Dysphagia May Attenuate Improvements in Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

Article Figures & Data

Table 1

Patient demographics.

Characteristic	Total (N = 91)
Age, y, mean ± SD	48.1 ± 10.1
Body mass index, mean ± SD	29.5 ± 5.7
Gender
Female	35.2% (32)
Male	64.8% (59)
Diabetic status
Nondiabetic	85.7% (78)
Diabetic	14.3% (13)
Smoking status
Nonsmoker	84.6% (77)
Smoker	15.4% (14)
American Society of Anesthesiologists score
<2	25.0% (18)
≥2	75.0% (54)
Charlson Comorbidity Index score
<1	38.2% (34)
≥1	61.8% (55)
Insurance
Medicare/Medicaid	1.1% (1)
Workers’ compensation	27.5% (25)
Private	71.4% (65)

Table 2

Perioperative characteristics.

Characteristic	Total (N = 91)
Spinal pathology
Herniated nucleus pulposus	86.8% (79)
Central spinal stenosis^{^a}	6.6% (6)
Degenerative disk disease^{^a}	6.6% (6)
Neuropathy
Radiculopathy	15.5% (15)
Myelopathy	1.1% (1)
Myeloradiculopathy	83.3% (75)
Number of operative levels
1 level	62.6% (57)
2 levels	37.4% (34)
Operative level
C5-C6	29.7% (27)
C6-C7	30.8% (28)
C7-T1	2.2% (2)
C5-C7	35.2% (32)
C6-T1	2.2% (2)
Cervical plating
Standalone cage	36.3% (33)
Anterior plate	63.7% (58)
Operative time, min, mean ± SD	55.3 ± 15.3
Estimated blood loss, mL mean ± SD	28.3 ± 11.3
Length of stay, h, mean ± SD	9.9 ± 7.5
Day of discharge
POD 0	83.1% (74)
POD 1	16.9% (15)
In-hospital complications
Urinary retention^{^b}	1.0% (1)
Tracheoesophageal hematoma^{^c}	1.0% (1)

Abbreviation: POD, postoperative day.
Note: Data presented as % (n) unless otherwise indicated.
↵a Stenosis not attributed to a herniated nucleus pulposus
↵b One patient demonstrated a postvoid residual volume of 300 mL on POD 0. The patient required straight catheterization and was placed on Flomax. The patient was able to void spontaneously on POD 2.
↵c One patient had an expanding superficial hematoma while in the postoperative recovery area. An emergent evacuation of a pretracheal hematoma was performed. The patient was discharged safely home on POD 1.

Table 3

Postoperative outcome measures (N = 91).

Outcome Measures	Mean ± SD (n)	P Value^{^a}
Swallowing quality of life
Preoperative	90.4 ± 6.8 (91)	-
6 wk	88.3 ± 10.2 (74)	0.007
12 wk	91.0 ± 8.1 (57)	0.557
6 mo	93.7 ± 6.1 (42)	0.002
VAS neck
Preoperative	5.7 ± 2.5 (89)	-
6 wk	3.2 ± 2.4 (82)	<0.001
12 wk	2.6 ± 2.3 (78)	<0.001
6 mo	2.4 ± 2.2 (63)	<0.001
VAS arm
Preoperative	5.8 ± 2.4 (89)	-
6 wk	2.6 ± 2.4 (81)	<0.001
12 wk	3.1 ± 3.1 (73)	<0.001
6 mo	2.5 ± 2.6 (61)	<0.001
Neck Disability Index
Preoperative	36.4 ± 19.2 (88)	-
6 wk	29.4 ± 18.4 (80)	0.009
12 wk	24.9 ± 18.9 (73)	<0.001
6 mo	18.2 ± 17.5 (60)	<0.001
12-Item Short Form Physical Component Score
Preoperative	35.9 ± 8.6 (84)	-
6 wk	35.0 ± 9.1 (71)	0.984
12 wk	38.7 ± 10.1 (56)	0.021
6 mo	41.3 ± 10.7 (55)	<0.001
PROMIS-PF
Preoperative	40.3 ± 6.7 (77)	-
6 wk	41.6 ± 6.7 (62)	0.299
12 wk	44.7 ± 9.7 (50)	<0.001
6 mo	48.0 ± 8.9 (44)	<0.001
9-Item Patient Health Questionnaire
Preoperative	7.3 ± 6.4 (56)	-
6 wk	5.3 ± 5.7 (51)	0.007
12 wk	4.8 ± 6.7 (40)	0.004
6 mo	5.4 ± 5.8 (34)	0.153

Abbreviation: PROMIS-PF, Patient-Reported Outcome Measurement Information System Physical Function; VAS, visual analog score.
Note: Boldface indicates statistical significance
↵a P values calculated using paired t test

Table 4

SWAL-QOL as a predictor of PROMs.

Note: Boldface indicates statistical significance
↵a P values calculated using simple linear regression to determine effect of SWAL-QOL on outcomes.
Abbreviation: NDI, Neck Diability Index; PHQ-9, 9-Item Patient Health Questionnaire; PROMIS-PF, Patient-Reported Outcome Measurement Information System Physical Function; SF-12 PCS, 12-Item Short Form Physical Component Score; VAS, visual analog scale.