Postoperative complications in patients with sickle cell disease undergoing single-level anterior cervical discectomy and fusion

Abstract

Background: Sickle cell disease (SCD) is the most common genetic disorder in the United States, affecting approximately 300,000 infants worldwide annually. As advancements in treatment have led to increased life expectancy for individuals with SCD, this population may be considered for anterior cervical discectomy and fusion (ACDF) due to potentially accelerated degenerative disc disease. The current study sought to characterize 90-day postoperative outcomes among SCD patients undergoing ACDF using matched cohorts.

Methods: Adult patients undergoing single-level ACDF were identified from the 2010 to 2021 Q1 M151 PearlDiver database. Those with SCD were matched 1:4 to controls based on age, sex, and Elixhauser Comorbidity Index (ECI). The occurrence of 90-day postoperative adverse events, readmissions, and emergency department (ED) visits were assessed. Patient characteristics and postoperative outcomes were compared using Student's t-tests and chi-square tests. Multivariable logistic regression was performed to compare outcomes between the matched cohorts. p < 0.05 was considered statistically significant.

Results: After matching, 82 SCD patients and 324 controls were identified. Patients with SCD had significantly higher odds of adverse events including: any 90-day adverse events (OR 3.06), serious adverse events (OR 2.91), minor adverse events (OR 3.62), readmissions (OR 3.50), and ED visits (OR 3.64) (p < 0.05 for all). In terms of individual adverse events, in decreasing OR order patients with SCD had higher odds of: pneumonia (OR 10.41), acute kidney injury (OR 6.65), deep vein thrombosis (OR 6.73), sepsis (OR 5.30), urinary tract infections (OR 3.43) (p < 0.05 for all).

Conclusions: SCD patients undergoing single-level ACDF were found to have significantly higher odds of multiple postoperative complications compared to matched controls. These findings suggest that SCD patients may require more intensive perioperative care and monitoring to minimize such adverse outcomes. Further research is needed to optimize management strategies for this high-risk population.

Keywords: Adverse events; Anterior cervical discectomy and fusion; Emergency department visits; Postoperative outcomes; Readmissions; Sickle cell disease.

Figure

Forest plot depicting odds of 90-day adverse events for patients with sickle cell disease relative to those without sickle cell disease following single-level ACDF. Black bars indicate statistical significance (p < 0.05). SSI and wound dehiscence were excluded from the figure since there were no documented cases of these adverse events. Myocardial infarction was also excluded from the figure, due to an inability to capture the wide confidence interval (p > 0.05).