Atlantoaxial fusion: Sixteen years of epidemiology, indications, and complications in New York State

Peter B. Derman, Lukas P. Lampe, Stephen Lyman, Janina Kueper, Ting Jung Pan, Federico P. Girardi, Todd J. Albert, Alexander P. Hughes

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Study Design. A retrospective state database analysis. Objective. The aim of this study was to describe the epidemiology and complications of as well as indications for primary isolated atlantoaxial fusion. Summary of Background Data. Atlantoaxial fusion involves unique indications, techniques, and complications. There is limited epidemiologic literature focused specifically on this procedure. Methods. New York's Statewide Planning and Research Cooperative System database, an all-payer hospitalization reporting system, was queried to identify all patients undergoing primary isolated atlantoaxial fusion in the state from 1997 to 2012. Demographic and clinical data were extracted and analyzed. United States Census Bureau figures were used to calculate population-adjusted surgical rates. Results. One thousand five hundred fifty-nine patients underwent isolated primary atlantoaxial fusion during the study period. The overall population-adjusted annual surgical rate did not change significantly over time. By 2012, individuals aged-70 years had the highest incidence of surgery [2.37 per 100,000 population; 95% confidence interval (95% CI) 1.68-3.07]. Medicare was the most common payer (44.0% of claims). Approximately 85% of patients had a Charlson/Deyo Comorbidity Index of zero or one. Over time, a significantly lower proportion of atlantoaxial fusions were attributable to rheumatic disease, and a significantly higher proportion were due to fracture. By 2012, management of fractures was the most common indication for C1-C2 fusion (44.1% of cases). Dysphagia or dysphonia occurred after 0.8% of cases, dural tear after 0.3%, infection after 0.5%, and seroma, hematoma, or hemorrhage after 0.5%. In-hospital mortality was 2.7%, of which 76% had fracture as the surgical indication. Conclusion. Isolated atlantoaxial fusions have been performed at a stable, low level over the past 16 years in New York. Although most of these patients are relatively healthy preoperatively, approximately one in 10 experience an in-hospital complication and nearly 3% die in-hospital. Knowledge of these risks will hopefully spur further efforts to minimize them and allow for more accurate counseling of patients and their families.

Original languageEnglish
Pages (from-to)1586-1592
Number of pages7
JournalSpine
Volume41
Issue number20
DOIs
Publication statusPublished - Oct 15 2016

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Epidemiology
Databases
Population
Seroma
Dysphonia
Censuses
Deglutition Disorders
Medicare
Hospital Mortality
Rheumatic Diseases
Tears
Hematoma
Atlanto-Axial Fusion
Comorbidity
Counseling
Hospitalization
Demography
Confidence Intervals
Hemorrhage
Incidence

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Derman, P. B., Lampe, L. P., Lyman, S., Kueper, J., Pan, T. J., Girardi, F. P., ... Hughes, A. P. (2016). Atlantoaxial fusion: Sixteen years of epidemiology, indications, and complications in New York State. Spine, 41(20), 1586-1592. https://doi.org/10.1097/BRS.0000000000001603

Atlantoaxial fusion : Sixteen years of epidemiology, indications, and complications in New York State. / Derman, Peter B.; Lampe, Lukas P.; Lyman, Stephen; Kueper, Janina; Pan, Ting Jung; Girardi, Federico P.; Albert, Todd J.; Hughes, Alexander P.

In: Spine, Vol. 41, No. 20, 15.10.2016, p. 1586-1592.

Research output: Contribution to journalArticle

Derman, PB, Lampe, LP, Lyman, S, Kueper, J, Pan, TJ, Girardi, FP, Albert, TJ & Hughes, AP 2016, 'Atlantoaxial fusion: Sixteen years of epidemiology, indications, and complications in New York State', Spine, vol. 41, no. 20, pp. 1586-1592. https://doi.org/10.1097/BRS.0000000000001603
Derman, Peter B. ; Lampe, Lukas P. ; Lyman, Stephen ; Kueper, Janina ; Pan, Ting Jung ; Girardi, Federico P. ; Albert, Todd J. ; Hughes, Alexander P. / Atlantoaxial fusion : Sixteen years of epidemiology, indications, and complications in New York State. In: Spine. 2016 ; Vol. 41, No. 20. pp. 1586-1592.
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abstract = "Study Design. A retrospective state database analysis. Objective. The aim of this study was to describe the epidemiology and complications of as well as indications for primary isolated atlantoaxial fusion. Summary of Background Data. Atlantoaxial fusion involves unique indications, techniques, and complications. There is limited epidemiologic literature focused specifically on this procedure. Methods. New York's Statewide Planning and Research Cooperative System database, an all-payer hospitalization reporting system, was queried to identify all patients undergoing primary isolated atlantoaxial fusion in the state from 1997 to 2012. Demographic and clinical data were extracted and analyzed. United States Census Bureau figures were used to calculate population-adjusted surgical rates. Results. One thousand five hundred fifty-nine patients underwent isolated primary atlantoaxial fusion during the study period. The overall population-adjusted annual surgical rate did not change significantly over time. By 2012, individuals aged-70 years had the highest incidence of surgery [2.37 per 100,000 population; 95{\%} confidence interval (95{\%} CI) 1.68-3.07]. Medicare was the most common payer (44.0{\%} of claims). Approximately 85{\%} of patients had a Charlson/Deyo Comorbidity Index of zero or one. Over time, a significantly lower proportion of atlantoaxial fusions were attributable to rheumatic disease, and a significantly higher proportion were due to fracture. By 2012, management of fractures was the most common indication for C1-C2 fusion (44.1{\%} of cases). Dysphagia or dysphonia occurred after 0.8{\%} of cases, dural tear after 0.3{\%}, infection after 0.5{\%}, and seroma, hematoma, or hemorrhage after 0.5{\%}. In-hospital mortality was 2.7{\%}, of which 76{\%} had fracture as the surgical indication. Conclusion. Isolated atlantoaxial fusions have been performed at a stable, low level over the past 16 years in New York. Although most of these patients are relatively healthy preoperatively, approximately one in 10 experience an in-hospital complication and nearly 3{\%} die in-hospital. Knowledge of these risks will hopefully spur further efforts to minimize them and allow for more accurate counseling of patients and their families.",
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AU - Pan, Ting Jung

AU - Girardi, Federico P.

AU - Albert, Todd J.

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N2 - Study Design. A retrospective state database analysis. Objective. The aim of this study was to describe the epidemiology and complications of as well as indications for primary isolated atlantoaxial fusion. Summary of Background Data. Atlantoaxial fusion involves unique indications, techniques, and complications. There is limited epidemiologic literature focused specifically on this procedure. Methods. New York's Statewide Planning and Research Cooperative System database, an all-payer hospitalization reporting system, was queried to identify all patients undergoing primary isolated atlantoaxial fusion in the state from 1997 to 2012. Demographic and clinical data were extracted and analyzed. United States Census Bureau figures were used to calculate population-adjusted surgical rates. Results. One thousand five hundred fifty-nine patients underwent isolated primary atlantoaxial fusion during the study period. The overall population-adjusted annual surgical rate did not change significantly over time. By 2012, individuals aged-70 years had the highest incidence of surgery [2.37 per 100,000 population; 95% confidence interval (95% CI) 1.68-3.07]. Medicare was the most common payer (44.0% of claims). Approximately 85% of patients had a Charlson/Deyo Comorbidity Index of zero or one. Over time, a significantly lower proportion of atlantoaxial fusions were attributable to rheumatic disease, and a significantly higher proportion were due to fracture. By 2012, management of fractures was the most common indication for C1-C2 fusion (44.1% of cases). Dysphagia or dysphonia occurred after 0.8% of cases, dural tear after 0.3%, infection after 0.5%, and seroma, hematoma, or hemorrhage after 0.5%. In-hospital mortality was 2.7%, of which 76% had fracture as the surgical indication. Conclusion. Isolated atlantoaxial fusions have been performed at a stable, low level over the past 16 years in New York. Although most of these patients are relatively healthy preoperatively, approximately one in 10 experience an in-hospital complication and nearly 3% die in-hospital. Knowledge of these risks will hopefully spur further efforts to minimize them and allow for more accurate counseling of patients and their families.

AB - Study Design. A retrospective state database analysis. Objective. The aim of this study was to describe the epidemiology and complications of as well as indications for primary isolated atlantoaxial fusion. Summary of Background Data. Atlantoaxial fusion involves unique indications, techniques, and complications. There is limited epidemiologic literature focused specifically on this procedure. Methods. New York's Statewide Planning and Research Cooperative System database, an all-payer hospitalization reporting system, was queried to identify all patients undergoing primary isolated atlantoaxial fusion in the state from 1997 to 2012. Demographic and clinical data were extracted and analyzed. United States Census Bureau figures were used to calculate population-adjusted surgical rates. Results. One thousand five hundred fifty-nine patients underwent isolated primary atlantoaxial fusion during the study period. The overall population-adjusted annual surgical rate did not change significantly over time. By 2012, individuals aged-70 years had the highest incidence of surgery [2.37 per 100,000 population; 95% confidence interval (95% CI) 1.68-3.07]. Medicare was the most common payer (44.0% of claims). Approximately 85% of patients had a Charlson/Deyo Comorbidity Index of zero or one. Over time, a significantly lower proportion of atlantoaxial fusions were attributable to rheumatic disease, and a significantly higher proportion were due to fracture. By 2012, management of fractures was the most common indication for C1-C2 fusion (44.1% of cases). Dysphagia or dysphonia occurred after 0.8% of cases, dural tear after 0.3%, infection after 0.5%, and seroma, hematoma, or hemorrhage after 0.5%. In-hospital mortality was 2.7%, of which 76% had fracture as the surgical indication. Conclusion. Isolated atlantoaxial fusions have been performed at a stable, low level over the past 16 years in New York. Although most of these patients are relatively healthy preoperatively, approximately one in 10 experience an in-hospital complication and nearly 3% die in-hospital. Knowledge of these risks will hopefully spur further efforts to minimize them and allow for more accurate counseling of patients and their families.

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