JAAOS - 2026-09-15 - Journal Article
Impact of Obstructive Sleep Apnea on Outcomes Following Anterior Cervical Discectomy and Fusion.
Tummala S, Avramis I, Rizkalla JM
Topics
Key Takeaway
OSA patients undergoing ACDF face significantly higher rates of respiratory failure, mechanical ventilation, dysphagia, and persistent opioid use, but pseudarthrosis, implant failure, and revision surgery rates are equivalent to non-OSA patients at 5-year follow-up.
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Summary
This retrospective cohort study used the TriNetX national database to determine whether preoperative OSA increases postoperative complication rates following elective ACDF in adults from 2003–2020. After 1:1 propensity-score matching across 18,800 patients, OSA was associated with significantly higher rates of respiratory failure, mechanical ventilation, dysphagia, and persistent opioid use at all time points (all P<0.05). Structural outcomes including pseudarthrosis, implant failure, revision surgery, readmissions, and ED visits were statistically equivalent between OSA and non-OSA cohorts at both 2- and 5-year follow-up.
Key Limitation
OSA severity (AHI, CPAP compliance) is not captured in TriNetX, preventing dose-response analysis and potentially masking differential risk among mild versus severe OSA subgroups.
Original Abstract
STUDY DESIGN
Retrospective cohort study; level III level of evidence.
BACKGROUND
Obstructive sleep apnea (OSA) is a prevalent comorbidity associated with increased perioperative risks. Although its influence on posterior and lumbar spinal procedures has been studied, data on its impact following anterior cervical diskectomy and fusion (ACDF) remain limited.
OBJECTIVE
The purpose of this study was to determine whether preoperative OSA is associated with increased short- and long-term postoperative complications, including structural surgical failure, following ACDF.
METHODS
A retrospective cohort study was conducted using the TriNetX national database. Adults undergoing elective ACDF between 2003 and 2020 were identified and stratified by OSA status. Propensity-score matching was applied (1:1) to control for baseline differences across 18,800 patients. Postoperative outcomes were assessed at 30 and 90 days (short term) and at 2 and 5 years (long term). Primary outcomes included respiratory failure, mechanical ventilation, dysphagia, opioid use, pseudarthrosis, implant failure, and revision surgery.
RESULTS
OSA was associated with markedly higher rates of dysphagia, mechanical ventilation, respiratory failure, and persistent opioid use across multiple time points (all P < 0.05). However, no notable differences were observed in pseudarthrosis, implant failure, or revision surgery rates at long-term follow-up. Healthcare utilization metrics (readmissions, ED visits) also remained comparable across all time points.
CONCLUSION
Although OSA was associated with increased risks of respiratory failure, mechanical ventilation, dysphagia, and long-term opioid use following ACDF, it was not linked to elevated rates of major structural complications, namely, implant failure, pseudarthrosis, or revision surgery, supporting the long-term fusion success and procedural safety of ACDF in this population. This study suggests that a preoperative OSA diagnosis may not represent a strict contraindication to ACDF; however, perioperative strategies such as preoperative counseling, vigilant monitoring, and tailored risk mitigation remain essential to improving patient outcomes and addressing the elevated medical morbidity observed.