Demographic, clinical, and operative factors affecting long-term revision rates after cervical spine arthrodesis

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

Research output: Contribution to journalArticle

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Abstract

Background: Limited data exist on long-term revision rates following cervical spine arthrodeses. The purposes of this study were to define reoperation rates after primary cervical arthrodeses and to identify risk factors for revisions. Methods: New York State's all-payer health-care database was queried to identify all primary subaxial cervical arthrodeses occurring in the 16 years from 1997 through 2012. A total of 87,042 patients were included in the study cohort. Demographic information was extracted. Patients' preoperative medical comorbidities, surgical indications, and operative approaches were assembled using codes from the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification). The cohort was followed to revision surgical procedures, death, or the end of the study period. All subsequent contiguous spinal arthrodeses, including in the subaxial cervical spine, were considered revisions. The overall revision risk and the risk associated with various preoperative characteristics, surgical indications, and operative approaches were assessed using a Cox proportional hazard model. Results: During the study period, 6,721 patients (7.7%) underwent revision. The median time to revision was 24.5 months. The probability of undergoing at least one revision by 192 months was 12.6%. Arthrodeses performed via anterior-only approaches had a significantly higher probability of revision (p < 0.001) at 13.4% (95% confidence interval [95% CI], 12.9% to 13.9%) than those performed via posterior approaches at 7.4% (95% CI, 6.6% to 8.4%) or circumferential (anterior and posterior) approaches at 5.2% (95% CI, 4.0% to 6.8%). This relationship persisted in multivariate analysis; compared with anterior surgical procedures, there was a significantly lower risk of revision (p < 0.001) for posterior surgical approaches at a hazard ratio of 0.76 (95% CI, 0.69 to 0.84) and circumferential approaches at a hazard ratio of 0.53 (95% CI, 0.42 to 0.66). Patient age of 18 to 34 years, white race, insurance status of Workers' Compensation or Medicare, and surgical procedures for spinal stenosis, spondylosis, deformity, and neoplasm were associated with elevated revision risk. Arthrodeses spanning few levels and those performed for fractures had a lower revision risk. Conclusions: Primary subaxial cervical spine arthrodeses had a probability of revision approaching 13% over a 16-year period, with elevated reoperation rates in patients undergoing anterior-only surgical procedures. Age, race, insurance status, surgical indication, and number of spinal levels included in the arthrodesis were also associated with reoperation risk. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)1533-1540
Number of pages8
JournalJournal of Bone and Joint Surgery - American Volume
Volume98
Issue number18
DOIs
Publication statusPublished - Jan 1 2016
Externally publishedYes

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Arthrodesis
Spine
Demography
Reoperation
Confidence Intervals
Insurance Coverage
International Classification of Diseases
Spondylosis
Workers' Compensation
Spinal Stenosis
Medicare
Proportional Hazards Models
Comorbidity
Cohort Studies
Multivariate Analysis
Databases
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

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Demographic, clinical, and operative factors affecting long-term revision rates after cervical spine arthrodesis. / Derman, Peter B.; Lampe, Lukas P.; Hughes, Alexander P.; Pan, Ting Jung; Kueper, Janina; Girardi, Federico P.; Albert, Todd J.; Lyman, Stephen.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 98, No. 18, 01.01.2016, p. 1533-1540.

Research output: Contribution to journalArticle

Derman, Peter B. ; Lampe, Lukas P. ; Hughes, Alexander P. ; Pan, Ting Jung ; Kueper, Janina ; Girardi, Federico P. ; Albert, Todd J. ; Lyman, Stephen. / Demographic, clinical, and operative factors affecting long-term revision rates after cervical spine arthrodesis. In: Journal of Bone and Joint Surgery - American Volume. 2016 ; Vol. 98, No. 18. pp. 1533-1540.
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abstract = "Background: Limited data exist on long-term revision rates following cervical spine arthrodeses. The purposes of this study were to define reoperation rates after primary cervical arthrodeses and to identify risk factors for revisions. Methods: New York State's all-payer health-care database was queried to identify all primary subaxial cervical arthrodeses occurring in the 16 years from 1997 through 2012. A total of 87,042 patients were included in the study cohort. Demographic information was extracted. Patients' preoperative medical comorbidities, surgical indications, and operative approaches were assembled using codes from the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification). The cohort was followed to revision surgical procedures, death, or the end of the study period. All subsequent contiguous spinal arthrodeses, including in the subaxial cervical spine, were considered revisions. The overall revision risk and the risk associated with various preoperative characteristics, surgical indications, and operative approaches were assessed using a Cox proportional hazard model. Results: During the study period, 6,721 patients (7.7{\%}) underwent revision. The median time to revision was 24.5 months. The probability of undergoing at least one revision by 192 months was 12.6{\%}. Arthrodeses performed via anterior-only approaches had a significantly higher probability of revision (p < 0.001) at 13.4{\%} (95{\%} confidence interval [95{\%} CI], 12.9{\%} to 13.9{\%}) than those performed via posterior approaches at 7.4{\%} (95{\%} CI, 6.6{\%} to 8.4{\%}) or circumferential (anterior and posterior) approaches at 5.2{\%} (95{\%} CI, 4.0{\%} to 6.8{\%}). This relationship persisted in multivariate analysis; compared with anterior surgical procedures, there was a significantly lower risk of revision (p < 0.001) for posterior surgical approaches at a hazard ratio of 0.76 (95{\%} CI, 0.69 to 0.84) and circumferential approaches at a hazard ratio of 0.53 (95{\%} CI, 0.42 to 0.66). Patient age of 18 to 34 years, white race, insurance status of Workers' Compensation or Medicare, and surgical procedures for spinal stenosis, spondylosis, deformity, and neoplasm were associated with elevated revision risk. Arthrodeses spanning few levels and those performed for fractures had a lower revision risk. Conclusions: Primary subaxial cervical spine arthrodeses had a probability of revision approaching 13{\%} over a 16-year period, with elevated reoperation rates in patients undergoing anterior-only surgical procedures. Age, race, insurance status, surgical indication, and number of spinal levels included in the arthrodesis were also associated with reoperation risk. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.",
author = "Derman, {Peter B.} and Lampe, {Lukas P.} and Hughes, {Alexander P.} and Pan, {Ting Jung} and Janina Kueper and Girardi, {Federico P.} and Albert, {Todd J.} and Stephen Lyman",
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T1 - Demographic, clinical, and operative factors affecting long-term revision rates after cervical spine arthrodesis

AU - Derman, Peter B.

AU - Lampe, Lukas P.

AU - Hughes, Alexander P.

AU - Pan, Ting Jung

AU - Kueper, Janina

AU - Girardi, Federico P.

AU - Albert, Todd J.

AU - Lyman, Stephen

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Limited data exist on long-term revision rates following cervical spine arthrodeses. The purposes of this study were to define reoperation rates after primary cervical arthrodeses and to identify risk factors for revisions. Methods: New York State's all-payer health-care database was queried to identify all primary subaxial cervical arthrodeses occurring in the 16 years from 1997 through 2012. A total of 87,042 patients were included in the study cohort. Demographic information was extracted. Patients' preoperative medical comorbidities, surgical indications, and operative approaches were assembled using codes from the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification). The cohort was followed to revision surgical procedures, death, or the end of the study period. All subsequent contiguous spinal arthrodeses, including in the subaxial cervical spine, were considered revisions. The overall revision risk and the risk associated with various preoperative characteristics, surgical indications, and operative approaches were assessed using a Cox proportional hazard model. Results: During the study period, 6,721 patients (7.7%) underwent revision. The median time to revision was 24.5 months. The probability of undergoing at least one revision by 192 months was 12.6%. Arthrodeses performed via anterior-only approaches had a significantly higher probability of revision (p < 0.001) at 13.4% (95% confidence interval [95% CI], 12.9% to 13.9%) than those performed via posterior approaches at 7.4% (95% CI, 6.6% to 8.4%) or circumferential (anterior and posterior) approaches at 5.2% (95% CI, 4.0% to 6.8%). This relationship persisted in multivariate analysis; compared with anterior surgical procedures, there was a significantly lower risk of revision (p < 0.001) for posterior surgical approaches at a hazard ratio of 0.76 (95% CI, 0.69 to 0.84) and circumferential approaches at a hazard ratio of 0.53 (95% CI, 0.42 to 0.66). Patient age of 18 to 34 years, white race, insurance status of Workers' Compensation or Medicare, and surgical procedures for spinal stenosis, spondylosis, deformity, and neoplasm were associated with elevated revision risk. Arthrodeses spanning few levels and those performed for fractures had a lower revision risk. Conclusions: Primary subaxial cervical spine arthrodeses had a probability of revision approaching 13% over a 16-year period, with elevated reoperation rates in patients undergoing anterior-only surgical procedures. Age, race, insurance status, surgical indication, and number of spinal levels included in the arthrodesis were also associated with reoperation risk. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Limited data exist on long-term revision rates following cervical spine arthrodeses. The purposes of this study were to define reoperation rates after primary cervical arthrodeses and to identify risk factors for revisions. Methods: New York State's all-payer health-care database was queried to identify all primary subaxial cervical arthrodeses occurring in the 16 years from 1997 through 2012. A total of 87,042 patients were included in the study cohort. Demographic information was extracted. Patients' preoperative medical comorbidities, surgical indications, and operative approaches were assembled using codes from the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification). The cohort was followed to revision surgical procedures, death, or the end of the study period. All subsequent contiguous spinal arthrodeses, including in the subaxial cervical spine, were considered revisions. The overall revision risk and the risk associated with various preoperative characteristics, surgical indications, and operative approaches were assessed using a Cox proportional hazard model. Results: During the study period, 6,721 patients (7.7%) underwent revision. The median time to revision was 24.5 months. The probability of undergoing at least one revision by 192 months was 12.6%. Arthrodeses performed via anterior-only approaches had a significantly higher probability of revision (p < 0.001) at 13.4% (95% confidence interval [95% CI], 12.9% to 13.9%) than those performed via posterior approaches at 7.4% (95% CI, 6.6% to 8.4%) or circumferential (anterior and posterior) approaches at 5.2% (95% CI, 4.0% to 6.8%). This relationship persisted in multivariate analysis; compared with anterior surgical procedures, there was a significantly lower risk of revision (p < 0.001) for posterior surgical approaches at a hazard ratio of 0.76 (95% CI, 0.69 to 0.84) and circumferential approaches at a hazard ratio of 0.53 (95% CI, 0.42 to 0.66). Patient age of 18 to 34 years, white race, insurance status of Workers' Compensation or Medicare, and surgical procedures for spinal stenosis, spondylosis, deformity, and neoplasm were associated with elevated revision risk. Arthrodeses spanning few levels and those performed for fractures had a lower revision risk. Conclusions: Primary subaxial cervical spine arthrodeses had a probability of revision approaching 13% over a 16-year period, with elevated reoperation rates in patients undergoing anterior-only surgical procedures. Age, race, insurance status, surgical indication, and number of spinal levels included in the arthrodesis were also associated with reoperation risk. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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