Hybrid surgery: a comparison of early postoperative outcomes between anterior cervical discectomy and fusion and cervical disc arthroplasty

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  • 1 Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;
  • | 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;
  • | 3 Mayo Clinic Alix School of Medicine, Rochester, Minnesota; and
  • | 4 Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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OBJECTIVE

Hybrid surgery (HS) is the combination of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) at different levels in the same operation. The aim of this study was to investigate perioperative variables, 30-day postoperative outcomes, and complications of HS in comparison with those of CDA and ACDF.

METHODS

The authors queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry for patients who underwent multilevel primary HS, CDA, and ACDF for degenerative disc disease from 2015 to 2019. The authors compared these three operations in terms of 30-day postoperative outcomes, specifically readmission and reoperation rates, discharge destination, and complications.

RESULTS

This analysis included 439 patients who underwent HS, 976 patients who underwent CDA, and 27,460 patients who underwent ACDF. Patients in the HS and CDA groups were younger, had fewer comorbidities, and myelopathy was less often the indication for surgery compared with patients who underwent ACDF. For the HS group, the unplanned readmission rate was 0.7%, index surgery–related reoperation rate was 0.3%, and nonroutine discharge rate was 2.1%. Major and minor complications were also rare, with rates of 0.2% for each. The mean length of stay in the HS group was 1.5 days. The association of HS with better outcomes in univariate analysis was not evident after adjustment for confounding factors.

CONCLUSIONS

The authors found that HS was noninferior to ACDF and CDA in terms of early postoperative outcomes among patients treated for degenerative disc disease.

ABBREVIATIONS

ACCF = anterior cervical corpectomy and fusion; ACDF = anterior cervical discectomy and fusion; ACS-NSQIP = American College of Surgeons National Surgical Quality Improvement Program; ASA = American Society of Anesthesiologists Physical Status Classification System; ASD = adjacent-segment disease; CDA = cervical disc arthroplasty; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CPT = Current Procedural Terminology; DDD = degenerative disc disease; DVT = deep venous thrombosis; HO = heterotopic ossification; HS = hybrid surgery; ICD-10 = International Classification of Diseases, Tenth Revision; LOS = length of stay; ROM = range of motion; SSI = surgical site infection; VA = Veterans Affairs.

Supplementary Materials

    • Supplemental Figures 1 and 2 (PDF 8,544 KB)

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