Home > Journals > Journal of Neurosurgical Sciences > Past Issues > Articles online first > Journal of Neurosurgical Sciences 2017 May 11

CURRENT ISSUE
 

ARTICLE TOOLS

Reprints
Cite this article as

JOURNAL OF NEUROSURGICAL SCIENCES

A Journal on Neurosurgery


Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,522


eTOC

 

Journal of Neurosurgical Sciences 2017 May 11

DOI: 10.23736/S0390-5616.17.03970-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Serious dysphagia following anterior cervical discectomy and fusion: long-term incidence in a national cohort

Wu-Fu CHUNG 1, 2, Shih-Wei LIU 1, Liang-Chung HUANG 1, Hsuan-Kan CHANG 2, 3, Jau-Ching WU 2, 3, Li-Fu CHEN 1, 2, Yu-Chun CHEN 2, 4, 5, Wen-Cheng HUANG 2, 3, Henrich CHENG 2, 3, 4, Su-Shun LO 1, 2

1 Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan; 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3 Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; 4 Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 5 Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan; 6 Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan


PDF  


BACKGROUND: Although dysphagia is often self-limiting after anterior cervical discectomy and fusion (ACDF), its incidence, risks, and long-term outcomes remain unclear. The present study aimed to analyze dysphagia up to 5 years post-ACDF using a nation-scaled cohort.
METHODS: Incidences of permanent dysphagia requiring nasogastric-tube feeding after ACDF were analyzed using three million-sample cohorts derived from the National Health Insurance Research Database of Taiwan. All identified subjects were stratified into four groups (40s, 50s, 60s, and >70) according to their age at operation, and were subsequently followed up for 5 years. The risks of dysphagia were compared between the groups using Kaplan-Meier analysis and Cox regression hazard ratio model.
RESULTS: A total of 2,723 patients (> 40 years old) who received first-time ACDF surgery were identified from a cohort of three million and followed up for a maximum of 5 years post-operation. The 5-year incidence rates of persistent dysphagia (requiring use of a nasogastric tube) were 6.1, 4.0, 12.0, and 22.8 per 1,000 person-years for each age group (40s, 50s, 60s, and 70+ years old, respectively). The overall incidence rate of dysphagia after ACDF was 18.4, 10.9, and 8.9 per 1,000 person-years at 3 months, 1 year, and 5 years follow-up, respectively. The incidence rates of dysphagia and use of home care services were highest at 3 months post-operation in all age groups, but dropped to a stable level after one year post-operation. The risks of dysphagia and the necessity of using home care services were higher (hazard ratio= 2.69 and 4.96) in the elderly group (aged 70 years and over) at all follow-up time points.
CONCLUSION: The elderly patients had higher risks of short- and long-term severe dysphagia after ACDF. Therefore, although the incidence rates were still low (approximately 2.3%), older patients (aged 70 years and over) should be cautioned for dysphagia requiring a nasogastric tube and home care services if they undergo ACDF.


KEY WORDS: Anterior cervical discectomy and fusion (ACDF) - Dysphagia - Home-care - Incidence - National Health Insurance Research Database (NHIRD)

top of page

Publication History

Cite this article as

Chung WF, Liu SW, Huang LC, Chang HK, Wu JC, Chen LF, et al. Serious dysphagia following anterior cervical discectomy and fusion: long-term incidence in a national cohort. J Neurosurg Sci 2017 May 11. DOI: 10.23736/S0390-5616.17.03970-4 

Corresponding author e-mail

jauching@gmail.com