The MarketScan Database was accessed from 2007 to 2016 to identify adult patients up to 65 years old who underwent an anterior cervical discectomy and fusion (ACDF) procedure using the International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. MarketScan, a national insurance claims database, contains millions of patient records from all 50 states. Among 138,839 patients who had ACDF surgeries, 8500 (6.1%) experienced complications within 90 days, and 7,433 (5.4%) required surgical revision within 2 years. Even though anterior cervical plating was employed, the risk of complications within the first 90 days was significantly lower even though it did not predict a 2-year reoperation (adjusted odds ratio [aOR]: 0.32; 95% CI: 0.30-0.34; P<0.001). Upon multivariate analysis, the female sex was linked to a lower risk of 2-year reoperation (aOR: 0.83; 95% CI: 0.79-0.87; P<0.001), whereas depression was linked to a higher risk of reoperation by 50% (aOR: 1.51; 95% CI: 1.43-1.59; P<0.001). However, the presence of a 90-day postoperative complication was the single factor with the highest correlation to the risk of reoperation (aOR: 1.79% CI: 1.66-1.94; P<0.001). Postoperative complications were found to be more likely in patients with more comorbid conditions and when bone morphogenic protein was used, whereas cervical plating was strongly associated with a reduction in this risk. Furthermore, the risk of a 2-year revision was outweighed by the patient’s poor mental health rather than other comorbidities. The main modifiable risk factor for reoperation risk was the existence of a postoperative complication. As a result of the study’s findings, surgeons may be able to more accurately identify high-risk ACDF patients who can then be managed with greater care and with better patient selection, counselling, and informed consent.
