National Trends and Risk Factors for Dysphagia After ACDF Surgery

Dysphagia remains one of the most frequent complications following anterior cervical discectomy and fusion. A recent national analysis revealed that the incidence of dysphagia after ACDF surgery was approximately 7.7% between 2016 and 2022. Interestingly, while the overall volume of ACDF procedures declined significantly, the relative odds of patients experiencing swallowing difficulties increased annually. Consequently, understanding the specific risk factors is essential for clinicians to optimize postoperative care and manage patient expectations effectively.

Identifying Patient and Surgical Risk Factors

The study identified several key predictors of postoperative dysphagia. Specifically, female patients and those with a history of smoking or myelopathy faced a higher risk. Furthermore, surgical complexity played a major role. Multilevel fusions consistently showed higher rates of swallowing impairment compared to single-level procedures. Notably, the odds of dysphagia were significantly higher in patients undergoing surgery for myelopathy rather than simple disc herniation. Therefore, preoperative counseling should emphasize these variables to ensure better patient preparedness.

Managing Dysphagia after ACDF Surgery

Effective management begins with early identification. Since the odds of dysphagia are rising despite fewer total surgeries, clinicians must maintain a high index of suspicion. Moreover, the use of predictive tools, such as the newly developed nomograms, can help surgeons stratify risk levels. These models allow for tailored interventions, such as adjusting surgical techniques or involving speech and swallow therapists early in the recovery phase. By focusing on these preventive measures, healthcare providers can potentially reduce the long-term impact on patient quality of life.

Frequently Asked Questions

What are the primary risk factors for dysphagia after ACDF surgery?

The most significant risk factors include female sex, smoking, and undergoing multilevel fusion. Patients with myelopathy also have a higher likelihood of experiencing swallowing issues compared to those with other indications.

Is the rate of dysphagia increasing despite fewer ACDF procedures?

Yes, national data indicates that while the total number of ACDF surgeries has declined, the odds of developing dysphagia have increased by approximately 11.4% annually. This trend highlights the need for more targeted screening and management protocols.

How can surgeons predict the risk of swallowing difficulties?

Surgeons can utilize predictive nomograms that incorporate patient demographics, surgical levels, and specific indications. These tools help identify high-risk individuals who may require specialized postoperative monitoring.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Ha CJ et al. National Trends and Risk Factors for Dysphagia After Anterior Cervical Discectomy and Fusion. Laryngoscope. 2026 Apr 27. doi: 10.1002/lary.70588. PMID: 42045981.

Cochran J, et al. Dysphagia Following Anterior Cervical Discectomy and Fusion: A PearlDiver Analysis of Incidence, Risk Factors, and Interventions. Dysphagia. 2025 Aug 8. doi: 10.1007/s00455-025-10867-7. PMID: 40775465.

Alentado VJ, et al. National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery. NIH PMC. 2021. doi: 10.1155/2021/6634848.