title: Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion.
abstract: Anterior cervical fusion (ACF) after discectomy and/or corpectomy is a common procedure with traditionally good patient outcomes. Though typically mild, postoperative dysphagia can result in significant patient morbidity. In this study, we examine the relationship between postoperative dysphagia and in-hospital outcomes, readmissions, and overall costs. The University HealthSystem Consortium (UHC) database was utilized to perform a retrospective cohort study of all adults who underwent a principal procedure of ACF of the anterior column (International Classification of Diseases, Ninth Revision [ICD-9] procedure code 81.02) between 2013 and 2015. Patients with a diagnosis of dysphagia (ICD-9 78720-78729) were compared to those without. Patient demographics, length of stay, in-hospital mortality, 30-day readmissions, and direct costs were recorded. A total of 49,300 patients who underwent ACF were identified. Mean age was 54.5years and 50.2% were male. Dysphagia was documented in 3,137 patients (6.4%) during their hospital stay. Patients with dysphagia had an average 2.1 comorbidities, while patients without dysphagia had 1.5 (p<0.01). Mean length of stay was 6.38days in patients with dysphagia, and 2.13days in those without (p<0.01). In-hospital mortality was 0.10% in patients without dysphagia, and 0.61% in those with dysphagia (p<0.01). Direct costs were $13,099 in patients without dysphagia, and $21,245 in those with dysphagia (p<0.01). Thirty-day readmission rate was 2.9% in patients without dysphagia, and 5.3% in those with dysphagia (p=0.01). In summary, dysphagia in patients who undergo ACF correlates with significantly increased length of stay, 30-day readmissions, and in-hospital mortality. Direct costs are similarly increased as a result.
authors.affiliation: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Dr., Room 3553 TC, Ann Arbor, MI 48109-5338, USA.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Joseph
authors.affiliation: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Dr., Room 3553 TC, Ann Arbor, MI 48109-5338, USA.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, CA 94143, USA.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.affiliation: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Dr., Room 3553 TC, Ann Arbor, MI 48109-5338, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: La Marca
authors.affiliation: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Dr., Room 3553 TC, Ann Arbor, MI 48109-5338, USA. Electronic address: ppark@med.umich.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D003365:Costs and Cost Analysis; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000209:etiology; D017586:Diskectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*
keywords: Anterior cervical fusion; Corpectomy; Dysphagia