Dysphagia Risk After Single vs Multi-level Anterior Cervical Discectomy and Fusion in Octogenarians: A Propensity Score Matched Analysis

Retrospective cohort study. To evaluate the independent associations of operative extent and advanced age with postoperative dysphagia after anterior cervical discectomy and fusion (ACDF). Dysphagia is common after ACDF and may be especially consequential in octogenarians. The relative contributions of multi-level surgery and advanced age to dysphagia risk after adjustment for comorbidity remain unclear. We performed a retrospective cohort study using the TriNetX Research Network to identify patients aged 80 to 89 years undergoing ACDF from 2015 to 2023. Single-level ACDF was defined as CPT 22551 without 22552 and multi-level ACDF as CPT 22551 plus 22552. Cohorts were propensity score matched 1:1 on demographics and comorbidities. The primary outcome was new onset dysphagia at 0 to 2 weeks, 6 to 24 weeks, and 1 to 2 years. Secondary outcomes included aspiration pneumonia, reoperation, readmission, and mortality. Additional matched analyses compared octogenarians with younger patients aged 50 to 69 years stratified by operative extent. After matching, 993 octogenarians remained in each operative extent cohort. Dysphagia was more frequent after multi-level versus single-level ACDF at 0 to 2 weeks (11.5% vs 8.0%; RR 1.44, 95% CI 1.10 to 1.90; P =0.008), but did not differ at later timepoints. Other major postoperative complications did not differ by operative extent. In age stratified analyses, octogenarians had higher dysphagia rates than younger patients at 0 to 2 weeks after both single-level ACDF (7.7% vs. 4.5%; RR 1.71, 95% CI 1.23 to 2.39; P =0.001) and multi-level ACDF (11.6% vs. 8.0%; RR 1.45, 95% CI 1.13 to 1.85; P =0.003), with differences resolving by 6 to 24 weeks. Multi-level ACDF in octogenarians is associated with higher acute dysphagia risk than single-level ACDF. Advanced age is associated with increased early dysphagia after both procedures, supporting focused counseling and early dysphagia mitigation strategies. III.