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
{"title":"与 PCDF 相比，ACDF 提高了老年颈椎间盘突出症患者的出院率：倾向匹配分析","authors":"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","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"ACDF Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to PCDF: A Propensity-Matched Analysis.\",\"authors\":\"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\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-11-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.10.145\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.10.145","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
ACDF Associated with Increased Home Discharge Rates in Geriatric Patients with Cervical Disc Herniation Compared to PCDF: A Propensity-Matched Analysis.
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.
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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