Increased Rates of Dysphagia, Longer Length of Stay, Nonroutine Discharge, and Higher Hospital Costs in Patients Over 65 Undergoing Single-Level Cervical Disc Arthroplasty: A Propensity Score-Matched Analysis

Abstract

CONTEXT: Cervical disc arthroplasty (CDA) is a safe and effective treatment for cervical spine conditions, with increasing utilization. As the population over 65 grows, understanding the suitability of CDA in older patients is critical. AIMS: This study evaluates differences in postoperative complications, hospital course, and costs between patients aged 18 and 65 and those over 65 undergoing CDA. SETTINGS AND DESIGN: This was a retrospective cohort study using the National Inpatient Sample, a nationally representative database of U.S. hospital discharges. SUBJECTS AND METHODS: Patients undergoing single-level CDA from 2016 to 2020 were identified. The cohort was divided into two groups: 18-65 years and \u3e65 years. Propensity score matching (1:5) was applied based on sex, race, obesity, chronic lung disease, and the Elixhauser Comorbidity Index. Outcomes included postoperative complications, length of stay (LOS), hospital costs, and discharge disposition. Statistical significance was set at P \u3c 0.05. STATISTICAL ANALYSIS USED: Propensity score matching ensured group balance. Chi-square tests and Student\u27s t-tests assessed outcomes, with a Benjamini-Hochberg adjustment for multiple comparisons. RESULTS: After matching, 4550 cases from the 18 to 65 years of group and 910 from the \u3e65 group were analyzed. Dysphagia rates were higher in the older cohort (8.8% vs. 3.8%, P = 0.007). LOS was significantly longer for older patients (2.15 ± 0.20 days vs. 1.38 ± 0.04 days, P \u3c 0.001). Hospital costs were higher in the \u3e65 group ($25,900 ± 1000 vs.$22,500 ± 400, P = 0.005), and nonroutine discharge was more common (19.2% vs. 7.1%, P \u3c 0.001). CONCLUSIONS: Older patients undergoing CDA experience more complications, longer hospital stays, and higher costs, highlighting the need for tailored care strategies