Revision PCDF has lower risk of ICU stay but higher hospitalisation and surgical costs than primary PCDF procedures

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Patients undergoing revision posterior cervical discectomy and fusion (PCDF) procedures had a decreased risk of required intensive care unit (ICU) stay but greater risk of 30-day emergency department (ED) admission and higher direct hospitalisation and surgical costs than those undertaking a primary PCDF procedure, new research has concluded. 

The study, published in the journal Spine by Michael Martini (Icahn School of Medicine at Mount Sinai, New York, USA) et al, was designed to compare perioperative outcomes and hospitalisation costs between patients undergoing primary or revision PCDF.

The findings of this retrospective analysis showed that complication rates, including incidental durotomy, were similar between the primary and revision PCDF cohorts and, although prior surgery status did not predict complication risk, comorbidity burden did.

Institutional records were queried for cases involving isolated PCDF procedures to evaluate preoperative characteristics and outcomes for patients undergoing primary versus revision PCDF between 2008 and 2016. The primary outcome was perioperative complications, while perioperative and resource utilisation measures such as hospitalisation length, required stay in the ICU, direct hospitalisation costs, and 30-day ED admissions were explored as secondary outcomes.

A total of 1,124 patients underwent PCDF with 218 (19.4%) undergoing a revision procedure. Patients undergoing revision procedures were younger (53 versus 60.5 years), but had higher Elixhauser scores compared with the non-revision cohort. Revision cases tended to involve fewer spinal segments (3.6 versus 4.1) and shorter surgical durations (179.3 versus 206.3 min), without significant differences in estimated blood loss.

There were no significant differences in the overall complication rates (P= 0.20), however, the primary cohort had greater rates of required ICU stays (P= 0.0005) and non-home discharges (P= 0.0003). The revision cohort did experience significantly increased odds of 30-day ED admission (P= 0.04) and had higher direct hospitalisation (P= 0.03) and surgical (P< 0.0001) costs.


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