Myelopathy Is Associated With Increased All-Cause Morbidity and Mortality Following Anterior Cervical Discectomy and Fusion A Study of 5256 Patients in American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)

Study Design. Retrospective cohort. Objective. To evaluate whether myelopathy is associated with increased morbidity and mortality after anterior cervical discectomy and fusion (ACDF) compared with other indications for this procedure. Summary of Background Data. ACDF is the most common surgical procedure for the management of a spectrum of cervical spine pathologies. As a more advanced condition, myelopathy is generally thought to be associated with higher morbidity and mortality after this procedure, but there is limited evidence to support this supposition. The current study compares outcomes of ACDF procedures performed for myelopathy with those performed for other indications, controlling for other patient factors. Methods. Patients who underwent ACDF between 2010 and 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with myelopathy were identified by diagnosis codes for cervical myelopathy. Bivariate and multivariate logistic regressions were performed to compare 30-day adverse events and readmission between groups. Multivariate analyses controlled for patient and surgical characteristics. Results. A total of 5256 ACDF procedures met inclusion criteria, of which 1425 (27.3%) were performed for cervical myelopathy. Patients with myelopathy were older and were less healthy than patients without myelopathy. Multivariate analysis controlling for baseline patient characteristics found that patients with myelopathy were at significantly increased risk of any adverse event (odds ratio = 1.5), any severe adverse event (odds ratio = 1.8), and death (odds ratio = 8.9) compared with patients without myelopathy. Conclusion. After adjusting for baseline patient characteristics, not only were any adverse events and serious adverse events more common after ACDF for patients with myelopathy than for patients without myelopathy, but mortality was approximately 9 times more likely. It is important for surgical planning and patient counseling to keep this significant difference in mind for this common procedure that has different morbidities based on the pathology for which it is performed.