Anterior Cervical Discectomy and Fusion Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to Posterior Cervical Decompression and Fusion: A Propensity-Matched Analysis

Bahie Ezzat, Priya Bhanot, Roshini Kalagara, Yehia Elkersh, Muhammad Ali, Charles Laurore, Matthew T. Carr, Alexander J. Schüpper, Hanya M. Qureshi, Eugene Hrabarchuk, Addison Quinones, Jonathan Gal, Tanvir F. Choudhri

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Cervical disc herniation often necessitates surgery in elderly patients when nonoperative treatments fail. This study compares discharge outcomes of anterior cervical discectomy and fusion (ACDF) vs. posterior cervical decompression and fusion (PCDF) in geriatric patients. Methods: A retrospective analysis of 8622 spine surgery patients (January 2008-December 2020) was performed. Geriatric patients (age ≥65) undergoing primary 2–4 level ACDF or PCDF were included. Propensity score matching (1:1) based on age, sex, ethnicity, body mass index, insurance, American Society of Anesthesiologists classification, Elixhauser comorbidity index, preoperative diagnosis, fusion levels, estimated blood loss, intraoperative transfusion, and procedure length was used. Discharge outcomes were dichotomized to home or nonhome. Results: After matching, 122 patients (ACDF = 61, PCDF = 61) were analyzed. A larger proportion of ACDF patients were discharged home compared to PCDF (84% vs. 64%, P = 0.02). On binary logistic regression, younger age (OR = 0.88 [0.79, 0.98], P = 0.02), male sex (OR = 2.04 [1.79, 3.28], P = 0.001), lower estimated blood loss (OR = 0.99 [0.99, 0.99], P = 0.001), intraoperative transfusion (OR = 0.43 [0.22, 0.92], P = 0.03), and ACDF approach (OR = 4.34 [1.91, 6.77], P = 0.01) were significant predictors of home discharge. Conclusions: ACDF in geriatric patients with cervical disc herniation was associated with higher rates of home discharge compared to PCDF. Tailored surgical approaches based on patient demographics may improve recovery outcomes.

Original languageEnglish
Pages (from-to)920-928
Number of pages9
JournalWorld Neurosurgery
Volume193
DOIs
StatePublished - Jan 2025

Keywords

  • Anterior cervical discectomy and fusion (ACDF)
  • Cervical disc herniation
  • Geriatrics
  • Hospital discharge destinations
  • Posterior cervical decompression and fusion (PCDF)
  • Surgical outcomes

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