Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion. (September 2016)

• Record Type: Journal Article
• Authors: Joseph, Jacob R.; Smith, Brandon W.; Mummaneni, Praveen V.; La Marca, Frank; Park, Paul
• Is Part Of: Journal of clinical neuroscience. Volume 31(2016:Sep.)
• Page Start: 172
• Page End: 175
• Publication Date: 2016-09
• Subjects: Anterior cervical fusion -- Corpectomy -- Dysphagia; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2016.03.011
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Postoperative dysphagia was documented in 6.4% of patients after ACF. Patients undergoing more than 2 levels of fusion had higher rates of dysphagia. Dysphagia after ACF correlates with significantly increased morbidity and costs. Thirty-day readmission rates are increased in patients with postoperative dysphagia. Abstract: Anterior cervical fusion (ACF) after discectomy and/or corpectomy is a common procedure with traditionally good patient outcomes. Though typically mild, postoperative dysphagia can result in significant patient morbidity. In this study, we examine the relationship between postoperative dysphagia and in-hospital outcomes, readmissions, and overall costs. The University HealthSystem Consortium (UHC) database was utilized to perform a retrospective cohort study of all adults who underwent a principal procedure of ACF of the anterior column (International Classification of Diseases, Ninth Revision [ICD-9] procedure code 81.02) between 2013 and 2015. Patients with a diagnosis of dysphagia (ICD-9 78720-78729) were compared to those without. Patient demographics, length of stay, in-hospital mortality, 30-day readmissions, and direct costs were recorded. A total of 49, 300 patients who underwent ACF were identified. Mean age was 54.5 years and 50.2% were male. Dysphagia was documented in 3, 137 patients (6.4%) during their hospital stay. Patients with dysphagia had an average 2.1 comorbidities, while patients without dysphagia had 1.5 ( p < 0.01). Mean length of stay was 6.38 days in patients with dysphagia, and 2.13 days in those without ( p < 0.01). In-hospital mortality was 0.10% in patients without dysphagia, and 0.61% in those with dysphagia ( p < 0.01). Direct costs were $13, 099 in patients without dysphagia, and $21, 245 in those with dysphagia ( p < 0.01). Thirty-day readmission rate was 2.9% in patients without dysphagia, and 5.3% in those with dysphagia ( p = 0.01). In summary, dysphagia in patients who undergo ACF correlates with significantly increased length of stay, 30-day readmissions, and in-hospital mortality. Direct costs are similarly increased as a result.