Assessing Surgical Site Infection and Readmission in PCF vs ACDF for Cervical Radiculopathy

Introduction: Surgical management of cervical radiculopathy involves anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The clinically favorable surgical approach remains unclear. This study compared ACDF and PCF outcomes utilizing the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database.

Methods: Following STROBE guidelines, this retrospective study screened the NSQIP database, including single-level ACDF or PCF from 2005 to 2022. Cases with data non-availability, additional procedures, or surgeries by non-neurosurgery or orthopedic surgeons were excluded. Baseline characteristics, surgical details, and postoperative outcomes were extracted. Primary outcomes were differences in operative time, hospital length of stay(LOS), postoperative complications (overall surgical site infection (SSI), superficial SSI, deep incisional (DI) SSI, organ space SSI), 30-day readmission, 30-day readmission for overall and specific SSIs, and re-operation rate. Propensity-scored stabilized inverse probability of treatment weighting (SIPTW) adjusted for confounding factors, and absolute standardized mean differences (aSMD) evaluated balancing. Weighted analysis of the treatment effect was performed using regression models with 95% confidence intervals, adjusting p-values with Benjamini-Hochberg correction.

Results: After screening NSQIP database (N=11,634,075) and applying inclusion and exclusion criteria, 9,362 (ACDF:7,323,PCF:2,039) cases were included. After SIPTW, all 42 baseline characteristics were balanced (aSMD < 0.10). The PCF group had a significantly higher rate of postoperative overall SSI (proportion difference (PD):2.9%,2.1%to3.7%, P=0.003), superficial SSI (PD:1.9%,1.2%to2.5%), and DI SSI (PD:0.8%,0.4%to1.2%). 30-day readmission for any SSI (PD:1.2%,0.7%to1.7%) and DI SSI (PD:0.8%,0.4%to1.2%) were significant. The PCF group had more systemic sepsis occurrences (PD:0.8%,0.3%to1.3%), shorter hospital LOS (mean difference (MD):-0.7 days, -0.9to-0.5), and operative time (MD:-32.4 min,-35.2to-29.5). All P=0.003.

Conclusion : Compared to ACDF, PCF was significantly associated with a higher rate of postoperative overall SSI, superficial SSI, DI SSI, postoperative sepsis, 30-day readmission for overall SSI, superficial SSI, and DI SSI, but shorter operative time and LOS. These findings suggest that ACDF may be the ideal procedure for avoiding these complications.