Evidence & Methods
Revision procedures for anterior cervical discectomy and fusion (ACDF) as well as disc replacement (TDR) are not well characterized. The authors sought to describe revision rates, complications and costs for revision procedures following primary ACDF or TDR using the Nationwide Inpatient Sample (NIS).
In this retrospective analysis, the authors evaluated 3,536 revision procedures following ACDF and 256 revisions for TDR. Revisions associated with TDR were found to have statistically increased hospital lengths of stay, risk of perioperative wound infection, and resultant health care costs. The authors maintain that their findings result from more invasive procedures necessary to revise cervical TDR.
The NIS is a representative sample drawn from hospitals across the country. While heavily utilized in a number of investigations associated with spine surgical research, the dataset was not specifically designed to support such efforts. As a result, certain procedures are particularly under-represented, such as the limited number of cases associated with revision TDR (n=256) identified here. This constrains the number of outcomes associated with the population under study and thus, some of the statistically significant associations presented by the authors may have occurred solely by chance. The NIS also cannot account for clustering of patients within surgeons and hospitals (eg, those that can treat patients who necessitate revision TDR) and, due to its methodology, complications are certainly under-reported. The advantage of the NIS lies in its capacity to capture a large number of procedures (often in the tens to hundreds of thousands) from centers across the US. When the types of surgery performed are particularly rare, or very limited in the NIS dataset, the database loses much of its power. Thus, the information presented here cannot be considered better than level IV evidence and a number of other study designs would likely provide more translatable data on this topic.
—The Editors