Table 1.
Patient Characteristics and Intraoperative Variables in Patients Undergoing ACDF from ACS-NSQIP 2006 to 2016
| 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | P Value | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total ACDF | 31 | 211 | 538 | 848 | 183 | 373 | 3853 | 5725 | 6577 | 8578 | 9937 | |
| Demographics | ||||||||||||
| Age | 48.2 [1.5] | 51.4 [0.8] | 52.5 [0.5] | 52.1 [0.4] | 52.1 [0.9] | 52.7 [0.6] | 53.3 [0.2] | 53.6 [0.2] | 53.3 [0.1] | 53.7 [0.1] | 54.1 [0.1] | <0.001 |
| BMI | 29.4 [1.3] | 29.6 [0.4] | 29.8 [0.3] | 30.0 [0.2] | 30.3 [0.5] | 30.1 [0.4] | 30.3 [0.1] | 30.1 [0.1] | 30.3 [0.1] | 30.4 [0.1] | 30.5 [0.1] | 0.003 |
| Male | 14 (45.2%) | 88 (41.7%) | 250 (46.5%) | 417 (49.2%) | 90 (49.2%) | 195 (57.4%) | 1850 (48.4%) | 2717 (47.7%) | 3289 (50.3%) | 4251 (49.9%) | 2768 (50.4%) | 0.001 |
| Race | <0.001 | |||||||||||
| White | NA | 0 | 395 (73.4%) | 679 (80.1%) | 135 (73.8%) | 268 (10.5%) | 3195 (82.9%) | 4604 (82.2%) | 5338 (81.2%) | 6887 (80.3%) | 7947 (80.0%) | |
| Black | NA | 1 (0.5%) | 54 (10.0%) | 67 (7.9%) | 28 (15.3%) | 56 (15.0%) | 357 (9.3%) | 493 (8.6%) | 615 (9.4%) | 878 (10.2%) | 991 (10.0%) | |
| Asian | NA | 0 | 7 (1.3%) | 5 (0.6%) | 2 (1.1%) | 9 (2.4%) | 61 (1.6%) | 117 (2.0%) | 128 (1.9%) | 172 (2.0%) | 174 (1.8%) | |
| American Indian/Alaska Native | NA | 0 | 16 (3.0%) | 21 (2.5%) | 0 | 0 | 7 (0.2%) | 35 (0.6%) | 64 (1.0%) | 82 (1.0%) | 59 (0.6%) | |
| Native Hawaiian/Pacific Islander | NA | 0 | 0 | 0 | 0 | 1 (0.3%) | 13 (0.3%) | 18 (0.3%) | 35 (0.5%) | 29 (0.3%) | 38 (0.4%) | |
| Ethnicity | <0.001 | |||||||||||
| Hispanic | NA | 0 | 32 (5.9%) | 35 (4.1%) | 9 (4.9%) | 21 (5.6%) | 170 (4.4%) | 239 (4.2%) | 316 (4.8%) | 417 (4.9%) | 465 (4.7%) | |
| Non-Hispanic | NA | 1 (0.5%) | 506 (94.1%) | 813 (95.9%) | 166 (90.7%) | 325 (87.1%) | 3507 (91.0%) | 5183 (90.5%) | 5758 (87.5%) | 7542 (87.9%) | 8583 (86.4%) | |
| Comorbidities | ||||||||||||
| Diabetes (with insulin) | 1 (3.2%) | 8 (3.8%) | 15 (2.8%) | 35 (4.1%) | 14 (7.7%) | 27 (7.2%) | 161 (4.2%) | 269 (4.7%) | 354 (5.4%) | 439 (5.1%) | 539 (5.7%) | <0.001 |
| Current smoker (within 1 year) | 18 (58.1%) | 82 (38.9%) | 183 (34.0%) | 280 (33.0%) | 53 (29.0%) | 114 (30.6%) | 1157 (30.0%) | 1692 (29.6%) | 1831 (27.8%) | 2261 (26.4%) | 2633 (26.5%) | <0.001 |
| Dyspnea | <0.001 | |||||||||||
| Dyspnea with moderate exertion | 8 (25.8%) | 11 (5.2%) | 33 (6.1%) | 38 (4.5%) | 17 (9.3%) | 15 (4.0%) | 235 (6.1%) | 302 (5.3%) | 289 (4.4%) | 379 (4.4%) | 421 (4.2%) | |
| Dyspnea at rest | 0 | 0 | 3 (0.6%) | 1 (0.1%) | 0 | 20 (0.5%) | 20 (0.5%) | 9 (0.2%) | 10 (0.2%) | 14 (0.2%) | 34 (0.3%) | |
| Functional status | 0.054 | |||||||||||
| Partially dependent | 0 | 10 (4.7%) | 10 (1.9%) | 21 (2.5%) | 5 (2.7%) | 10 (2.7%) | 58 (1.5%) | 63 (1.1%) | 72 (1.1%) | 93 (1.1%) | 129 (1.3%) | |
| Totally dependent | 0 | 2 (0.9%) | 2 (0.4%) | 1 (0.1%) | 1 (0.5%) | 0 (0.0%) | 8 (0.2%) | 2 (0.0%) | 6 (0.1%) | 6 (0.1%) | 9 (0.1%) | |
| COPD | 2 (6.5%) | 4 (1.9%) | 16 (3.0%) | 24 (2.8%) | 6 (3.3%) | 10 (2.9%) | 129 (3.4%) | 253 (4.4%) | 282 (4.3%) | 337 (3.9%) | 410 (4.1%) | 0.052 |
| Hypertension requiring medication | 12 (38.7%) | 84 (39.8%) | 226 (42.0%) | 358 (42.2%) | 78 (42.6%) | 157 (42.10%) | 1648 (42.8%) | 2453 (42.8%) | 2847 (43.3%) | 3784 (44.1%) | 4439 (44.7%) | 0.332 |
| On dialysis | 0 | 0 | 0 | 0 | 1 (0.5%) | 3 (0.8%) | 16 (0.4%) | 8 (0.1%) | 13 (0.2%) | 10 (0.1%) | 20 (0.2%) | 0.005 |
| Open wound or wound infection | 0 | 0 | 1 (0.2%) | 1 (0.1%) | 3 (1.6%) | 1 (0.3%) | 17 (0.4%) | 11 (0.2%) | 9 (0.1%) | 21 (0.2%) | 18 (0.2%) | 0.055 |
| Steroid use | 1 (3.2%) | 9 (4.3%) | 11 (2.0%) | 26 (3.1%) | 4 (2.2%) | 20 (5.4%) | 119 (3.1%) | 166 (2.9%) | 183 (2.8%) | 274 (3.2%) | 274 (3.2%) | 0.055 |
| >10% weight loss in <6 months | 0 | 2 (0.9%) | 1 (0.2%) | 7 (0.8%) | 1 (0.5%) | 1 (0.3%) | 4 (0.1%) | 10 (0.2%) | 10 (0.2%) | 10 (0.1%) | 12 (0.1%) | 0.818 |
| Bleeding disorders | 0 | 3 (1.4%) | 4 (0.7%) | 10 (1.2%) | 0 | 5 (1.3%) | 29 (0.8%) | 51 (0.9%) | 64 (1.0%) | 84 (1.0%) | 111 (1.1%) | 0.614 |
| Sepsis | 0.766 | |||||||||||
| SIRS | 1 (3.2%) | 1 (0.5%) | 4 (0.7%) | 3 (0.4%) | 1 (0.5%) | 2 (0.5%) | 6 (0.2%) | 8 (0.1%) | 11 (0.2%) | 15 (0.2%) | 20 (0.2%) | |
| Sepsis | 0 | 0 | 0 | 1 (0.1%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Preoperative transfusion RBC | 0 | 0 | 0 | 0 | 1 (0.0%) | 0 (0.0%) | 1 (0.0%) | 0 (0.0%) | 1 (0.0%) | 2 (0.0%) | 0 (0.0%) | 0.943 |
| Inpatient vs. outpatient | <0.001 | |||||||||||
| Inpatient | 22 (71.0%) | 175 (82.9%) | 460 (85.5%) | 719 (84.8%) | 154 (84.2%) | 323 (86.6%) | 2974 (77.2%) | 4347 (75.9%) | 4916 (74.7%) | 6187 (72.1%) | 7012 (70.6%) | |
| Outpatient | 9 (29.0%) | 36 (17.1%) | 78 (14.5%) | 129 (15.2%) | 29 (15.8%) | 50 (13.4%) | 879 (22.8%) | 1378 (24.1%) | 1661 (25.3%) | 2391 (27.9%) | 2925 (29.4%) | |
| Radiculopathy | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 5 | 837 | 3543 | <0.001 |
| Myelopathy | 5 (16.1%) | 75 (35.5%) | 172 (32.0%) | 274 (32.3%) | 174 (95.1%) | 350 (93.8%) | 1111 (28.8%) | 1754 (30.6%) | 2055 (31.2%) | 2454 (28.6%) | 2184 (22.0%) | <0.001 |
| ASA class | <0.001 | |||||||||||
| I: no disturbance | 0 | 20 (9.5%) | 24 (4.5%) | 46 (5.4%) | 13 (7.1%) | 15 (4.0%) | 177 (4.6%) | 241 (4.2%) | 294 (4.5%) | 368 (4.3%) | 402 (4.0%) | |
| II: mild disturbance | 21 (67.7%) | 123 (58.3%) | 327 (60.8%) | 498 (58.7%) | 93 (50.8%) | 214 (57.4%) | 2240 (58.1%) | 3339 (58.3%) | 3760 (57.2%) | 4846 (56.5%) | 5308 (53.4%) | |
| III: severe disturbance | 10 (32.3%) | 59 (28.0%) | 175 (32.5%) | 292 (34.4%) | 75 (41.0%) | 139 (37.3%) | 1366 (35.5%) | 2058 (35.9%) | 2427 (36.9%) | 3231 (37.7%) | 4060 (40.9%) | |
| IV: life threatening | 0 | 8 (3.8%) | 11 (2.0%) | 11 (1.3%) | 2 (1.1%) | 5 (1.3%) | 63 (1.6%) | 75 (1.3%) | 90 (1.4%) | 125 (1.5%) | 154 (1.5%) | |
| Operation time | 143.3 [11.4] | 150.8 [4.7] | 137.5 [3.0] | 130.5 [2.2] | 133.2 [4.4] | 130.8 [3.4] | 124.3 [1.1] | 122.1 [0.9] | 124.3 [0.8] | 124.0 [0.7] | 124.5 [0.7] | 0.003 |
| Hospital variables | ||||||||||||
| Total hospital length of stay | 1.7 [0.3] | 2.1 [0.3] | 1.9 [0.1] | 2.0 [0.1] | 1.9 [0.6] | 6.1 [2.0] | 1.6 [0.1] | 1.4 [0.0] | 1.6 [0.0] | 1.5 [0.0] | 1.5 [0.0] | <0.001 |
| Days from operation to discharge | 1.6 [0.2] | 1.9 [0.2] | 1.7 [0.1] | 1.8 [0.1] | 1.5 [0.6] | 2.1 [0.2] | 1.6 [0.1] | 1.5 [0.0] | 1.5 [0.0] | 1.5 [0.0] | 1.5 [0.0] | <0.001 |
Data are displayed as n (%) or mean [standard deviation].
ACDF, anterior cervical discectomy and fusion; ACS-NSQIP, American College of Surgeons National Surgical Quality Improvement Program database; BMI, body mass index; NA, not available; COPD, chronic obstructive pulmonary disease; SIRS, systemic inflammatory response syndrome; RBC, red blood cell; ASA, American Society of Anesthesiologists.