Does Approach Matter? Comparison of Early Postoperative Life-threatening Complications in Elderly Patients With Multilevel Cervical Stenosis.

Study Design: Retrospective cohort study.

Summary Of Background Data: The optimal surgical approach for multilevel cervical stenosis in elderly patients is controversial because of the risk of life-threatening complication.

Objective: To compare life-threatening early complication rates between ≥3 levels anterior and posterior cervical surgery in elderly patients.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) were queried for patients 65 years or older who underwent ACDF or PS between 2016 and 2021. Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3-5 levels; ACDF3+), laminoplasty or laminectomy (3-5 levels), and posterior decompression and fusion (3-5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches.

Results: We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P =0.275), airway complications (0.9% vs. 0.9%; P =1.000), and VTE (1.1% vs. 0.7%; P =0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P =0.045), UTI (1.1% vs. 3.0%; P =0.035), and LOS (2.5±6.1 vs, 4.3±3.9 d; P <0.001).

Conclusions: Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.