Dysphagia Following Anterior Cervical Discectomy and Fusion: A PearlDiver Analysis of Incidence, Risk Factors, and Interventions.

Abstract

Anterior cervical discectomy and fusion (ACDF) is a well-established surgical procedure, with wide variation in reported postoperative dysphagia rates (1-79%). No standardized guidelines exist for screening, diagnosis, and treatment of postoperative ACDF dysphagia. The goal of the current study is to utilize a large database of US healthcare insurance claims to investigate incidence of dysphagia post-ACDF as well as risk factors for dysphagia and interventions performed in a large patient cohort. PearlDiver database was used to identify patients without preoperative dysphagia undergoing ACDF between 2010 and 2022 and create cohorts of patients with and without postoperative ACDF dysphagia. International Classification of Disease version 9 and 10 (ICD-9 and ICD-10), and Current Procedural Terminology (CPT) codes were used to retrieve patient records. The two cohorts were compared in terms of age, gender, comorbidities, prior neck surgery, postoperative vocal fold paralysis, and dysphagia related interventions. OR with 95% CI were calculated, stratifying by various risk factors. Prevalence of various postoperative diagnoses and interventions were calculated. Of 618,170 patients undergoing primary ACDF from 2010 to 2022, 88,899 (14.4%) developed postoperative dysphagia. Females, smokers, diabetics, and obese patients had higher odds of developing post ACDF dysphagia (OR 1.14, 2.51, 2.18, 2.50 respectively). 3% of patients with post ACDF dysphagia had new postoperative vocal fold motion impairment (VFMI) versus 0.3% without dysphagia (OR 8.69). Within the dysphagia cohort,14.9% underwent laryngoscopy, 19.0% underwent MBSS, 0.80% underwent FEES, and 5.2% received swallow therapy. Dysphagia is commonly diagnosed after ACDF, with females, smokers, diabetics, and obese patients having the highest odds of diagnosis. Yet, a low percentage of patients are being referred for evaluation or treatment. Providers performing ACDF should consider screening protocols and early referral to providers offering interventions for dysphagia diagnosis and treatment.