Surgical outcomes following multi-level sub-axial anterior cervical discectomy and fusion versus posterior cervical decompression and fusion in an obese cohort.

OBJECTIVES

Anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) are widely utilized surgical techniques to address cervical spine pathology. Obesity rates continue to rise, making the surgical management of common cervical pathology more challenging.

METHODS

The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was queried to identify obese adult patients who underwent multilevel sub-axial ACDF or PCDF from 2015-2022. Univariate comparison and multivariate logistic regression analyses were performed. The aims of this study are to compare 30-day re-operation (RTOR) and readmission rates, presence of any post-operative complication, non-home discharges and length of stay (LOS) between cohorts.

RESULTS

15,460 cases were identified. In univariate analysis, PCDF had higher rates of RTOR (4.9% vs 1.7%, p < 0.001), 30-day readmissions (8.6% vs 3.4%, p < 0.001), non-home discharges (30.9% vs 5.4%, p < 0.0005) and post-operative complications (13.3% vs 3.5%, p < 0.001) as well as longer LOS (4.3 ± 3.5 vs 1.8 ± 2.4 days, p < 0.0005). When employing multivariate analysis to control for levels instrumented and baseline characteristics, PCDF remains associated with greater odds of longer LOS (OR = 1.5, 95% CI [1.39-1.66], p < 0.001), however, significance is lost among other outcome measures.

CONCLUSIONS

Compared to ACDF, PCDF was associated with longer LOS, but not increased rates of 30-day readmissions, RTOR, post-operative complications or non-home discharges when controlling for confounding variables in an obese cohort. Surgical approach should continue to be tailored to the individual patient, guided by the surgeon's judgement.