title: Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database.
abstract: OBJECTIVE The authors performed a population-based analysis of national trends, costs, and outcomes associated with cervical spondylotic myelopathy (CSM) in the United States. They assessed postoperative complications, resource utilization, and predictors of costs, in this surgically treated CSM population. METHODS MarketScan data (2006-2010) were used to retrospectively analyze the complications and costs of different spine surgeries for CSM. The authors determined outcomes following anterior cervical discectomy and fusion (ACDF), posterior fusion, combined anterior/posterior fusion, and laminoplasty procedures. RESULTS The authors identified 35,962 CSM patients, comprising 5154 elderly (age ≥ 65 years) patients (mean 72.2 years, 54.9% male) and 30,808 nonelderly patients (mean 51.1 years, 49.3% male). They found an overall complication rate of 15.6% after ACDF, 29.2% after posterior fusion, 41.1% after combined anterior and posterior fusion, and 22.4% after laminoplasty. Following ACDF and posterior fusion, a significantly higher risk of complication was seen in the elderly compared with the nonelderly (reference group). The fusion level and comorbidity-adjusted ORs with 95% CIs for these groups were 1.54 (1.40-1.68) and 1.25 (1.06-1.46), respectively. In contrast, the elderly population had lower 30-day readmission rates in all 4 surgical cohorts (ACDF, 2.6%; posterior fusion, 5.3%; anterior/posterior fusion, 3.4%; and laminoplasty, 3.6%). The fusion level and comorbidity-adjusted odds ratios for 30-day readmissions for ACDF, posterior fusion, combined anterior and posterior fusion, and laminoplasty were 0.54 (0.44-0.68), 0.32 (0.24-0.44), 0.17 (0.08-0.38), and 0.39 (0.18-0.85), respectively. CONCLUSIONS The authors' analysis of the MarketScan database suggests a higher complication rate in the surgical treatment of CSM than previous national estimates. They found that elderly age (≥ 65 years) significantly increased complication risk following ACDF and posterior fusion. Elderly patients were less likely to experience a readmission within 30 days of surgery. Postoperative complication occurrence, and 30-day readmission were significant drivers of total cost within 90 days of the index surgical procedure.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Connolly
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Layton
authors.initials: L
authors.lastname: Lamsam
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Christian
authors.initials: C
authors.lastname: Swinney
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Tej D
authors.initials: TD
authors.lastname: Azad
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery; D015331:Cohort Studies; D018672:Community Health Planning; D016208:Databases, Factual / Q000706:statistics & numerical data; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D065406:Laminoplasty / Q000191:economics / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D013123:Spinal Fusion / Q000191:economics / Q000379:methods*; D055009:Spondylosis / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: ACDF = anterior cervical discectomy and fusion; COPD = chronic obstructive pulmonary disease; CPT = Current Procedural Terminology; CSM = cervical spondylotic myelopathy; DVT = deep vein thrombosis; MarketScan; NIS = Nationwide Inpatient Sample; OPLL = ossification of the posterior longitudinal ligament; adverse events; cervical spondylotic myelopathy; costs