Journal of orthopaedics · 2026
Comparing outcomes between patients admitted through clinic versus emergency department with degenerative cervical myelopathy.
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Piña Dagoberto, Watson Jared, Villegas Alex, Zhao Audrey, Ponzini Matthew D, Shahzad Hania, Vander Voort Wyatt, Ortega Brandon, Conry Keegan, Roberto Rolando, Khan Safdar, Le Hai
Аннотация
INTRODUCTION: Degenerative cervical myelopathy (DCM) can lead to pain, disability, and permanent neurologic impairment. Timely surgical intervention is essential to optimize functional outcomes. Here, we compared patients who were admitted through clinic versus the emergency department (ED) for surgical management of DCM.
METHODS: Patients aged ≥18 years admitted for surgery for DCM through clinic (Elective cohort) were compared to a surgical cohort who were evaluated through the ED (ED cohort). Basic demographics included age, gender, race, ethnicity, and insurance payor. Sociodemographic characteristics were estimated using the Social Deprivation Index (SDI) and the Area Deprivation Index (ADI). Cervical MRIs were reviewed to assess severity of spinal cord compression. Other outcomes included number of motion segments operated on, Nurick grade, length of stay (LOS), disposition, and 30-day reoperation and readmission rates.
RESULTS: From 2015 to 2021, 327 DCM patients underwent surgery (227 elective, 100 call). A greater proportion of elective patients were female (48.0% vs 30.0%, p = 0.002) and white (72.7% vs 51.0%, p=<0.001). A higher proportion of ED patients were covered by Medicare/other Government insurance (77.0% vs 63.9%, p = 0.044), with higher median SDI (70 vs 63, p < 0.001), ADI (9 vs 8, p = 0.002), and radiographic stenosis (79.4 vs 42.9% Grade III compression, p < 0.001). Elective patients had shorter median LOS (2 vs 6.5 days, p < 0.001), discharged to home (82.3% vs 35.0%, p < 0.001). No differences were identified in baseline Nurick grading (2.1 vs 2.2, p = 0.341), median operative levels (3 vs 3, p = 0.164). 30-day reoperations (2.2% vs 10%, p = 0.003) differed, but readmissions (17.0% vs 11.9%, p = 0.21) did not. Elective patients had greater improvement in Nurick grade (1.9 vs 0.1, p=<0.001).
DISCUSSION: Patients admitted for emergent management of DCM were more likely to be male, non-White, and disadvantaged, with longer hospital stay, lower likelihood of discharge home, and worse functional improvement.
LEVEL OF EVIDENCE: Retrospective Case Series, Level IV Evidence.
METHODS: Patients aged ≥18 years admitted for surgery for DCM through clinic (Elective cohort) were compared to a surgical cohort who were evaluated through the ED (ED cohort). Basic demographics included age, gender, race, ethnicity, and insurance payor. Sociodemographic characteristics were estimated using the Social Deprivation Index (SDI) and the Area Deprivation Index (ADI). Cervical MRIs were reviewed to assess severity of spinal cord compression. Other outcomes included number of motion segments operated on, Nurick grade, length of stay (LOS), disposition, and 30-day reoperation and readmission rates.
RESULTS: From 2015 to 2021, 327 DCM patients underwent surgery (227 elective, 100 call). A greater proportion of elective patients were female (48.0% vs 30.0%, p = 0.002) and white (72.7% vs 51.0%, p=<0.001). A higher proportion of ED patients were covered by Medicare/other Government insurance (77.0% vs 63.9%, p = 0.044), with higher median SDI (70 vs 63, p < 0.001), ADI (9 vs 8, p = 0.002), and radiographic stenosis (79.4 vs 42.9% Grade III compression, p < 0.001). Elective patients had shorter median LOS (2 vs 6.5 days, p < 0.001), discharged to home (82.3% vs 35.0%, p < 0.001). No differences were identified in baseline Nurick grading (2.1 vs 2.2, p = 0.341), median operative levels (3 vs 3, p = 0.164). 30-day reoperations (2.2% vs 10%, p = 0.003) differed, but readmissions (17.0% vs 11.9%, p = 0.21) did not. Elective patients had greater improvement in Nurick grade (1.9 vs 0.1, p=<0.001).
DISCUSSION: Patients admitted for emergent management of DCM were more likely to be male, non-White, and disadvantaged, with longer hospital stay, lower likelihood of discharge home, and worse functional improvement.
LEVEL OF EVIDENCE: Retrospective Case Series, Level IV Evidence.