Predictors of airway, respiratory, and pulmonary complications following elective anterior cervical discectomy and fusion

Introduction: Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure on the cervical spine. While the procedure is generally well tolerated, respiratory and pulmonary complications (RPC) are an unlikely yet possible complication following ACDF. Few previous studies have specifically identified risk factors associated with RPC following ACDF. As the incidence of an RPC is rare at a single institution, a large national database is required for meaningful analysis.Objective: The goal of this study is to characterize the predictors for RPC following an ACDF by utilizing a large national database. Methods: The National Inpatient Sample (NIS) was queried from 2016 to 2018 for all patients who had received elective ACDF for degenerative cervical spine disease. We categorized several complications as airway complications including various abscess, angioedema, laryngeal edema, vocal cord paralysis, dysphonia, various etiologies of pneumonia, and acute respiratory distress syndrome. A Firth's logistic regression model was used to identify predictors of RPC.Results: We identified a final cohort of 52,575 admissions in which an ACDF was performed of which 1454 admissions had an RPC. Older patients were 1.03 times more likely to have an RPC (OR = 1.03, 95%CI: 1.02-1.04). African American patients compared to Caucasian patients were 1.44 times more likely to have an RPC (OR = 1.44, 95%CI: 1.23-1.68). Obese patients were found to be 1.64 to have an RPC (OR = 1.64, 95%CI: 1.45-1.85). Diabetic patients are 2.07 times more likely to have an RPC (OR = 2.07, 95%CI: 1.76-2.44). Hypertensive patients are 1.91 times more likely to have an RPC (OR = 1.91, 95%CI: 1.59-2.27). Urban based hospitals were 1.11 and 1.46 times more likely to have an RPC (OR = 1.11, 95%CI: 0.79-1.59; OR = 1.46, 95% CI: 1.06-2.08; teaching and non-teaching respectively). Patients who underwent multilevel procedure were 1.32 times more likely to experience a follow-on RPC (OR = 1.32, 95%CI: 1.17-1.49) Discussion: Our study identified modifiable predictors of RPC after elective ACDF (e.g. obesity, diabetes) which can be used to guide preoperative patient optimization.

Automated summary

This study utilized a large national database to analyze the predictors of respiratory and pulmonary complications (RPC) following anterior cervical discectomy and fusion (ACDF). The results showed that older age, African American ethnicity, obesity, diabetes, hypertension, receiving surgery at urban hospitals, and undergoing multilevel procedures were associated with a higher likelihood of experiencing RPC. These predictors can be used to guide preoperative patient optimization.