28 Aug Risk Factors That May Affect Readmission Rates for Anterior Cervical Fusion in Elderly Patients
An anterior cervical discectomy and fusion (also known as anterior cervical decompression surgery) are a surgical procedure that involve the removal of a disc in the neck due to either herniation or degeneration. The goal of the procedure is to relieve pressure on the spinal cord or nerve roots and alleviate pain, tingling, and numbness in the limbs. After the disc is removed, a bone graft is put in place to fuse the bones together above and below it to inhibit mobility, stabilize the vertebral column and therefore permanently diminish pain.
Most elderly patients (aged 65 or older) who undergo an anterior cervical fusion procedure will experience no major issues as a result. The readmission rate for these patients is low. But according to Medicare data, for those elderly patients who do end up being readmitted within 30 days following an anterior cervical fusion, the most common reason for readmission is a hematoma (a solid swelling of clotted blood) or seroma (a pocket of clear serous fluid that can develop after surgery). Over time, unplanned readmission rates following an anterior cervical fusion procedure increased from around 1 percent (at 30 days) to around 14 percent (at 1-year post-op).
Researchers analyzed Medicare data for 45,248 patients over the age of 65 who underwent one-level or two-level anterior cervical fusion and 12,103 patients who underwent three or more levels of cervical fusion for cervical spondylosis to learn more about readmission and postoperative complications. The specific purpose of the study was to look more closely at readmission rates following surgery at 30 days, 90 days, and 1-year post-op. Investigators also looked for risk factors in the Medicare data that led to readmissions among this age-group to determine that the development of hematomas or seromas were the most significant risk in terms of readmission.
Hematomas cause significant swelling and inflammation that can cause nearby organs and tissues to become irritated. This and infection are the primary complications associated with the development of hematomas in the body. For hematomas requiring readmission to the hospital, patients may need to undergo surgery to have it removed or drained. Seromas have a similar treatment trajectory. A seroma is a build-up of tissue fluids in an area of the body where tissue has been removed. They’re a normal response to surgery, and most of them are harmless and can heal naturally, but in some cases, readmission may be necessary to surgically drain it or to do a fine-needle aspiration. Prolonged and ongoing drainage of a seroma can increase the risk of infection, which would delay the healing process.
The results of the Medicare study show that readmission rates following this type of surgery, go up slightly over time with only 1 percent to 1.4 percent of patients being readmitted after 30 days, 2.7 percent to 3.6 percent after 90 days, and 13.2 percent to 14.1 percent after 1 year. Noteworthy was the fact that the biggest risk factors for readmission after 30 days included male gender, diabetes, obesity, smoking, and chronic pulmonary disease.