Postoperative Dysphonia After Anterior Cervical Discectomy and Fusion (ACDF): A Large Scale Cohort Analysis

Introduction: Anterior cervical discectomy and fusion (ACDF) is a widely performed procedure for cervical spine pathologies, but postoperative dysphonia remains an underexplored complication. This study aims to evaluate the prevalence, risk factors, and management of postoperative dysphonia in adult patients undergoing ACDF.

Methods: This retrospective cohort study analyzed data from the PearlDiver Patient Records Database, which includes deidentified records from over 144 million patients in the United States. Patients undergoing primary ACDF without prior dysphonia between 2010 and 2022 were identified using ICD-10 codes. Cohorts were divided into those with and without postoperative dysphonia. Odds ratios with 95% confidence intervals were calculated to assess patient and procedure-specific risk factors. Prevalence of postoperative diagnoses and interventions was analyzed using CPT and ICD-10 codes. Independent variables included demographics, comorbidities, and procedural factors, while outcome measures focused on postoperative dysphonia diagnosis and interventions such as laryngoscopy and voice therapy.

Results: Of 618,170 patients undergoing primary ACDF, 16,063 (2.6%) developed postoperative dysphonia. Significant risk factors included female gender (OR 1.43, 95% CI: 2.96-3.16), smoking (OR 2.41, 95% CI: 2.33–2.49), diabetes (OR 1.89, 95% CI: 1.83–1.95), obesity (OR 2.80, 95% CI: 2.71–2.89), and multilevel surgery (OR 1.20, 95% CI: 1.17–1.24). Only 53% of patients with post-ACDF dysphonia underwent laryngoscopy, and 15% received postoperative voice therapy, indicating underutilization of diagnostic and therapeutic interventions.

Conclusions: Dysphonia is a significant postoperative complication of ACDF, with females, smokers, diabetics, and obese patients at the highest risk. Despite its prevalence, diagnostic and therapeutic interventions remain underutilized. These findings underscore the need for increased awareness and proactive management of dysphonia in ACDF patients, including standardized screening protocols and early referral for evaluation and treatment.