A study recently published in Spine compares in-hospital morbidity and mortality rates between the anterior and nonanterior approach procedures for thoracic disc herniation.
The researchers examined the National Inpatient Sample to identify patients who underwent surgery for thoracic disc herniation from 2000 to 2009. There were 25,413 patients included in the study. Here are five things to know about the study:
1. The anterior approach was associated with higher overall in-hospital complications — 26.8 percent compared with 9.6 percent among nonanterior approaches. "Anterior approach procedures for thoracic disc herniation were associated with increased in-hospital morbidity and mortality rates, as well as increased healthcare burden, compared with nonanterior approach procedures. If thoracic disc herniation can be adequately excised by either approach, a nonanterior approach procedure may be better," concluded the study authors.
2. There was a higher mortality rate among patients with anterior approaches — 0.7 percent compared with 0.2 percent for nonanterior procedures. A 2011 study published in Spine examined morbidity and mortality among anterior, posterior and anterior/posterior noncervical spinal procedures. The incidence of procedure-related complications were:
• Anterior spinal fusion: 18.68 percent
• Posterior spinal fusion: 15.72 percent
• Anterior/posterior spinal fusion: 23.81
3. The patients with the anterior approach had 7.6 days in the hospital compared with 4.8 days in the hospital. A 2013 study published in The Spine Journal examined hospital length of stay among posterior lumbar instrumented fusion. The average length of stay was 3.6±1.8 days, and 79 percent of the patients stayed for less than four days. The average length of stay for patients with postoperative complications was 5.1±2.3 days, compared with 2.9±0.9 days for patients without complications.
4. The hospital charges were significantly higher among patients who had the anterior approach. The hospital charges were $84,199 for patients with the anterior approach compared with $46,837 for the nonanterior approach. The technique and days spent in the hospital has an impact on overall costs. A 2012 study published in the Journal of Spinal Disorders and Techniques examined the costs associated with minimally invasive and open lumbar interbody fusions. The total inflation-adjusted acute hospitalization costs were:
• $29,187 for MIS one-level procedures
• $299,947 for open one-level surgery
• $33,879 for MIS two-level procedures
• $35,984 for open two-level surgery
5. There were several risk factors identified for mortality among patients who had the surgical treatment for thoracic disc herniation. The risk factors include:
• 85 years or older
• Female sex
• Complications — respiratory, cardiac, urinary and renal
More Articles on Spine Surgery:
5 Points on Spinal Fusion Length of Stay: ACDF
20 Spine Surgeons Leading ASCs
Medtronic's $22M Infuse Settlement: 5 Things to Know