• World Neurosurg · Nov 2024

    Anterior Cervical Discectomy and Fusion Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to Posterior Cervical Decompression and Fusion: A Propensity-Matched Analysis.

    • Bahie Ezzat, Priya Bhanot, Roshini Kalagara, Yehia Elkersh, Muhammad Ali, Charles Laurore, Matthew T Carr, Alexander J Schüpper, Hanya M Qureshi, Eugene Hrabarchuk, Addison Quinones, Jonathan Gal, and Tanvir F Choudhri.
    • Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: bahie.ezzat@icahn.mssm.edu.
    • World Neurosurg. 2024 Nov 25; 193: 920928920-928.

    IntroductionCervical disc herniation often necessitates surgery in elderly patients when nonoperative treatments fail. This study compares discharge outcomes of anterior cervical discectomy and fusion (ACDF) vs. posterior cervical decompression and fusion (PCDF) in geriatric patients.MethodsA retrospective analysis of 8622 spine surgery patients (January 2008-December 2020) was performed. Geriatric patients (age ≥65) undergoing primary 2-4 level ACDF or PCDF were included. Propensity score matching (1:1) based on age, sex, ethnicity, body mass index, insurance, American Society of Anesthesiologists classification, Elixhauser comorbidity index, preoperative diagnosis, fusion levels, estimated blood loss, intraoperative transfusion, and procedure length was used. Discharge outcomes were dichotomized to home or nonhome.ResultsAfter matching, 122 patients (ACDF = 61, PCDF = 61) were analyzed. A larger proportion of ACDF patients were discharged home compared to PCDF (84% vs. 64%, P = 0.02). On binary logistic regression, younger age (OR = 0.88 [0.79, 0.98], P = 0.02), male sex (OR = 2.04 [1.79, 3.28], P = 0.001), lower estimated blood loss (OR = 0.99 [0.99, 0.99], P = 0.001), intraoperative transfusion (OR = 0.43 [0.22, 0.92], P = 0.03), and ACDF approach (OR = 4.34 [1.91, 6.77], P = 0.01) were significant predictors of home discharge.ConclusionsACDF in geriatric patients with cervical disc herniation was associated with higher rates of home discharge compared to PCDF. Tailored surgical approaches based on patient demographics may improve recovery outcomes.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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