Introduction: Surgical complications contribute to patient morbidity and mortality as well as increase the cost of healthcare. With an increasing trend of negative incentivization for in-hospital complications, it is important to determine how patient diagnosis and procedure affects outcomes. The purpose of this study is to describe the incidence of and compare the in-hospital complications and mortality of cervical spine fusion surgery in traumatic spine injuries and degenerative disease.

Methods: Data was obtained using the Nationwide Inpatient Sample (NIS) between 2007 and 2011. Patients with traumatic cervical spine injuries requiring fusion surgery (i.e. occipital-cervical (OCF), anterior cervical (ACF), posterior cervical (PCF)) were identified using the International Classification of Diseases, 9th edition (ICD-9). In-hospital complications associated cervical fusions were also identified using ICD-9 codes. Univariate analysis was used to determine whether the complication rates of cervical fusions differed between traumatic injuries and degenerative disease.

Results: From 2007-2011, 159,802 were admitted with traumatic cervical spine injuries (cervical spine fracture with or without spinal cord injury (SCI), cervical dislocation) and 804,150 were admitted with degenerative cervical disease. Of those with traumatic C-spine injuries 36,516 (22.8%) had a fusion. 605,879 (75.3%) patients with degenerative disease had fusion surgery. The overall complication rate for all types of cervical fusion procedures was found to be significantly higher in patients with traumatic cervical spine injuries. The complication rates based type of traumatic cervical injuries requiring fusion surgery was also noted to be significantly higher than patients with degenerative disease.

Conclusions: The complication rates of cervical fusion surgery was significantly higher in patients with traumatic injuries compared to those with degenerative disease. Thus, one may consider the admitting diagnosis in reviewing hospital quality and outcomes data for cervical fusion surgery instead of evaluation based on the procedure alone.

Patient Care: In a time where health care is increasingly focused on quality and outcomes, it is important to determine complication rates, a commonly utilized metric for quality, on a national level. In addition, it is important to differentiate the complication rates for common spine surgical procedures (e.g. cervical fusions) for various pathologies. Determining the complication rates for cervical fusion surgery and differentiating them for traumatic and degenerative cervical spine disease could potentially be used as a reference when comparing a surgeon’s or hospital’s quality data and prompt improvement in delivering care to the patient.

Learning Objectives: By the conclusion of this session, the participant should be able to: 1. Describe the complication rates of cervical fusion surgery for patients with traumatic cervical spine injury or degenerative disease. 2. Understand the differences in complication rates for all types of cervical fusion surgeries with respect the initial diagnosis (i.e. trauma versus non-trauma). 3. Consider factoring in or separating the initial diagnosis in cervical fusion surgeries in analyzing hospital quality and outcomes data.

References: Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA. Complications and Mortality Associated With Cervical Spine Surgery for Degenerative Disease in the United States. Spine 2007. 32:342-7. Campbell PG, Yadla S, Malone J, et al. Early Complications Related to Approach in Cervical Spine Surgery: Single-Center Prospective Study. World Neurosurg 2010. 74:363-8. Shen Y, Silverstein JC, Roth S. In-hospital Complications and Mortality After Elective Spinal Fusion Surgery in the United States. A Study of the Nationwide Inpatient Sample From 2001 to 2005. J Neurosurg Anesthesiol 2009. 21:21-30.