Higher infection rates seen for revision to cervical disc replacement vs revision to ACDF

The results also showed patients whose cervical disc replacements were revised had longer hospital stays.

NEW ORLEANS — Revision cervical total disc replacement showed a significantly greater rate of postoperative infection compared with one-level and two-level revision anterior cervical discectomy and fusion in the results of a retrospective analysis done using the Nationwide Inpatient Sample database.

“[The revision] cervical disc replacement cohort did demonstrate a significantly greater rate of postoperative infections. Patients undergoing revision total disc replacement also incurred a greater length of stay than those undergoing a one- or two-level revision anterior cervical discectomy and fusion [ACDF],” Kern Singh, MD, said at the North American Spine Society Annual Meeting, here. He is a member of the Spine Surgery Today Editorial Board.

“We propose that these differences may be due to the more invasive nature of revising a total disc replacement as opposed to an ACDF,” he said.

Kern Singh

Database statistics used

Singh and colleagues identified 3,432 patients in the Nationwide Inpatient Sample database who underwent revision for one- and two-level ACDF and 229 patients who had revision for cervical total disc replacement (CDR) in the 8 years from 2002 to 2009.

The length of stay for revision ACDF was approximately one day shorter than for revision CDR, according to Singh.

In addition to finding an increased length of hospital stay for the revision CDR group, the investigators found a higher rate of postoperative infection for the revision CDR group of 26.2 infections vs. 10.5 infections per 1,000 cases.

Complications, costs by group

“Although not statistically significant, the disc replacement revision cohort did demonstrate a greater incidence of postoperative neurologic complications and dysphagia as compared to the ACDF revisions,” Singh said. “There were no significant differences in hospital costs and mortality between groups,” he said.

Singh noted that costs were $15,972 for revision ACDF and $17,796 for revision CDR. Mortality rates per 1,000 cases were 1.5 for ACDF vs. 0 for CDR.

Whether or not the revision surgery was performed at a teaching hospital did not reach statistical significance in either group, as noted in the abstract of the study.

“CDR and ACDF provide comparable outcomes for degenerative cervical spine disease. However, the outcomes associated with revision of these procedures are not well characterized. We utilized a national database to assess the rates of revision and the associated outcomes and costs. It appears that CDR revisions are associated with a greater incidence of perioperative infection, length of stay, and costs when compared with a revision ACDF. We propose that these differences are by virtue of the inherently more invasive nature of revising total disc replacements,” Singh told Spine Surgery Today. “In addition, when compared with primary cases, revision procedures are associated with greater costs, LOS, and complications including wound infections, dysphagia, hematomas, and neurological events. These additional risks must be considered prior to opting for a revision procedure.” – by Gina Brockenbrough, MA, and Susan M. Rapp

Reference:

Nandyala SV. Paper #3. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans.

For more information:

Kern Singh, MD, can be reached at the Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612; email: kern.singh@rushortho.com.
Disclosures: Some of the authors are board directors for Truview Surgical. Singh is a consultant for Globus, Stryker and Pioneer, receives royalties from Pioneer, Stryker, Zimmer, Thieme and Lippincott Williams & Wilkins, and is on the board of directors for TruVue Surgical and Vital 5 and is the editor of Contemporary Spine Surgery.