• Hiroyuki Yoshihara and Daisuke Yoneoka.
• *Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY; and ‡Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
• Spine. 2014 May 20;39(12):E728-33.

Study DesignAnalysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.ObjectiveTo compare in-hospital morbidity and mortality rates between anterior and nonanterior approach procedures for thoracic disc herniation at national level.Summary Of Background DataSurgical treatment for thoracic disc herniation can be largely divided into anterior and nonanterior approach procedures. An anterior approach necessitates invasion of the thoracic cavity, which may subject the patient to increased risk of certain complications. Large sample studies comparing anterior and nonanterior procedures in terms of morbidity and mortality are lacking.MethodsThe Nationwide Inpatient Sample was used to identify patients who underwent surgical treatment for thoracic disc herniation from 2000 to 2009 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes. Patients were then divided into those who underwent anterior approach procedures and those who received nonanterior approach procedures using the appropriate ICD-9 codes. Patient- and health care system-related demographic data were retrieved and analyzed.ResultsThere were 25,413 patients included in this study. Anterior approach procedures were associated with a significantly higher overall in-hospital complication rate (26.8% vs. 9.6%) and mortality rate (0.7% vs. 0.2%), as well as a longer hospital stay (7.6 vs. 4.8 d) and increased hospital charges ($84,199 vs. $46,837) compared with nonanterior approach procedures. Risk factors for mortality in surgical treatment for thoracic disc herniation included age 85 years or more, female sex, and the presence of complications (respiratory, cardiac, and urinary and renal).ConclusionAnterior approach procedures for thoracic disc herniation were associated with increased in-hospital morbidity and mortality rates, as well as increased health care burden, compared with nonanterior approach procedures. If thoracic disc herniation can be adequately excised by either approach, a nonanterior approach procedure may be a better option.

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