RESUMO
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 53.7â±â11.3 years, mean levels operated on were 2.0â±â0.79, and mean body mass index (BMI) was 30.3â±â6.9. In those who did not, mean age was 51.8â±â10.9 years, mean levels operated on were 1.48â±â0.65, and mean BMI was 29.9â±â6.3. 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 (Pâ=â0.92), reintubation (Pâ=â0.94), or mortality (Pâ=â0.49). The mean per-patient cost was significantly higher (Pâ=â0.009) in those who received PACU x-rays, $1031.76â±â948.67, versus those in the control group, $700.26â±â634.48. Mean length of stay was significantly longer in those who had PACU x-rays (Pâ=â0.01). 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.Level of Evidence: 3.