Introduction: The anterior cervical discectomy and fusion (ACDF) is performed for a variety of cervical pathologies. Episode-based bundled payment models have forced a reevaluation of healthcare quality metrics and associated risk factors for poor outcomes. The objective of the present study is to evaluate anesthesia time as a risk factor for poor outcomes following ACDF.
Methods: Patients undergoing ACDF at a single institution from 2006-2016 were identified using the CPT codes 63075, 22554, and 22551. Those undergoing concomitant posterior cervical decompression and fusion were excluded. Patients were stratified into quintiles based on anesthesia time, and chi-square, Student's t-test, and multivariable logistic regression comparisons were made between the shortest group and all other groups. Regression models controlled for age, sex and ASA Class. A Bonferroni correction was utilized to account for multiple comparisons, such that alpha=0.0125, and all confidence intervals are 98.75%.
Results: 2370 patients underwent ACDF. The shortest quintile was less sick (as measured by ASA Class) than those in second (p=0.0009), third (p<0.0001), fourth (p<0.0001), and fifth (p<0.0001) quintiles (Figure 1). Adjusted logistic regression shows higher rates of nonhome discharge (NHD) for the second (OR: 1.59; CI: 1.07-2.35; p=0.003) and third quintiles (OR: 1.89; CI: 1.29-2.76; p<0.0001) compared to the first quintile (Figure 1). The fourth quintile had higher rates of required ICU stay (OR: 5.60; CI: 1.18-26.54; p=0.006), NHD (OR: 2.88; CI: 1.97-4.20; p<0.0001), and prolonged length of stay (LOS) (OR: 9.14; CI: 1.43-58.35; p=0.003) than the first quintile (Figure 1). The fifth quintile had higher rates of required ICU stay (OR: 12.23; CI: 2.70-55.36; p<0.0001), in-hospital complications (OR: 3.10; CI: 1.06-9.08; p<0.009), NHD (OR: 5.60; CI: 3.81-8.23; p<0.0001), prolonged LOS (OR: 19.84; CI: 3.21-122.6; p<0.0001), 30-day readmission (OR: 17.4; CI: 1.33-227.7; p=0.006), and 90-day readmission (OR: 4.02; CI: 1.48-10.94; p=0.0005) than the first quintile (Figure 1).
Conclusions: Longer anesthesia time is significantly associated with higher rates of perioperative and postoperative complications.
Patient Care: The present results raise awareness to the fact that anesthesia time, in addition to regular operative time, are necessary for preventing complications.
Learning Objectives: Following this presentation, viewers will be able to understand that increased anesthesia time places patients at greater risk for poor outcomes following spine surgery and that this association appears to be dose-dependent, with those undergoing anesthesia for the longest time having the longest duration of poor outcomes.