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  • Surgical Site Infections After the Transoral versus Posterior Approaches to Atlantoaxial Fusions: A Matched Cohort Study

    Final Number:
    1137

    Authors:
    Mohamed Macki MD, MPH; Azam Basheer MD; Ilan Rubinfeld MD, MBA; Muwaffak Abdulhak MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: In the past, spine surgeons have evaded the transoral approach to the atlantoaxial segment for concerns of unacceptable patient morbidity. The objective of this study is to measure 30-day postoperative complications, especially surgical site infections (SSI), after the transoral versus posterior approach to atlantoaxial fusions.

    Methods: The source population was provided by the American College of Surgeons National Surgical Quality Improvement Program database, which was queried for all patients who underwent atlantoaxial fusion for degenerative/spondylotic disease and/or trauma between 2005 and 2014. In order to eliminate a bias of unequal sample sizes, the transoral approach was matched with the posterior approach (generally 1:5 ratio) based on age ± 5 years and modified frailty index score (a measure of preoperative comorbidity burden) [Figure]. Because the rare SSI incidence, adjusted odds ratios (ORadj) of SSI were calculated with a Penalized Maximum Likelihood Estimation.

    Results: Of the 318 patients included, the transoral cohort (N=56) compared with the posterior cohort (N=262) did not statistically significantly differ in the 30-day postoperative individual complications, including SSI (1.79% vs 1.91%, p=0.951), as well as composite complications (10.71% vs 6.87%, p=0.323). Controlling for sex and smoking, the odds of SSI in the transoral approach was almost equal to the odds in the posterior approach (ORadj=1.17, p=0.866). While the unplanned reoperation rate of 5.36% after the transoral surgery was higher than the 1.53% after posterior surgery, the difference approached, but did not reach, statistical significance (p=0.076).

    Conclusions: Transoral versus posterior surgery for atlantoaxial fusions did not differ in 30-day unexpected outcomes. Therefore, spinal pathology, rather than concern of postoperative complications, should adjudicate the technical approach to the atlantoaxial segment.

    Patient Care: Because unintended outcomes were equal between the two cohorts, spinal pathology, rather than concern of postoperative complications, should adjudicate the technical approach to the atlantoaxial segment.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand differences in surgical site infection in the anterior versus posterior approaches to the C1-C2 segment 2) Lists a few reasons for the similarity in surgical site infection between the anterior versus posterior approaches to the C1-C2 segment

    References:

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