Objective Anterior cervical discectomy and fusion (ACDF) is the most common performed surgery in the cervical spine. Dysphagia is one of the most frequent complications following ACDF. Several studies have identified certain demographic and perioperative risk factors associated with increased dysphagia rates, but few have reported recent trends. Our study aims to report current trends and factors associated with the development of inpatient postoperative dysphagia after ACDF.
Methods The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were selected. Time trend series plots were created for the yearly treatment trends for each fusion level by dysphagia outcome. Separate univariable followed by multivariable logistic regression analyses were performed to evaluate predictors of dysphagia.
Results A total of 1,212,475 ACDFs were identified in which 3.3% experienced postoperative dysphagia. A significant increase in annual dysphagia rates was observed from 2004–2014. Frailty, intraoperative neuromonitoring, 4 or more level fusions, African American race, fluid/electrolyte disorders, blood loss, and coagulopathy were all identified as significant independent risk factors for the development of postoperative dysphagia following ACDF.
Conclusion Postoperative dysphagia is a well-known postsurgical complication associated with ACDF. Our cohort showed a significant increase in the annual dysphagia rates independent of levels fused. We identified several risk factors associated with the development of postoperative dysphagia after ACDF.
Citations
Citations to this article as recorded by
LASSO-based machine learning algorithm for prediction of dysphagia in patients suffering anterior cervical discectomy and fusion Bingyu Wang, Jiawei Shi, Zefu Chen, Jingmin Liu, Yongjian Zhu, Zhongmin Zhang, Xin Zheng, Xiaobo Wang European Spine Journal.2026; 35(2): 559. CrossRef
The impact of postoperative drain placement on perioperative management in anterior cervical discectomy and fusion (ACDF) Xianxu Zhang, Changlin Zhou, Wenxiang Shen, Lei Huang, Bin Qian, Yuji Zhang, Zhixuan Nian, Rui Li, Shicheng Li, Zhiqiang Luo Journal of Clinical Neuroscience.2026; 143: 111768. CrossRef
Cost-effectiveness of early surgical intervention for asymptomatic cervical spinal cord compression:a Markov model analysis Mihir S. Dekhne, Tejas Subramanian, Michael Mazzucco, Gregory S. Kazarian, Han Jo Kim, Sravisht Iyer The Spine Journal.2026;[Epub] CrossRef
When combined frailty, anemia, and malnourishment exhibit a predictive power for 30-day outcomes following anterior cervical discectomy and fusions for cervical spondylotic myelopathy Jacob M. Gluski, Gabrielle Santangelo, Paul Serrato, Shaila Ghanekar, Ethan DL Brown, Aryaa Karkare, Aladine Elsamadicy, Sheng-fu Larry Lo, Daniel M. Sciubba Next Research.2026; 5: 101378. CrossRef
Behind the Procedure: Understanding Complications in Anterior Cervical Surgery Hussam Abu Nowar , Wesam Khraisat, Mu'taz Halasah, Laith Alomari, Osama Alabadi, Khalid Abu-Rumman Cureus.2026;[Epub] CrossRef
National Trends and Risk Factors for Dysphagia After Anterior Cervical Discectomy and Fusion Caryn J. Ha, Sraavya G. Anne, Sara Morgan, Fadar Oliver Otite, Kenneth Yan The Laryngoscope.2026;[Epub] CrossRef
Bibliometric study of research trends in dysphagia complicating following anterior cervical spine surgery Shang Qisong, Xiang Wei, Wu Yuanyuan, Song Xinghua Frontiers in Surgery.2025;[Epub] CrossRef
A machine learning-driven model predicts patient-reported dysphagia after instrumented cervical fusion Akash A. Shah, Changhee Lee, Amador Bugarin, Sai K. Devana, Alexander Upfill-Brown, Nelson F. SooHoo, Don Y. Park Artificial Intelligence Surgery.2025; 5(2): 210. CrossRef
Demand analysis of perioperative nursing service needs for patients with cervical spondylosis based on the Kano model: a cross-sectional study LinLing Hu, Lei Wang, Yan Wang, Jing Huang, Ping Dong, Chunmei Luo BMC Nursing.2025;[Epub] CrossRef
Evaluating the Effect of Gastroesophageal Reflux Disease on Postoperative Dysphagia Following Anterior Cervical Spine Surgery-A Prospective, Multicenter Study Aditya Mazmudar, Taylor Paziuk, John Mangan, Khoa Tran, Samuel Oh, Sandy Li, Brandon Sherrod, Erica Bisson, Darrel Brodke, Christopher Kepler, Gregory Schroeder, Alexander Vaccaro, Alan Hilibrand, Jeffrey A. Rihn Global Spine Journal.2024; 14(5): 1595. CrossRef
The efficacy of post-operative drains for anterior cervical discectomy and fusion: a systematic review and meta-analysis Aaron Lerch, Anthony Minh Tien Chau British Journal of Neurosurgery.2024; 38(1): 3. CrossRef
Impact of Frailty and Cervical Radiographic Parameters on Postoperative Dysphagia Following Anterior Cervical Spine Surgery Tomoyuki Asada, Sumedha Singh, Omri Maayan, Pratyush Shahi, Nishtha Singh, Tejas Subramanian, Kasra Araghi, Maximilian Korsun, Olivia Tuma, Anthony Pajak, Amy Lu, Eric Mai, Yeo Eun Kim, James Dowdell, Evan D. Sheha, Sravisht Iyer, Sheeraz A. Qureshi Spine.2024; 49(2): 81. CrossRef
The Effect of the Coronavirus Disease 2019 Pandemic on Pituitary Surgery Evan Luther, Ian Ramsay, Vaidya Govindarajan, Chandler N. Berke, Vivien Makhoul, Martin Merenzon, Katherine Berry, Alexis Morell, Daniel Eichberg, Victor M. Lu, Ashish Shah, Ricardo J. Komotar, Michael E. Ivan World Neurosurgery.2024; 186: e440. CrossRef
Comparison of the efficacy of ROI-C cage with Zero-P device in anterior cervical discectomy and fusion of cervical degenerative disc disease: a two-year follow-up study Penghuan Wu, Sifan Yang, Yu Wang, Qiang Wu, Yingze Zhang Frontiers in Surgery.2024;[Epub] CrossRef
Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age Alexandria F. Naftchi, John Vellek, Julia Stack, Eris Spirollari, Sima Vazquez, Ankita Das, Jacob D. Greisman, Zehavya Stadlan, Omar H. Tarawneh, Sabrina Zeller, Jose F. Dominguez, Merritt D. Kinon, Chirag D. Gandhi, Syed Faraz Kazim, Meic H. Schmidt, Chr Dysphagia.2023; 38(3): 837. CrossRef
Leveraging HFRS to assess how frailty affects healthcare resource utilization after elective ACDF for CSM Aladine A. Elsamadicy, Andrew B. Koo, Margot Sarkozy, Wyatt B. David, Benjamin C. Reeves, Saarang Patel, Justice Hansen, Mani Ratnesh S. Sandhu, Astrid C. Hengartner, Andrew Hersh, Luis Kolb, Sheng-Fu Larry Lo, John H. Shin, Ehud Mendel, Daniel M. Sciubba The Spine Journal.2023; 23(1): 124. CrossRef
Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy? Huajian Zhong, Chen Xu, Ruizhe Wang, Xiaodong Wu, Huiqiao Wu, Baifeng Sun, Xinwei Wang, Huajiang Chen, Xiaolong Shen, Wen Yuan Frontiers in Surgery.2023;[Epub] CrossRef
Safety and Efficacy of Local Steroid Application on Dysphagia Following Anterior Cervical Discectomy and Fusion Jun-wu Wang, Peng-zhi Shi, Kai Li, Lei Zhu, Xin-min Feng, Wen-jie Zhang, Liang Zhang Clinical Spine Surgery.2023; 36(7): 265. CrossRef
Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery Woon Tak Yuh, Minjung Kim, Yunhee Choi, Junghoon Han, Junhoe Kim, Taeshin Kim, Chun Kee Chung, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Moon Soo Park, Chi Heon Kim Scientific Reports.2023;[Epub] CrossRef
Standalone versus Anterior Cervical Plating for One-To-Two Level Anterior Cervical Discectomy and Fusion: A Propensity Score-Matched Comparative Study Ammad A. Baig, Alexander O. Aguirre, Mohamed A.R. Soliman, Cathleen C. Kuo, Jaims Lim, Asham Khan, Ivette Chen, Kenneth V. Snyder, Elad I. Levy, Adnan H. Siddiqui, John Pollina, Jeffrey P. Mullin World Neurosurgery.2023; 177: e673. CrossRef
Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling Chang-Hwan Ahn, Sungwook Kang, Mingoo Cho, Seong-Hun Kim, Chi Heon Kim, Inbo Han, Chul-Hyun Kim, Sung Hyun Noh, Kyoung-Tae Kim, Jong-Moon Hwang Scientific Reports.2023;[Epub] CrossRef
What Type of Incision for Anterior Cervical Spine Surgery Involving Long Segments Can Bring Better Cosmetic and Functional Outcomes? Hyung Rae Lee, Dong-Ho Lee, Sang Yun Seok, Sehan Park, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee Neurospine.2022; 19(2): 412. CrossRef
A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion Xun Wang, Yanze Lin, Qiongtai Wang, Liqing Gao, Fabo Feng Journal of Pain Research.2022; Volume 15: 3137. CrossRef
Commentary: Transcondylar Odontoid Resection and Stabilization for Craniovertebral Degenerative Compression: 2-Dimensional Operative Video Evan Luther, Gurvinder Kaur, Ricardo Komotar, Michael Ivan Operative Neurosurgery.2021; 21(5): E431. CrossRef
Bibliometric and visualized analysis of the top 100 most-cited articles on anterior cervical surgery Junbo He, Tingkui Wu, Chen Ding, Beiyu Wang, Ying Hong, Hao Liu EFORT Open Reviews.2021; 6(12): 1203. CrossRef
Objective Obesity has become a public health crisis and continues to be on the rise. An elevated body mass index has been linked to higher rates of spinal degenerative disease requiring surgical intervention. Limited studies exist that evaluate the effects of obesity on perioperative complications in patients undergoing anterior cervical discectomy and fusion (ACDF). Our study aims to determine the incidence of obesity in the ACDF population and the effects it may have on postoperative inpatient complications.
Methods The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were identified. This cohort was stratified into patients with diagnosis codes indicating obesity. Separate univariable followed by multivariable logistic regression analysis were performed for the likelihood of perioperative inpatient outcomes among the patients with obesity.
Results From 2004 to 2014, estimated 1,212,475 ACDFs were identified in which 9.2% of the patients were obese. The incidence of obesity amongst ACDF patients has risen dramatically during those years from 5.8% to 13.4%. Obese ACDF patients had higher inpatient likelihood of dysphagia, neurological, respiratory, and hematologic complications as well as pulmonary emboli, and intraoperative durotomy.
Conclusion Obesity is a well-established modifiable comorbidity that leads to increased perioperative complications in various surgical specialties. We present one of the largest retrospective analyses evaluating the effects of obesity on inpatient complications following ACDF. Our data suggest that the number of obese patients undergoing ACDF is steadily increasing and had a higher inpatient likelihood of developing perioperative complications.
Citations
Citations to this article as recorded by
Glucagon-like peptide-1 receptor agonist use and perioperative outcomes after anterior cervical discectomy and fusion: a propensity-matched cohort study Kevin Y. Heo, Stephen R. Barchick, Aubrie M. Sowa, Myra Chao, Prashant V. Rajan, Brian C. Goh, Sangwook T. Yoon The Spine Journal.2026; 26(5): 882. CrossRef
Obesity does not significantly impact clinical outcomes following anterior cervical discectomy and fusion Ishan Shah, Alejandro Perez-Albela, Riya Shah, Charles Furlong, Puru Sadh, John Czerwein, Alan Daniels, Bryce A. Basques Journal of Clinical Neuroscience.2026; 144: 111807. CrossRef
The Effect of GLP-1 Receptor Agonists on Reoperation Following Anterior Cervical Discectomy and Fusion Nicholas C. Bank, Daniel Whittingslow, Sam Duggan, Joshua L. Morningstar, Douglas S. Weinberg World Neurosurgery.2026; 206: 124751. CrossRef
Impact of obesity on patient-reported outcome measures and complications following anterior cervical surgery for cervical spondylosis: A cohort study Of 7,993 patients Edisson Nemer, Victor Gabriel El-Hajj, Marcus Roland Victor Gustafsson, Victor E. Staartjes, Erik Edström, Adrian Elmi-Terander European Spine Journal.2026;[Epub] CrossRef
Surgical outcomes following multi-level sub-axial anterior cervical discectomy and fusion versus posterior cervical decompression and fusion in an obese cohort Taylor Furst, Aman Singh, Prasanth Romiyo, Jonathan Stone, Tyler Schmidt British Journal of Neurosurgery.2026; : 1. CrossRef
Cervical disc arthroplasty is safe across various obesity levels Manjot Singh, Benjamin Chanes, Mariah Balmaceno-Criss, Alan H. Daniels, Andrew S Zhang The Spine Journal.2025; 25(4): 756. CrossRef
Impact of Severe Obesity on Outcomes in Single-Level Anterior Cervical Discectomy and Fusion (ACDF): A Large-Scale Comparative Study David Maman, Ofek Bar, Yaniv Steinfeld, Ali Sleiman, Arsen Shpigelman, Lior Ben Zvi, Yaron Berkovich Surgical Techniques Development.2025; 14(1): 1. CrossRef
Factors predicting outcomes from chronic pain management interventions Steven P Cohen, Eric J Wang, Alexandra Roybal, Yian Chen BMJ Medicine.2025; 4(1): e001143. CrossRef
Single-level anterior cervical discectomy and fusion is associated with higher nonroutine discharge rates compared to cervical disc arthroplasty in obese patients Paul G. Mastrokostas, Luke B. Schwartz, Eli Berglas, Aaron B. Lavi, Leonidas E. Mastrokostas, Jonathan Dalton, Christopher K. Kepler, Arya Varthi, Jad Bou Monsef, Afshin E. Razi, Mitchell K. Ng Journal of Craniovertebral Junction and Spine.2025; 16(2): 205. CrossRef
Standardizing Preoperative Care for Elective Spine Surgery: The University of Oklahoma Elective Spine Surgery Protocol Lonnie Smith, David Barkyoumb, William C. Kaiser, Fauziyya Muhammad, Tara Sukut, Ishan Purani, Chao Li, DO, Karl Balsara, Hakeem J. Shakir, M. Burhan Janjua, John F. Burke, Andrew Jea, Zachary A. Smith GeroScience.2025;[Epub] CrossRef
Postoperative Physical Therapy Utilization for Anterior Cervical Discectomy and Fusion Justin M. Lantz, William J. Karakash, Andy T. Ton, Andreas Remis, Henry Avetisian, David B. Anderson, Yogi Matharu, Ram K. Alluri, Zorica Buser Spine.2025; 50(22): 1547. CrossRef
Complication Rates, Operative Times, and Hospital Costs Following Anterior Cervical Discectomy and Fusion in Obese Versus Nonobese Patients Stavros Matsoukas, Teleale Gebeyehu, Joshua E. Heller, Jack Jallo, James S. Harrop, Srinivas K. Prasad Clinical Spine Surgery.2025;[Epub] CrossRef
The Impact of Obesity on Fusion Rate Following Anterior Cervical Discectomy and Fusion: A Population-Based Study Wei-Thing Khor, Yu Chang, Hong-Min Lin, Kuan-Yu Chi, Junmin Song, Chien-Min Chen, Chi-Chen Huang World Neurosurgery.2025; 204: 124595. CrossRef
Anterior cervical surgery for morbidly obese patients should be performed in-hospitals Nancy E. Epstein, Marc A. Agulnick Surgical Neurology International.2024; 15: 2. CrossRef
Trends in Indications and Contraindications for Cervical Disk Arthroplasty from 2009 to 2019 Karim Shafi, Jerry Y. Du, Collin W. Blackburn, Han Jo Kim, Sravisht Iyer, Sheeraz Qureshi, Randall E. Marcus, Todd J. Albert Clinical Spine Surgery.2024; 37(7): E283. CrossRef
Disability and pain after anterior cervical decompression and fusion: A group-based trajectory analysis Sara S. Widbom-Kolhanen, Katri I. Pernaa, Roosa E. Lintuaho, Anna Kotkansalo, Mikhail Saltychev Scandinavian Journal of Surgery.2024; 113(2): 166. CrossRef
The Effect of the Coronavirus Disease 2019 Pandemic on Pituitary Surgery Evan Luther, Ian Ramsay, Vaidya Govindarajan, Chandler N. Berke, Vivien Makhoul, Martin Merenzon, Katherine Berry, Alexis Morell, Daniel Eichberg, Victor M. Lu, Ashish Shah, Ricardo J. Komotar, Michael E. Ivan World Neurosurgery.2024; 186: e440. CrossRef
The Effect of Patient Resilience on Postoperative Scores After One- and Two-Level Anterior Cervical Discectomy and Fusion Matthew H. Meade, Tyler Radack, Samantha Riebesell, Matthew J. Schultz, Levi Buchan, Alan S. Hilibrand, Mark F. Kurd, Victor Hsu, Ian David Kaye, Gregory D. Schroeder, Christopher Kepler, Alexander R. Vaccaro, Barrett I. Woods World Neurosurgery.2024; 189: e953. CrossRef
Leveraging HFRS to assess how frailty affects healthcare resource utilization after elective ACDF for CSM Aladine A. Elsamadicy, Andrew B. Koo, Margot Sarkozy, Wyatt B. David, Benjamin C. Reeves, Saarang Patel, Justice Hansen, Mani Ratnesh S. Sandhu, Astrid C. Hengartner, Andrew Hersh, Luis Kolb, Sheng-Fu Larry Lo, John H. Shin, Ehud Mendel, Daniel M. Sciubba The Spine Journal.2023; 23(1): 124. CrossRef
Intraoperative Monitoring of the Recurrent Laryngeal Nerve with Electromyography Endotracheal Tube in Anterior Cervical Discectomy and Fusion Nattawut Niljianskul, I-Sorn Phoominaonin, Alongkorn Jaiimsin World Neurosurgery: X.2023; 17: 100141. CrossRef
Anterior Cervical Discectomy and Fusion Outcomes in Patients With and Without Bariatric Surgery—Weight Loss Does Make a Difference Peter Y. Joo, Justin R. Zhu, Christopher Wilhelm, Kevin Tang, Wesley Day, Jay Moran, Jonathan N. Grauer Spine.2023; 48(6): 400. CrossRef
Morbid Obesity Increases Length of Surgery in Elective Anterior Cervical Discectomy and Fusion Procedures but Not Readmission or Reoperation Rates: A Cohort Study Evan G. Gross, Nicholas M.B. Laskay, James Mooney, M. Chandler McLeod, Travis J. Atchley, Dagoberto Estevez-Ordonez, Jakub Godzik World Neurosurgery.2023; 173: e830. CrossRef
The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis Woon Tak Yuh, Junghoon Han, Chang-Hyun Lee, Chi Heon Kim, Hyun-Seung Kang, Chun Kee Chung Journal of Korean Neurosurgical Society.2023; 66(4): 438. CrossRef
Severe Obesity Is an Independent Risk Factor of Early Readmission and Nonhome Discharge After Cervical Disc Replacement Tejas Subramanian, Daniel Shinn, Pratyush Shahi, Izzet Akosman, Troy Amen, Omri Maayan, Eric Zhao, Kasra Araghi, Junho Song, Sidhant Dalal, James Dowdell, Sravisht Iyer, Sheeraz Qureshi Neurospine.2023; 20(3): 890. CrossRef
Enhanced Intervertebral Disc Repair via Genetically Engineered Mesenchymal Stem Cells with Tetracycline Regulatory System Yeji Kim, Seong Bae An, Sang-Hyuk Lee, Jong Joo Lee, Sung Bum Kim, Jae-Cheul Ahn, Dong-Youn Hwang, Inbo Han International Journal of Molecular Sciences.2023; 24(22): 16024. CrossRef
Effects of Obesity on Cervical Disc Arthroplasty Complications Katherine M. Berry, Vaidya Govindarajan, Connor Berger, Krisna Maddy, Roberto J. Perez Roman, Evan M. Luther, Allan D. Levi Neurospine.2023; 20(4): 1399. CrossRef
Increased risk of postoperative wound complications among obesity classes II & III after ALIF in 10-year ACS-NSQIP analysis of 10,934 cases Evan M. Miller, Beck D. McAllister The Spine Journal.2022; 22(4): 587. CrossRef
ZERO-PROFILE DEVICE IMPLANTATION IN ANTERIOR CERVICAL DISCECTOMY AND FUSION: A SINGLE INSTITUTE EXPERIENCE Nattawut Niljianskul Journal of Southeast Asian Medical Research.2022; 6: e0104. CrossRef
Commentary on “Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients” Moon-Jun Sohn Neurospine.2022; 19(1): 63. CrossRef
Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques Kyung-Chung Kang, Tae Su Jang, Cheol Hyun Jung Asian Spine Journal.2022; 16(6): 995. CrossRef
The Effect of Diabetes and Metabolic Syndrome on Spine Surgery Outcomes Anitesh Bajaj, Rohan M. Shah, Hogan Brecount, Steven Kurapaty, Alpesh A. Patel, Srikanth N. Divi Current Reviews in Musculoskeletal Medicine.2022; 16(2): 39. CrossRef
National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery Roberto J. Perez-Roman, Evan M. Luther, David McCarthy, Julian G. Lugo-Pico, Roberto Leon-Correa, Steven Vanni, Michael Y. Wang Neurospine.2021; 18(1): 147. CrossRef
Independent Association of Obesity and Nonroutine Discharge Disposition After Elective Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy Andrew B. Koo, Aladine A. Elsamadicy, Margot Sarkozy, Wyatt B. David, Benjamin C. Reeves, Christopher S. Hong, Arianne Boylan, Maxwell Laurans, Luis Kolb World Neurosurgery.2021; 151: e950. CrossRef
Commentary: Transcondylar Odontoid Resection and Stabilization for Craniovertebral Degenerative Compression: 2-Dimensional Operative Video Evan Luther, Gurvinder Kaur, Ricardo Komotar, Michael Ivan Operative Neurosurgery.2021; 21(5): E431. CrossRef
First
Prev
