Complications and mortality associated with cervical spine surgery for degenerative disease in the United States

Study Design. Retrospective cohort. Objectives. To describe the incidence of complications and mortality associated with surgery for degenerative disease of the cervical spine using population-based data. To evaluate the associations between complications and mortality and age, primary diagnosis and type of surgical procedure. Summary of Background Data. Recent studies have shown an increase in the number of cervical spine surgeries performed for degenerative disease in the United States. However, the associations between complications and mortality and age, primary diagnosis and type of surgical procedure are not well described using population-based data. Methods. We created an algorithm defining degenerative cervical spine disease and associated complications using the International Classification of Diseases-ninth revision Clinical Modification codes. Using the Nationwide Inpatient Sample, we determined the primary diagnoses, surgical procedures, and associated in-hospital complications and mortality from 1992 to 2001. Results. From 1992 to 2001, the Nationwide Inpatient Sample included an estimated 932,009 ( 0.3%) hospital discharges associated with cervical spine surgery for degenerative disease. The majority of admissions were for herniated disc ( 56%) and cervical spondylosis with myelopathy ( 19%). Complications and mortality were more common in the elderly, and after posterior fusions or surgical procedures associated with a primary diagnosis of cervical spondylosis with myelopathy. Conclusions. There are significant differences in outcome associated with age, primary diagnosis, and type of surgical procedure. Administrative databases may underestimate the incidence of complications, but these population-based studies may provide information for comparison with surgical case series and help evaluate rare or severe complications.