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- 저자 : Schonfeld Ethan (검색결과 2 건)
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Rodrigues Adrian John,Schonfeld Ethan,Varshneya Kunal,Stienen Martin Nikolaus,Veeravagu Anand 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4
Study Design: Retrospective cohort study.Purpose: Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for patients diagnosed with cervical degenerative diseases with or without myelopathy. A thorough understanding of outcomes in patients with and without myelopathy undergoing ACDF is required because of the widespread utilization of ACDF for these indications.Overview of Literature: Non-ACDF approaches achieved inferior outcomes in certain myelopathic cases. Studies have compared patient outcomes across procedures, but few have compared outcomes concerning myelopathic versus nonmyelopathic cohorts.Methods: The MarketScan database was queried from 2007 to 2016 to identify adult patients who were ≤65 years old, and underwent ACDF using the international classification of diseases 9th version and current procedural terminology codes. Nearest neighbor propensity-score matching was employed to balance patient demographics and operative characteristics between myelopathic and nonmyelopathic cohorts.Results: Of 107,480 patients who met the inclusion criteria, 29,152 (27.1%) were diagnosed with myelopathy. At baseline, the median age of patients with myelopathy was higher (52 years vs. 50 years, p <0.001), and they had a higher comorbidity burden (mean Charlson comorbidity index, 1.92 vs. 1.58; p <0.001) than patients without myelopathy. Patients with myelopathy were more likely to undergo surgical revision at 2 years (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.54–1.73) or are readmitted within 90 days (OR, 1.27; 95% CI, 1.20–1.34). After patient cohorts were matched, patients with myelopathy remained at elevated risk for reoperation at 2 years (OR, 1.55; 95% CI, 1.44–1.67) and postoperative dysphagia (2.78% vs. 1.68%, p <0.001) compared to patients without myelopathy.Conclusions: We found inferior postoperative outcomes at baseline for patients with myelopathy undergoing ACDF compared to patients without myelopathy. Patients with myelopathy remained at significantly greater risk for reoperation and readmission after balancing potential confounding variables across cohorts, and these differences in outcomes were largely driven by patients with myelopathy undergoing 1–2 level fusions.
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Rodrigues Adrian John,Varshneya Kunal,Stienen Martin Nikolaus,Schonfeld Ethan,Than Khoi Duc,Veeravagu Anand 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4
Study Design: Retrospective cohort study.Purpose: To characterize the postoperative outcomes and economic costs of anterior cervical discectomy and fusion (ACDF) procedures using synthetic biomechanical intervertebral cage (BC) and structural allograft (SA) implants.Overview of Literature: ACDF is a common spine procedure that typically uses an SA or BC for the cervical fusion. Previous studies that compared the outcomes between the two implants were limited by small sample sizes, short-term postoperative outcomes, and procedures with single-level fusion.Methods: Adult patients who underwent an ACDF procedure in 2007–2016 were included. Patient records were extracted from MarketScan, a national registry that captures person-specific clinical utilization, expenditures, and enrollments across millions of inpatient, outpatient, and prescription drug services. Propensity-score matching (PSM) was employed to match the patient cohorts across demographic characteristics, comorbidities, and treatments.Results: Of 110,911 patients, 65,151 (58.7%) received BC implants while 45,760 (41.3%) received SA implants. Patients who underwent BC surgeries had slightly higher reoperation rates within 1 year after the index ACDF procedure (3.3% vs. 3.0%, <i>p</i>=0.004), higher postoperative complication rates (4.9% vs. 4.6%, <i>p</i>=0.022), and higher 90-day readmission rates (4.9% vs. 4.4%, <i>p</i> =0.001). After PSM, the postoperative complication rates did not vary between the two cohorts (4.8% vs. 4.6%, <i>p</i>=0.369), although dysphagia (2.2% vs. 1.8%, <i>p</i><0.001) and infection (0.3% vs. 0.2%, <i>p</i>=0.007) rates remained higher for the BC group. Other outcome differences, including readmission and reoperation, decreased. Physician’s fees remained high for BC implantation procedures.Conclusions: We found marginal differences in clinical outcomes between BC and SA ACDF interventions in the largest published database cohort of adult ACDF surgeries. After adjusting for group-level differences in comorbidity burden and demographic characteristics, BC and SA ACDF surgeries showed similar clinical outcomes. Physician’s fees, however, were higher for BC implantation procedures.
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