Evaluation of benefit and cost utility of immediate postanesthesia care unit radiographs to predict airway compromise after anterior cervical discectomy and fusion

Study Design. Retrospective review. Objective. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure that may be complicated by airway compromise postoperatively. This life-threatening complication may necessitate reintubation and reoperation. We evaluated the cost utility of conventional postoperative x-ray. Summary of Background Data. Studies have demonstrated minimal benefit in obtaining an x-ray on postoperative day 1, but there is some utility of postanesthesia care unit (PACU) x-rays for predicting the likelihood of reoperation. Methods. We retrospectively reviewed the records of consecutive patients who underwent ACDF between September 2013 and February 2017. Patients were dichotomized into those who received PACU x-rays and those who did not (control group). Primary outcomes were reoperation, reintubation, mortality, and health care costs. Results. Eight-hundred and fifteen patients were included in our analysis: 558 had PACU x-rays; 257 did not. In those who received PACU x-rays, mean age was 53.7 + 11.3 years, mean levels operated on were 2.0 + 0.79, and mean body mass index (BMI) was 30.3 + 6.9. In those who did not, mean age was 51.8 + 10.9 years, mean levels operated on were 1.48 + 0.65, and mean BMI was 29.9 + 6.3. Complications in the PACU x-ray group were reintubation—0.4%, reoperation—0.7%, and death—0.3% (due to prevertebral swelling causing airway compromise). Complications in the control group were reintubation—0.4%, reoperation—0.8%, and death—0. There were no differences between groups with respect to reoperation (P ¼ 0.92), reintubation (P ¼ 0.94), or mortality (P ¼ 0.49). The mean per-patient cost was significantly higher (P ¼ 0.009) in those who received PACU x-rays, $1031.76 + 948.67, versus those in the control group, $700.26 + 634.48. Mean length of stay was significantly longer in those who had PACU x-rays (P ¼ 0.01). Conclusion. Although there were no differences in reoperation, reintubation, or mortality, there was a significantly higher cost for care and hospitalization in those who received PACU x-rays. Further studies are warranted to validate the results of the presented study.