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Review
. 2025 Aug 7;10(4):e70215.
doi: 10.1002/lio2.70215. eCollection 2025 Aug.

Airway Compromise in Adults Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Anuja H Shah  1 , Emily A Clementi  1   2 , Kelsey Limage  3 , Earl H Harley  1   2
Affiliations
Review

Airway Compromise in Adults Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Anuja H Shah et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: Postoperative airway compromise is a rare but significant complication following anterior cervical discectomy and fusion (ACDF). This systematic review and meta-analysis aims to determine the incidence of airway compromise in ACDF patients and identify associated risk factors to guide otolaryngologists in optimizing the airway.

Data sources: Following PRISMA guidelines, CINAHL, Cochrane Library, PubMed, and Scopus were searched from inception to July 10, 2024.

Review methods: Articles reporting the incidence of airway complications following ACDF were included. Primary outcome measures included proportions (%) and odds ratios (OR) with 95% confidence intervals (CI).

Results: Of 449 abstracts identified, 42 studies (N = 960,092) were included. Among ACDF patients, the incidence of airway compromise was 0.78% [95% CI: 0.59-0.99], with unplanned reintubation occurring in 0.45% [95% CI: 0.35-0.57], delayed extubation in 1.5% [95% CI: 0.90-2.1], and tracheotomy in 0.54% [95% CI: 0.05-1.5] of patients. Patients who experienced airway compromise following ACDF demonstrated increased odds of having diabetes mellitus (OR: 2.05 [95% CI: 1.61-2.60]; p < 0.00001), pulmonary disease (OR: 3.44 [95% CI: 2.41-4.93]; p < 0.00001), and bleeding disorders or anticoagulant use at the time of surgery (OR: 3.06 [95% CI: 2.54-3.69]; p < 0.00001). ASA class 3 or 4 (OR: 4.55 [95% CI: 3.28-6.31]; p < 0.00001) and multilevel fusion (OR: 2.33 [95% CI: 1.41-3.84]; p = 0.001) were more common among those who experienced airway compromise.

Conclusions: Postoperative airway compromise is a rare but potentially lethal complication of ACDF. Preoperative identification of patient risk factors allows for tailored perioperative management by otolaryngologists and spine surgeons, minimizing the occurrence of airway compromise.

Keywords: airway outcomes; meta‐analysis; systematic review; tracheotomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta‐analyses systematic review flow diagram.
FIGURE 2
FIGURE 2
Joanna Briggs Institute risk of bias assessment for cohort studies. Y, yes; N, no; U, unclear.
FIGURE 3
FIGURE 3
Funnel plot to assess publication bias.
FIGURE 4
FIGURE 4
Forest plot of comorbidities in patients with and without postoperative airway compromise.
FIGURE 5
FIGURE 5
Forest plot of operative characteristics in patients with and without postoperative airway compromise.
FIGURE 6
FIGURE 6
Forest plot of surgical indications in patients with and without postoperative airway compromise.
See this image and copyright information in PMC

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