ACS-NSQIP PUF data from 2014 through 2019 were used to compare one- and two-level ACDF and cTDR with respect to: patient demographics, comorbidities, adverse events, and 30-day morbidity rates.
One- and two-level ACDF and cTDR patients were identified by CPT codes. Demographics, comorbidities, and adverse events were summarized. Unmatched cohorts were compared using Wilcoxon Rank Sum test for continuous variables, Pearson’s Chi Square test for categorical variables, and 30-day morbidity using inverse probability of treatment weighted (IPTW) log-binomial regression.
ACS-NSQIP 2014 through 2019 PUF datasets represent 4,862,497 unique patients, identifying 13347 one-level, 6933 two-level ACDF, 3114 one-level, and 862 two-level cTDR patient cohorts. Statistically significant differences between cohorts are extensive: age, sex, race, admission status, patient origin, discharge disposition, emergent surgery, surgical specialty, ASA classification, wound class, operative time, hospital LOS, BMI, functional status, smoking, diabetes, dyspnea, COPD, CHF, HTN, renal failure, dialysis, cancer, steroid use, anemia, bleeding disorders, systemic sepsis, and number of concurrent comorbid conditions. IPTW log-binomial models, demonstrated increased risk of DVT/thrombophlebitis, pulmonary embolism, deep incisional SSI, pneumonia, and unplanned return to OR associated with ACDF while increased risk of CVA/stroke with neurological deficit and myocardial infarction associated with cTDR. The composite complications outcome favors cTDR over ACDF for 30-day morbidity. No mortalities occurred within the cTDR cohort.
Adjusting for demographics and comorbidities; ACDF has a higher average risk of adverse event. When ACDF and cTDR are equipoise, consideration for cTDR may be indicated in populations with higher rates of comorbid conditions.