Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the united states from 2006 to 2013

Publication date: Available online 8 November 2017
Source:The Spine Journal
Author(s): Comron Saifi, Arielle Fein, Alejandro Cazzulino, Ronald Lehman, Frank M. Phillips, Howard S. An, K. Daniel Riew
Background ContextThe typically accepted surgical procedure for cervical disc pathology has been the anterior cervical discectomy and fusion (ACDF), although recent trials have demonstrated equivalent or improved outcomes with cervical disc arthroplasty (CDA). Trends for these two procedures regarding utilization, revision procedures, along with other demographic information have not been sufficiently explored.PurposeTo provide data regarding ACDF and CDA from 2006-2013 in the U.S.DesignRetrospective national database analysis.Patient Sample20% sample of discharges from U.S. hospitals, which is weighted to provide national estimates.Outcome MeasuresFunctional measures such as national incidence, hospital costs, length of stay (LOS), routine discharge, revision burden, and patient characteristics.MethodsPatients from the National Inpatient Sample (NIS) database who underwent primary ACDF, revision ACDF, primary CDA, and revision CDA from 2006-2013 were included. Demographic and economic data for the procedures' respective ICD-9 CM codes were collected.Results1,059,403 ACDF and 13,099 CDA surgeries were performed in the U.S. from 2006-2013. The annual number of ACDF increased 5.7% non-linearly from 120,617 in 2006 to 127,500 in 2013 (mean per year: 132,425; range: 120,617-147,966); CDA increased 190% non-linearly from 540 in 2006 to 1,565 in 2013 (mean per year: 1,637; range: 540-2,381). CDA patients were younger and had more private or 'other' insurance, including worker's compensation (p<0.0001). Mean LOS was longer for ACDF (ACDF 2.3 days vs. CDA 1.5; p<0.0001). Routine discharge was higher in the CDA group (CDA 96% vs. ACDF 89%; p-value<0.0001). The mean hospital-related cost was more expensive for ACDF (ACDF $16,178 vs. CDA $13,197; p-value=0.0007). CDA mean revision burden, defined as the ratio of revision procedures to the sum of primary and revision procedures, was greater (CDA 5.9% vs. ACDF 2.3%, p-value=0.01).ConclusionsNationally approximately 132,000 ACDFs are done each year compared to only 1,600 CDAs. The number of ACDF surgeries performed far outpaces CDA by a ratio of 81:1 in the U.S. without a clear direction in the trend for utilization given recent fluctuations. CDA revision burden was more than double compared to the ACDF revision burden (5.9% vs 2.3%), which was not accounted for by patient baseline demographics. The etiology of these findings are likely multifactorial and require further research.



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