Airway Compromise in Adults Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Abstract

Objective: Postoperative airway compromise is a rare but significant complication following anterior cervical discectomy and fusion (ACDF). This systematic review and meta-analysis aims to determine the incidence of airway compromise in ACDF patients and identify associated risk factors to guide otolaryngologists in optimizing the airway. Data Sources: Following PRISMA guidelines, CINAHL, Cochrane Library, PubMed, and Scopus were searched from inception to July 10, 2024. Review Methods: Articles reporting the incidence of airway complications following ACDF were included. Primary outcome measures included proportions (%) and odds ratios (OR) with 95% confidence intervals (CI). Results: Of 449 abstracts identified, 42 studies (N = 960,092) were included. Among ACDF patients, the incidence of airway compromise was 0.78% [95% CI: 0.59–0.99], with unplanned reintubation occurring in 0.45% [95% CI: 0.35–0.57], delayed extubation in 1.5% [95% CI: 0.90–2.1], and tracheotomy in 0.54% [95% CI: 0.05–1.5] of patients. Patients who experienced airway compromise following ACDF demonstrated increased odds of having diabetes mellitus (OR: 2.05 [95% CI: 1.61–2.60]; p < 0.00001), pulmonary disease (OR: 3.44 [95% CI: 2.41–4.93]; p < 0.00001), and bleeding disorders or anticoagulant use at the time of surgery (OR: 3.06 [95% CI: 2.54–3.69]; p < 0.00001). ASA class 3 or 4 (OR: 4.55 [95% CI: 3.28–6.31]; p < 0.00001) and multilevel fusion (OR: 2.33 [95% CI: 1.41–3.84]; p = 0.001) were more common among those who experienced airway compromise. Conclusions: Postoperative airway compromise is a rare but potentially lethal complication of ACDF. Preoperative identification of patient risk factors allows for tailored perioperative management by otolaryngologists and spine surgeons, minimizing the occurrence of airway compromise.