ACDF Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to PCDF: 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; Tanvir F Choudhri

doi:10.1016/j.wneu.2024.10.145

ACDF Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to PCDF: A Propensity-Matched Analysis

World Neurosurg. 2024 Nov 8:S1878-8750(24)01849-7. doi: 10.1016/j.wneu.2024.10.145. Online ahead of print.

Affiliations

¹ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: bahie.ezzat@icahn.mssm.edu.
² Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
³ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
⁴ Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

PMID: 39522814
DOI: 10.1016/j.wneu.2024.10.145

Abstract

Introduction: Cervical disc herniation often necessitates surgery in elderly patients when nonoperative treatments fail. This study compares discharge outcomes of Anterior Cervical Discectomy and Fusion (ACDF) versus Posterior Cervical Decompression and Fusion (PCDF) in geriatric patients.

Methods: A retrospective analysis of 8,622 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 (EBL), intraoperative transfusion, and procedure length was used. Discharge outcomes were dichotomized to home or non-home.

Results: After 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 EBL (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.

Conclusion: ACDF 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.

Keywords: Anterior Cervical Discectomy and Fusion (ACDF); Cervical Disc Herniation; Geriatrics; Hospital Discharge Destinations; Posterior Cervical Decompression and Fusion (PCDF); Surgical Outcomes.