Impact of tracheostomy timing on postoperative outcomes following anterior cervical discectomy and fusion for sub-axial cervical fractures: A retrospective analysis.

Abstract

To evaluate the association between tracheostomy timing after anterior cervical discectomy and fusion (ACDF) for sub-axial cervical spine injuries and 90-day postoperative complications. A retrospective cohort study was conducted. Patients aged 18-84 years who had fractures of the sub-axial cervical spine and underwent ACDF were identified using CPT and ICD codes from the PearlDiver database (2010-2022Q2) and stratified into early (0-5 days), intermediate (6-10 days), and late (11-20 days) tracheostomy groups post-ACDF. Exclusion criteria included prior cervical spine infection, malignancy, and posterior surgical approaches. Baseline comorbidities and surgical characteristics were assessed. 90-day primary and secondary outcomes were assessed with multivariable logistic regression. Among 594 patients, baseline differences were noted: the late group had higher rates of COPD (15.3 %), CHF (15.3 %), and pre-tracheostomy ventilator use (52.3 %) (all p < 0.05). Vertebral artery dissection was most common in the early group (17.0 %, p = 0.017). Intermediate tracheostomy was associated with a lower pneumonia rate vs. early (OR 0.59, 95 % CI: 0.38-0.93; p = 0.022). Late tracheostomy was associated with a lower cerebrovascular accident (CVA) rate vs. early (OR 0.05, 95 % CI: 0.00-0.40; p = 0.014). No significant differences were observed in wound infections, other complications, or ventilator dependence at discharge. Early tracheostomy after ACDF was not associated with increased surgical site infection, supporting its safety. However, the early group had a higher incidence of vertebral artery dissection pre-tracheostomy and was linked to higher 90-day pneumonia and CVA rates compared to intermediate and late groups, respectively.