DOI: 10.1097/bsd.0000000000002037 ISSN: 2380-0186

The Impact of Prior Fragility Fractures on Postoperative Outcomes in Anterior Cervical Discectomy and Fusion

Muhammad Zulfiqar, Ved A. Vengsarkar, Elizabeth Driskill, Zeeshan Akhtar, Steven C. Ludwig, Stephen D. Lockey
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Study Design:

Retrospective cohort study.

Objective:

To evaluate the impact of prior fragility fractures on complications following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

Fragility fractures indicate poor bone quality and increased comorbidities, potentially elevating surgical risks. Understanding the risks is critical for optimizing outcomes in ACDF patients.

Methods:

Patients undergoing a primary ACDF within 3 years of a fragility fracture were identified from 2013 to 2022. A control cohort without prior fragility fractures was matched 1:1. Exclusion criteria included traumatic fractures, prior revision ACDFs, and active spine infections. Outcomes assessed included 90-day medical and surgical complications, 30-day and 90-day emergency visits and readmission rates, and 2-year complications, including mortality. Statistical analyses included the Pearson χ² test, the Welch t test, and the multivariate logistic regression.

Results:

A total of 1236 patients were matched in each cohort. Prior fragility fractures were associated with higher risks of medical complications, such as atelectasis (4.4% vs. 1.7%, OR: 2.83, P <0.001), respiratory failure (5.0% vs. 2.3%, OR: 2.36, P <0.001), pleural effusion (3.6% vs. 0.9%, OR: 4.35, P <0.001), and urinary tract infections (9.3% vs. 4.5%, OR: 2.20, P <0.001). Surgical complications were also more frequent, including dysphagia (7.0% vs. 4.0%, OR: 1.81, P =0.001), spinal cord deficit (5.0% vs. 2.1%, OR: 27.46, P <0.001), and deep wound infection (1.2% vs. 0.4%, OR: 3.07, P <0.031). Subsequent fragility fractures at 2 years were significantly higher in patients who had a history of fragility fracture (29.0% vs. 4.4%, OR: 10.18, P <0.001), as were 30-day (12.5% vs. 7.3%, OR: 1.87, P <0.001) and 90-day (16.8% vs. 10.3%, OR: 1.82, P <0.001) readmission rates.

Conclusions:

Patients with a history of fragility fractures undergoing ACDF experience significantly higher rates of postoperative complications and readmission rates.

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