven
authors.forename: Javier Z
authors.initials: JZ
authors.lastname: Guzman
authors.forename: John
authors.initials: J
authors.lastname: Shin
authors.forename: Raj
authors.initials: R
authors.lastname: Shrivastava
authors.forename: John M
authors.initials: JM
authors.lastname: Caridi
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009055:Mouth / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D055815:Young Adult