title: Differences in Short-Term Outcomes Between Primary and Revision Anterior Cervical Discectomy and Fusion.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To compare short-term morbidity for primary and revision anterior cervical discectomy and fusion (ACDF).
  
  
  BACKGROUND
  Revision ACDF procedures are relatively common, yet their risks are poorly characterized in the literature. There is a need to assess the relative risk of revision ACDF procedures compared with primary surgery.
  
  
  METHODS
  The prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent primary and revision ACDF from 2005 to 2014. The occurrence of 30-day postoperative complications, readmission, operative time, and postoperative length of stay were compared between primary and revision procedures using multivariate regression to control for patient and operative characteristics.
  
  
  RESULTS
  A total of 20,383 ACDF procedures were identified, 1219 (6.0%) of which were revision cases. On multivariate analysis, revision procedures were associated with significantly increased risk of any adverse event (relative risk [RR] 2.3, P < 0.001), any severe adverse event (RR 2.2, P < 0.001), thromboembolic events (RR 3.3, P = 0.001), surgical site infections (RR 3.2, P < 0.001), return to the operating room (RR 1.9, P = 0.001), any minor adverse event (RR 2.5, P < 0.001), and blood transfusion (RR 8.3, P < 0.001). Revision procedures had significantly increased risk of readmission within 30 days (RR = 1.6, P = 0.001). Minor, but statistically significant increases in average operative time and postoperative length of stay were identified for revisions procedures (7 min and half a day, respectively [P < 0.001 for both]).
  
  
  CONCLUSIONS
  Revision procedures were associated with significantly increased risk of multiple adverse outcomes, including thromboembolic events, surgical site infections, return to the operating room, blood transfusion, and readmission within 30 days. These results are important for patient counseling and risk stratification.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Nathaniel T
authors.initials: NT
authors.lastname: Ondeck
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Geiger
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Andre M
authors.initials: AM
authors.lastname: Samuel
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Lukasiewicz
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Webb
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Dustin H
authors.initials: DH
authors.lastname: Massel
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Mayo
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery*; D016208:Databases, Factual; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D058996:Quality Improvement; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult