Postoperative 30-Day Comparative Complications of Multilevel Anterior Cervical Discectomy and Fusion and Laminoplasty for Cervical Spondylotic Myelopathy: An Evidence in Reaching Consensus
Abstract
:1. Introduction
2. Materials and Methods
2.1. Database and Patient Selection
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Before PSM | After 1:1 PSM | |||||
---|---|---|---|---|---|---|
Preoperative Characteristics | Multilevel ACDF (Group A) | LAMP (Group B) | p-Value | Multilevel ACDF (Group A) | Laminoplasty (Group B) | p-Value |
n | 4236 | 661 | X | 621 | 621 | X |
Mean age (std) | 59.00 (10.80) | 62.85 (10.93) | <0.0001 * | 60.69 (10.65) | 61.86 (10.37) | 0.0496 * |
Gender, male (%) | 2141 (50.54) | 431 (65.20) | <0.0001 * | 302 (48.63) | 412 (66.34) | <0.0001 * |
Mean BMI (std) | 30.51 (6.73) | 29.46 (6.46) | 0.0002 * | 30.72 (6.98) | 29.57 (6.46) | 0.0027 * |
Diabetes mellitus with oral agents or insulin (%) | 0 = No: 3417 (80.67) | 0 = No: 520 (78.67) | 0.4830 | 0 = No: 489 (78.74) | 0 = No: 493 (79.39) | 0.9607 |
1 = non-insulin: 537 (12.68) | 1 = non-insulin: 93 (14.07) | 1 = non-insulin: 87 (14.01) | 1 = non-insulin: 84 (13.53) | |||
2 = insulin: 282 (6.66) | 2 = insulin: 48 (7.26) | 2 = insulin: 45 (7.25) | 2 = insulin: 44 (7.09) | |||
Open wound/wound infection (%) | 13 (0.31) | 5 (0.76) | 0.0842 | 3 (0.48) | 5 (0.81) | 0.7257 |
Steroid use for chronic condition (%) | 174 (4.11) | 29 (4.39) | 0.7373 | 20 (3.22) | 21 (3.38) | 0.8738 |
Bleeding disorders (%) | 64 (1.51) | 12 (1.82) | 0.5557 | 10 (1.61) | 9 (1.45) | 0.8172 |
Preop transfusion of ≥1 unit of whole/packed RBCs in 72 h prior to surgery (%) | 0 (0) | 0 (0) | X | 0 (0) | 0 (0) | X |
Systemic sepsis (%) | 0 = none: 4226 (99.76) | 0 = none: 660 (99.85) | 1.0000 | 0 = none: 620 (99.84) | 0 = none: 620 (99.84) | 1.0000 |
1 = SIRS: 10 (0.24) | 1 = SIRS: 1 (0.15) | 1 = SIRS: 1 (0.16) | 1 = SIRS: 1 (0.16) | |||
2 = sepsis: 0 (0) | 2 = sepsis: 0 (0) | 2 = sepsis: 0 (0) | 2 = sepsis: 0 (0) | |||
3 = septic shock: 0 (0) | 3 = septic shock: 0 (0) | 3 = septic shock: 0 (0) | 3 = septic shock: 0 (0) | |||
Mean preoperative WBC (std) | 7.40 (2.41) | 7.15 (2.09) | 0.0043 * | 7.34 (2.70) | 7.15 (2.12) | 0.1708 |
Mean preoperative hematocrit (std) | 41.56 (4.22) | 41.48 (4.39) | 0.6569 | 40.79 (3.94) | 41.86 (4.06) | <0.0001 |
Hypertension requiring medication (%) | 2368 (55.90) | 408 (61.72) | 0.0050 * | 369 (59.42) | 376 (60.55) | 0.6852 |
CHF in 30 days before surgery (%) | 14 (0.33) | 4 (0.61) | 0.2909 | 2 (0.32) | 4 (0.64) | 0.6867 |
Mean preoperative serum creatinine (std) | 0.94 (0.53) | 0.99 (0.58) | 0.0433 * | 0.92 (0.33) | 0.97 (0.52) | 0.0656 |
Acute renal failure (preop) (%) | 1 (0.02) | 0 (0) | 1.0000 | 0 (0) | 0 (0) | X |
Currently on dialysis (preop) (%) | 16 (0.38) | 4 (0.61) | 0.3349 | 1 (0.16) | 1 (0.16) | 1.0000 |
Dyspnea (%) | 0 = no: 3949 (93.22) | 0 = no: 643 (97.28) | 0.0003 * | 0 = no: 576 (92.75) | 0 = no: 604 (97.26) | 0.0004 * |
1 = moderate exertion: 272 (6.42) | 1 = moderate exertion: 18 (2.72) | 1 = moderate exertion: 43 (6.92) | 1 = moderate exertion: 17 (2.74) | |||
2 = at rest: 15 (0.35) | 2 = at rest: 0 (0) | 2 = at rest: 2 (0.32) | 2 = at rest: 0 (0) | |||
History of severe COPD (%) | 243 (5.74) | 33 (4.99) | 0.4404 | 43 (6.92) | 30 (4.83) | 0.1168 |
Ventilator dependence (%) | 0 (0) | 0 (0) | X | 0 (0) | 0 (0) | X |
Disseminated cancer (%) | 6 (0.14) | 3 (0.45) | 0.1101 | 0 (0) | 0 (0) | X |
Current smoker within 1 year (%) | 1104 (26.06) | 147 (22.24) | 0.0361 * | 136 (21.90) | 145 (23.35) | 0.5416 |
Wound classification (%) | 1 = clean: 4222 (99.67) | 1 = clean: 656 (99.24) | 0.2079 | 1 = clean: 620 (99.84) | 1 = clean: 616 (99.19) | 0.2176 |
2 = clean/contaminated: 13 (0.31) | 2 = clean/contaminated: 5 (0.76) | 2 = clean/contaminated: 1 (0.16) | 2 = clean/contaminated: 5 (0.81) | |||
3 = contaminated: 0 (0) | 3 = contaminated: 0 (0) | 3 = contaminated: 0 (0) | 3 = contaminated: 0 (0) | |||
4 = dirty/infected: 1 (0.02) | 4 = dirty/infected: 0 (0) | 4 = dirty/infected: 0 (0) | 4 = dirty/infected: 0 (0) | |||
ASA classification (%) | 1 = no disturb: 86 (2.03) | 1 = no disturb: 7 (1.06) | 0.0852 | 1 = no disturb: 5 (0.81) | 1 = no disturb: 7 (1.13) | 0.3877 |
2 = mild disturb: 1890 (44.62) | 2 = mild disturb: 272 (41.15) | 2 = mild disturb: 254 (40.90) | 2 = mild disturb: 267 (43.00) | |||
3 = severe disturb: 2150 (50.76) | 3 = severe disturb: 365 (55.22) | 3 = severe disturb: 340 (54.75) | 3 = severe disturb: 234 (53.78) | |||
4 = life threat: 110 (2.60) | 4 = life threat: 17 (2.57) | 4 = life threat: 22 (3.54) | 4 = life threat: 13 (2.09) | |||
5 = moribund: 0 (0) | 5 = moribund: 0 (0) | 5 = moribund: 0 (0) | 5 = moribund: 0 (0) |
Before PSM | After 1:1 PSM | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Postoperation Occurrence | Multilevel ACDF (Group A) | LAMP (Group B) | p-Value | B versus AOR (95% CI) | p-Value of OR | Multilevel ACDF (Group A) | LAMP (Group B) | p-Value | B versus AOR (95% CI) | p-Value of OR |
n | 4236 | 661 | X | X | X | 621 | 621 | X | X | X |
Mean total operation time (std) | 159.32 (68.93) | 149.96 (58.02) | 0.0002 * | 0.835 (0.724, 0.962) | 0.0128 * | 158.60 (69.40) | 149.51 (57.64) | 0.0122 * | 0.837 (0.690, 1.015) | 0.0712 |
Superficial surgical site infection (%) | 5 (0.12) | 7 (1.06) | 0.0003 * | 9.057 (2.866, 28.621) | 0.0002 * | 0 (0) | 7 (1.13) | 0.0154 * | >999.999 (<0.001, >999.999) | 0.9531 |
Deep incisional SSI (%) | 3 (0.07) | 6 (0.91) | 0.0003 * | 12.925 (3.225, 51.807) | 0.0003 * | 0 (0) | 6 (0.97) | 0.0309 * | >999.999 (<0.001, >999.999) | 0.9341 |
Organ space SSI (%) | 5 (0.12) | 0 (0) | 1.0000 | <0.001 (<0.001, >999.999) | 0.9702 | 0 (0) | 0 (0) | X | X | X |
Wound disruption (%) | 2 (0.05) | 5 (0.76) | 0.0007 * | 16.136 (3.124, 83.339) | 0.0009 * | 0 (0) | 5 (0.81) | 0.0620 | >999.999 (<0.001, >999.999) | 0.9398 |
Pneumonia (%) | 38 (0.90) | 7 (1.06) | 0.6606 | 1.183 (0.526, 2.659) | 0.6851 | 8 (1.29) | 7 (1.13) | 0.7950 | 0.874 (0.315, 2.424) | 0.7952 |
Unplanned intubation (%) | 34 (0.80) | 1 (0.15) | 0.0783 | 0.187 (0.026, 1.370) | 0.0990 | 7 (1.13) | 1 (0.16) | 0.0694 | 0.141 (0.017, 1.153) | 0.0677 |
Ventilator > 48 h (%) | 26 (0.61) | 1 (0.15) | 0.1652 | 0.245 (0.033, 1.811) | 0.1683 | 5 (0.81) | 1 (0.16) | 0.2176 | 0.199 (0.023, 1.706) | 0.1407 |
Progressive renal insufficiency (%) | 1 (0.02) | 0 (0) | 1.0000 | <0.001 (<0.001, >999.999) | 0.9702 | 0 (0) | 0 (0) | X | X | X |
Acute renal failure (%) | 4 (0.09) | 1 (0.15) | 0.5158 | 1.603 (0.179, 14.364) | 0.6732 | 0 (0) | 0 (0) | X | X | X |
Urinary tract infection (%) | 24 (0.57) | 11 (1.66) | 0.0048 * | 2.970 (1.448, 6.098) | 0.0030 * | 5 (0.81) | 10 (1.61) | 0.1940 | 2.016 (0.685, 5.934) | 0.2028 |
Pulmonary embolism (%) | 18 (0.42) | 6 (0.91) | 0.1247 | 2.147 (0.849, 5.429) | 0.1063 | 2 (0.32) | 6 (0.97) | 0.2875 | 3.019 (0.607, 15.015) | 0.1770 |
Cardiac arrest requiring CPR (%) | 4 (0.09) | 2 (0.30) | 0.1887 | 3.211 (0.587, 17.565) | 0.1785 | 0 (0) | 2 (0.32) | 0.4996 | >999.999 (<0.001, >999.999) | 0.9426 |
Myocardial infarction (%) | 9 (0.21) | 1 (0.15) | 1.0000 | 0.712 (0.090, 5.626) | 0.7476 | 4 (0.64) | 1 (0.16) | 0.3740 | 0.249 (0.028, 2.232) | 0.2140 |
Return to OR (%) | 60 (1.42) | 14 (2.12) | 0.1691 | 1.506 (0.837, 2.710) | 0.1720 | 9 (1.45) | 13 (2.09) | 0.3895 | 1.454 (0.617, 3.426) | 0.3922 |
DVT/thrombophlebitis (%) | 11 (0.26) | 4 (0.61) | 0.1333 | 2.338 (0.742, 7.366) | 0.1467 | 2 (0.32) | 3 (0.48) | 1.0000 | 1.502 (0.250, 9.020) | 0.6563 |
Bleeding transfusions (%) | 15 (0.35) | 14 (2.12) | <0.0001 * | 6.089 (2.926, 12.674) | <0.0001* | 5 (0.81) | 10 (1.61) | 0.1940 | 2.016 (0.685, 5.934) | 0.2028 |
Sepsis (%) | 16 (0.38) | 2 (0.30) | 1.0000 | 0.801 (0.184, 3.489) | 0.7671 | 1 (0.16) | 2 (0.32) | 1.0000 | 2.003 (0.181, 22.149) | 0.5709 |
Septic shock (%) | 7 (0.17) | 2 (0.30) | 0.3480 | 1.834 (0.380, 8.845) | 0.4502 | 1 (0.16) | 1 (0.16) | 1.0000 | 1.000 (0.062, 16.023) | 1.0000 |
Mean length of total hospital stay (std) | 2.03 (2.83) | 3.22 (2.40) | <0.0001 * | 5.005 (4.300, 5.825) | <0.0001 * | 2.25 (3.86) | 3.11 (2.23) | <0.0001 * | 5.215 (4.190, 6.491) | <0.0001 * |
Mean days from operation to discharge (std) | 1.96 (2.39) | 3.18 (2.35) | <0.0001 * | 5.127 (4.403, 5.969) | <0.0001 * | 2.12 (2.94) | 3.08 (2.22) | <0.0001 * | 5.328 (4.278, 6.635) | <0.0001 * |
Still in hospital > 30 days (%) | 217 (5.12) | 49 (7.41) | 0.0157 * | 1.483 (1.075, 2.045) | 0.0163 * | 29 (4.67) | 46 (7.41) | 0.0429 * | 1.633 (1.012, 2.636) | 0.0446 * |
Unplanned reoperation (%) | 275 (6.49) | 62 (9.38) | 0.0064 * | 1.491 (1.117, 1.990) | 0.0067 * | 38 (6.12) | 58 (9.34) | 0.0336 * | 1.581 (1.033, 2.418) | 0.0348 * |
Death (%) | 13 (0.31) | 3 (0.45) | 0.4672 | 1.481 (0.421, 5.211) | 0.5406 | 0 (0) | 3 (0.48) | 0.2494 | >999.999 (<0.001, >999.999) | 0.9533 |
Before PSM | ||||
Parameter | Adjusted OR | 95% CI | p-Value | |
Age | 1.11 | 1.049 | 1.174 | 0.0003 * |
Preoperative hematocrit | 0.873 | 0.803 | 0.949 | 0.0014 * |
Preoperative serum creatinine | 0.36 | 0.12 | 1.083 | 0.0690 |
Steroid use for chronic condition | 4.74 | 1.315 | 17.086 | 0.0174 * |
CHF in 30 days before surgery | 15.267 | 0.92 | 253.327 | 0.0572 |
Currently on dialysis (preop) | 191.335 | 12.017 | >999.999 | 0.0002 * |
Dyspnea: moderate exertion vs. no | 0.362 | 0.021 | 6.325 | 0.4863 |
Dyspnea: at rest vs. no | 26.253 | 2.45 | 281.345 | 0.0069 * |
Disseminated cancer | 16.523 | 2.333 | 117.02 | 0.0050 * |
After PSM | ||||
CHF in 30 days before surgery | 123.402 | 9.577 | >999.999 | 0.0002 * |
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Chan, R.W.-Y.; Chiang, Y.-H.; Lin, H.-C.; Chang, C.-Y.; Tsou, Y.-S. Postoperative 30-Day Comparative Complications of Multilevel Anterior Cervical Discectomy and Fusion and Laminoplasty for Cervical Spondylotic Myelopathy: An Evidence in Reaching Consensus. Diagnostics 2023, 13, 2024. https://doi.org/10.3390/diagnostics13122024
Chan RW-Y, Chiang Y-H, Lin H-C, Chang C-Y, Tsou Y-S. Postoperative 30-Day Comparative Complications of Multilevel Anterior Cervical Discectomy and Fusion and Laminoplasty for Cervical Spondylotic Myelopathy: An Evidence in Reaching Consensus. Diagnostics. 2023; 13(12):2024. https://doi.org/10.3390/diagnostics13122024
Chicago/Turabian StyleChan, Ryan Wing-Yuk, Yung-Hsiao Chiang, Hsiu-Chen Lin, Chih-Yau Chang, and Yi-Syue Tsou. 2023. "Postoperative 30-Day Comparative Complications of Multilevel Anterior Cervical Discectomy and Fusion and Laminoplasty for Cervical Spondylotic Myelopathy: An Evidence in Reaching Consensus" Diagnostics 13, no. 12: 2024. https://doi.org/10.3390/diagnostics13122024
APA StyleChan, R. W.-Y., Chiang, Y.-H., Lin, H.-C., Chang, C.-Y., & Tsou, Y.-S. (2023). Postoperative 30-Day Comparative Complications of Multilevel Anterior Cervical Discectomy and Fusion and Laminoplasty for Cervical Spondylotic Myelopathy: An Evidence in Reaching Consensus. Diagnostics, 13(12), 2024. https://doi.org/10.3390/diagnostics13122024