Wesley M Durand, Amir Human Hoveidaei, Micheal Raad, Rajan Khanna, Amit Jain
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引用次数: 0
Abstract
Study design: Retrospective analysis using the MarketScan private insurance database from 2010-2020.
Objective: Determine the incidence of multiple revision cervical surgeries at 5 years following primary, single-level ACDF and assess the risk of subsequent revisions after the first and second surgeries.
Summary of background data: The rate of revision surgery after ACDF is well-documented, but data on multiple revision surgeries is limited.
Methods: Adult patients ≤65 years undergoing primary, single-level ACDF were identified. Patients with infectious, traumatic, or neoplastic etiologies were excluded. The primary endpoint was any revision cervical surgery with follow-up ending at 5 years. Kaplan-Meier and Cox proportional hazards regression were used, adjusting for sex, age, CCI, and region.
Results: A total of 42,845 patients undergoing primary, single-level ACDF (P) were included, with a mean age of 48.9 years (SD 9.0); 52.8% were female. The "first revision" (R1) group included 2,374 patients, and the "second revision" (R2) group had 195 patients. The mean revision-free follow-up was significantly different across the P, R1, and R2 groups, though with small absolute differences (P 2.2 years, R1 2.0 years, R2 2.0 years; P<0.0001). At 5-years post-operatively, the incidence of revision surgery was 10.8% after primary surgery, 24.1% after one revision, and 42.5% after two revisions. In multivariable Cox regression, the risk of subsequent revision surgery was significantly higher after one revision (HR 1.6 vs. primary, P<0.0001) and even more so after two revisions (HR 2.6 vs. primary, P<0.0001). Interval hazard analysis showed a significantly higher incidence of revision from 2-5 years with each subsequent revision (all P<0.05).
Conclusion: After primary ACDF in patients <65 years, approximately 10% underwent revision at 5 years post-operatively. The occurrence of subsequent revision surgery was higher; >20% after one revision, and >40% after two revisions, which is critical for patient decision-making.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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