Increased Rates of Dysphagia, Longer Length of Stay, Non-Routine Discharge, and Higher Hospital Costs in Elderly Patients Undergoing Single-Level Cervical Disc Arthroplasty

Introduction: Cervical disc arthroplasty (CDA) has become a preferred alternative to anterior cervical discectomy and fusion due to its motion-preserving benefits. While typically used in younger patients, the suitability of CDA for individuals over 65 remains underexplored. This study aimed to assess the differences in 1) postoperative complications, 2) hospital course, and 3) costs between patients above and below the age of 65 undergoing CDA.

Methods: Patients who underwent single-level CDA were identified using ICD-10 procedural codes using the National Inpatient Sample (NIS) database. The patient cohort was divided into two age groups: 18-64 years and 65 years and older. Propensity score-matching (1:5 ratio) was employed based on sex, race, and the Elixhauser Comorbidity Index (ECI) to create balanced cohorts. Postoperative complications, LOS, total hospital costs, and discharge disposition were analyzed. Statistical significance was set at the P < 0.05 level.

Results: After matching, the cohorts consisted of 5,300 weighted cases under 65 and 1,060 weighted cases aged 65 and older, with no significant differences in baseline demographics (P > 0.05 for all). Patients under 65 had significantly lower rates of dysphagia (4.15% vs. 9.43%, P = 0.001) and non-routine discharge (5.47% vs. 17.92%, P < 0.001) compared to those over 65. Additionally, patients under 65 experienced a shorter LOS (1.39 vs. 2.04 days, P < 0.001) and incurred lower hospital costs ($21,900 vs. $26,400, P < 0.001).

Conclusion : Elderly patients undergoing single-level CDA experience higher rates of postoperative complications, longer hospital stays, and increased costs compared to younger patients. These findings underscore the need for age-specific preoperative assessments and tailored post-operative care strategies to optimize outcomes in this growing demographic.