Ramifications of Postoperative Dysphagia on Health Care Resource Utilization Following Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy

被引:8
作者
Elsamadicy, Aladine A. [1 ]
Koo, Andrew B. [1 ]
David, Wyatt B. [1 ]
Freedman, Isaac G. [1 ]
Reeves, Benjamin C. [1 ]
Ehresman, Jeff [2 ]
Pennington, Zach [2 ]
Sarkozy, Margot [1 ]
Laurans, Maxwell [1 ]
Kolb, Luis [1 ]
Shin, John H. [3 ]
Sciubba, Daniel M. [2 ,4 ,5 ]
机构
[1] Yale Univ, Dept Neurosurg, Sch Med, 333 Cedar St, New Haven, CT 06520 USA
[2] Johns Hopkins Sch Med, Dept Neurosurg, Baltimore, MD USA
[3] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02115 USA
[4] Northwell Hlth, Zucker Sch Med Hofstra, Dept Neurosurg, Long Isl Jewish Med Ctr, Manhasset, NY USA
[5] Northwell Hlth, North Shore Univ Hosp, Manhasset, NY USA
来源
CLINICAL SPINE SURGERY | 2022年 / 35卷 / 03期
关键词
dysphagia; anterior cervical discectomy and fusion; cervical spondylotic myelopathy; LENGTH-OF-STAY; SPINE SURGERY; RISK-FACTORS; OUTCOMES; LEVEL; COMPLICATIONS; LIKELIHOOD; RATES; COST;
D O I
10.1097/BSD.0000000000001241
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design: This is a retrospective cohort study. Objective: The aim of this study was to investigate patient risk factors and health care resource utilization associated with postoperative dysphagia following elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. Summary of Background Data: There is a paucity of data on factors predisposing patients to dysphagia and the burden this complication has on health care resource utilization following ACDF. Methods: A retrospective cohort study was performed using the Nationwide Inpatient Sample (NIS) database from 2016 to 2017. All adult (above 18 y old) patients undergoing ACDF for cervical spondylotic myelopathy were identified using the ICD-10-CM diagnosis and procedural coding system. Patients were then categorized by whether they had a recorded postoperative dysphagia or no dysphagia. Weighted patient demographics, comorbidities, perioperative complications, length of hospital stay (LOS), discharge disposition, and total cost of admission were assessed. A multivariate stepwise logistic regression was used to determine both the odds ratio for risk-adjusted postoperative dysphagia as well as extended LOS. Results: A total of 17,385 patients were identified, of which 1400 (8.1%) experienced postoperative dysphagia. Compared with the No-Dysphagia cohort, the Dysphagia cohort had a greater proportion of patients experiencing a complication (P=0.004), including 1 complication (No-Dysphagia: 2.9% vs. Dysphagia: 6.8%), and >1 complication (No-Dysphagia: 0.3% vs. Dysphagia: 0.4%). The Dysphagia cohort experienced significantly longer hospital stays (No-Dysphagia: 1.9 +/- 2.1 d vs. Dysphagia: 4.2 +/- 4.3 d, P<0.001), higher total cost of admission (No-Dysphagia: $19,441 +/- 10,495 vs. Dysphagia: $25,529 +/- 18,641, P<0.001), and increased rates of nonroutine discharge (No-Dysphagia: 16.5% vs. Dysphagia: 34.3%, P<0.001). Postoperative dysphagia was found to be a significant independent risk factor for extended LOS on multivariate analysis, with an odds ratio of 5.37 (95% confidence interval: 4.09, 7.05, P<0.001). Conclusion: Patients experiencing postoperative dysphagia were found to have significantly longer hospital LOS, higher total cost of admission, and increased nonroutine discharge when compared with the patients who did not.
引用
收藏
页码:E380 / E388
页数:9
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