TY - JOUR
T1 - 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
T2 - A Propensity-Matched Analysis
AU - Ezzat, Bahie
AU - Bhanot, Priya
AU - Kalagara, Roshini
AU - Elkersh, Yehia
AU - Ali, Muhammad
AU - Laurore, Charles
AU - Carr, Matthew T.
AU - Schüpper, Alexander J.
AU - Qureshi, Hanya M.
AU - Hrabarchuk, Eugene
AU - Quinones, Addison
AU - Gal, Jonathan
AU - Choudhri, Tanvir F.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/1
Y1 - 2025/1
N2 - 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.
AB - 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.
KW - Anterior cervical discectomy and fusion (ACDF)
KW - Cervical disc herniation
KW - Geriatrics
KW - Hospital discharge destinations
KW - Posterior cervical decompression and fusion (PCDF)
KW - Surgical outcomes
UR - http://www.scopus.com/inward/record.url?scp=85210543333&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2024.10.145
DO - 10.1016/j.wneu.2024.10.145
M3 - Article
C2 - 39522814
AN - SCOPUS:85210543333
SN - 1878-8750
VL - 193
SP - 920
EP - 928
JO - World Neurosurgery
JF - World Neurosurgery
ER -