Patients with Ehlers-Danlos syndrome (EDS) are at increased risk of both medical and surgical complications following anterior cervical discectomy and fusion (ACDF). As such, spine surgeons should be cognisant of the increased risks in this patient population and provide appropriate preoperative counselling and enhanced perioperative medical management. This is according to research published in the Global Spine Journal by Xudong Li (University of Virginia, Charlottesville, USA) et al.
The retrospective analysis was designed to study postoperative complication rates following ACDF in patients with EDS compared with patients without EDS.
Li et al utilised the Mariner database to identify patients with EDS undergoing one or two level ACDF. Postoperative short-term outcomes assessed included medical complications, readmissions, and emergency department (ED) visits within 90 days of surgery. Additionally, surgical complications including wound complications, surgical site infection, one- and two-year anterior revision along with posterior revision, pseudarthrosis, and hardware failure within two years were assessed. Multivariate logistic regression was used to adjust for demographic variables, comorbidities and number of levels operated on.
There were a total of 533 patients with EDS and 2,634 patients in the matched control group that underwent primary ACDF. One-level and two-level intervention were included in the study with two-level accounting for 29.3% in the EDS cohort and 26.2% in the control cohort. In all, 89.7% of patients were female and over 65% of the EDS cohort was comprised of patients aged between 35 and 54. There were no statistical differences in age, gender, comorbidities, and levels of intervention between the EDS and the control cohorts.
Multivariate analysis showed that patients with EDS undergoing ACDF were found to have increased incidence of 90-day major medical complications (odds ratio [OR] 3.31; p<0.001). These included cerebrovascular accident (1.9% vs. 0.6%; OR 3.23, 95% confidence interval [CI] 1.39–7.17; p=0.004), sepsis (1.1% vs. 0.3%; OR 3.4, 95% CI 1.07–10.24; p=0.029), pneumonia (3.6% vs. 1%; OR 3.6, 95% CI 1.94–6.54; p<0.001).
Other medical complications within 90 days include dysphagia (15.4% vs. 3.6%; OR 4.98, 95% CI 3.61–6.86; p<0.001), deep vein thrombosis (2.6% vs. 0.2%; OR 11.87, 95% CI 4.69–34.01; p<0.001), transfusion (1.3% vs. 0.2%; OR 5.49, 95% CI 1.41–21.89; p=0.012), urinary tract infection (13.5% vs. 3%; OR 5.19, 95% CI 3.69–7.29; p<0.001). EDS was also associated with higher incidences of 90-day ED-visit (38.1% vs. 16.1%; OR 3.4, 95% CI 2.75–4.2; p<0.001), and 90-day readmission (4.7% vs. 3.3%; OR 2.01, 95% CI 1.24–3.16; p=0.003).
In addition, EDS patients had increased rates of surgical complications: 90-day wound complications (3.4% vs. 1.2%; OR 2.94, 95% CI 1.59–5.29; p<0.001), 90-day surgical site infection (6.4% vs. 0.8%; OR 8.60, 95% CI 4.96–15.26; p<0.001), two-year pseudarthrosis (5.4% vs. 2.4%; OR 2.33, 95% CI 1.46–3.64; p<0.001), two-year instrument failure (6% vs 1.6%; OR 4.03, 95% CI 2.49–6.46; p<0.001), one-year anterior revision (38.8% vs. 2.6%; OR 25.17, 95% CI 18.68–34.3; p<0.001), two-year anterior revision (44.8% vs. 3.6%; OR 22.87, 95% CI 17.47–30.17; p<0.001), one-year posterior revision (5.3% vs. 1.1%; OR 5.18, 95% CI 3–8.98; p<0.001), and two-year posterior revision (6.2% vs. 2.1%; OR 3.17, 95% CI 2–4.96; p<0.001).
