Predictors of Readmission and Prolonged Length of Stay After Cervical Disc Arthroplasty

Michelle Zeidan, MD; Vadim Goz, MD; Nikita Lakomkin, MD; Nicholas Spina, MD; Darrel S. Brodke, MD; William R. Spiker, MD

Disclosures

Spine. 2021;46(8):487-491. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective cohort study.

Objective: The aim of the study was to assess which factors increase risk of readmission within 30 days of surgery or prolonged length of stay (LOS) (≥2 days) after cervical disc arthroplasty (CDA).

Summary of Background Data: Several studies have shown noninferiority at mid- and long-term outcomes after cervical disc arthroplasty (CDA) compared to anterior cervical discectomy and fusion ACDF, but few have evaluated short-term outcomes regarding risk of readmission or prolonged LOS after surgery.

Methods: Demographics, comorbidities, operative details, postoperative complications, and perioperative outcomes were collected for patients undergoing single level CDA in the National Surgical Quality Improvement Program (NSQIP) database. Patients with prolonged LOS, defined as >2 days, and readmission within 30 days following CDA were identified. Univariable and multivariable logistic regression models were used to identify risk factors for prolonged LOS and readmission.

Results: A total of 3221 patients underwent single level CDA. Average age was 45.6 years (range 19–82) and 53% of patients were male. A total of 472 (14.7%) experienced a prolonged LOS and 36 (1.1%) patients were readmitted within 30 days following surgery. Predictors of readmission were postoperative superficial wound infection (odds ratio [OR] = 73.83, P < 0.001), American Society of Anesthesiologists (ASA) classification (OR = 1.98, P = 0.048), and body mass index (BMI) (OR = 1.06, P = 0.02). Female sex (OR = 1.76, P < 0.001), diabetes (OR = 1.50, P = 0.024), postoperative wound dehiscence (OR = 13.11, P = 0.042), ASA class (OR = 1.43, P < 0.01), and operative time (OR = 1.01, P < 0.001) were significantly associated with prolonged LOS.

Conclusion: From a nationwide database analysis of 3221 patients, wound complications are predictors of both prolonged LOS and readmission. Patient comorbidities, including diabetes, higher ASA classification, female sex, and higher BMI also increased risk of prolonged LOS or readmission.

Level of Evidence: 3

Introduction

Cervical disc arthroplasty (CDA) has emerged as a viable alternative to anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative disc disease. The traditional indications for CDA are patients with one- or two-level stenosis causing radiculopathy or myelopathy that have failed conservative management. Contraindications include, but are not limited to, patients with significant pre-operative instability (>3.5-mm translation on flexion-extension lateral radiographs), axial neck pain, inflammatory arthropathies, severe facet arthropathy, or disc space collapse.[1] The key advantage of CDA over ACDF is motion preservation, which some studies suggest results in decreased rates of adjacent segment disease, although the literature shows conflicting results in this regard.[2–5] There are also decreased subjective complaints of dysphagia, earlier return to work, and improved neck disability index and neck pain scores.[2–4,6,7]

Although the number of disc replacements has rapidly increased in recent years,[8] little is known regarding the rates and predictors of suboptimal postoperative outcomes, specifically those requiring readmission or prolonged length of stay (LOS). When comparing inpatient and outpatient CDA, a study by Hill et al[9] suggests that diabetes and higher body mass index (BMI) may be related to need for inpatient status, but the literature is sparse regarding further predictors of outcomes. As such, the purpose of this study was to identify the incidence and specific causes of readmissions and prolonged LOS following inpatient CDA.

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