The Impact of Crossing the Cervicothoracic Junction on Opioid Consumption, Readmission, and Revision Rates.

Abstract

Introduction: The risks and benefits of extending posterior cervical decompression and fusion (PCDF) constructs across the cervicothoracic junction (CTJ) remain controversial. Previous studies have used fusions beginning at different levels and varying in construct length. There are no studies that examine the effect of crossing the CTJ on opioid consumption. This study aims to compare short-term and long-term postoperative outcomes among patients undergoing PCDF at C3 and ending at C7, T1, or T2.

Methods: Adult patients who underwent C3-C7, C3-T1, and C3-T2 PCDF from 2017 to 2022 were identified. All patients were retrospectively reviewed for demographic and surgical information. Perioperative opioid utilization from 1 year preoperatively to 1 year postoperatively was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Acute postoperative outcomes included rates of 30-day and 90-day readmission and any revision surgery.

Results: This study included 72 (C3-C7: 30.2%), 143 (C3-T1: 60.1%), and 23 (C3-T2: 9.7%) patients-groups were demographically similar. The average length of follow-up was 503 ± 433 days. Cut-to-close time differed between groups (166 ± 37.9 [C3-C7] vs. 182 ± 43.2 vs. 199 ± 40.9 minutes [C3-T2]; P = 0.003). Total in-hospital morphine milligram equivalents (205 ± 136 [C3-C7] vs. 247 ± 191 vs. 285 ± 136 [C3-T2]; P = 0.007) and average daily in-hospital morphine milligram equivalents (59.5 ± 29.9 [C3-C7] vs. 73.2 ± 52.1 vs. 81.0 ± 22.9 [C3-T2]; P = 0.008) were highest among C3-T2 fusions. Patients who underwent C3-T2 fusion consumed higher MMEs from 0 to 90 days postoperatively (148 ± 197 [C3-C7] vs. 223 ± 307 vs. 260 ± 363 [C3-T2]; P = 0.027). Length of stay, opioid use beyond 90 days, 30-day and 90-day readmission rates, revision surgery rates, and revision rates were similar between groups.

Conclusion: Crossing the CTJ increased cut-to-close time and early postoperative opioid consumption but did not affect length of stay, readmission rates, long-term opioid misuse, or revision surgery rates.