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Gordon AM, Golub IJ, Lam AW, Ng MK, Saleh A. Primary Cervical Disc Arthroplasty Among Medicare Beneficiaries Versus Alternative Payers: Is It Time to Consider Nationwide Coverage? Global Spine J 2024; 14:1148-1154. [PMID: 36214218 DOI: 10.1177/21925682221134498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES As of 2022, the Centers for Medicare and Medicaid Services does not provide nationwide coverage for cervical disc arthroplasty (CDA). The aim was to determine whether Medicare beneficiaries have differences in: (1) lengths of stay (LOS); (2) complications; (3) readmissions; and (4) costs of care. METHODS Using the 2010 to 2020 PearlDiver database, we queried patients undergoing primary CDA for degenerative disc pathology. Study groups patients were those undergoing CDA with Medicare coverage (n = 1467); patients without Medicare coverage were the comparison cohort (n = 15,389). Endpoints were to compare demographics and comorbidities within the Elixhauser comorbidity index (ECI), LOS, 90-day complications, 90-day readmissions, and 90-day reimbursements. A multivariate logistic regression was used to calculate odds (OR) of medical complications and readmissions within 90-days. A P-value less than .003 was significant. RESULTS Patients with Medicare coverage undergoing CDA had higher mean ECI compared to alternative payers (5.24 vs 3.26; P < .0001). Mean LOS was significantly higher for Medicare beneficiaries (2.20 vs 1.76 days; P < .010). There was no significant differences in odds of all medical complications (OR: 1.19, 95% CI: .98-1.44; P = .069) or readmission rates (1.77% vs 1.33%, OR:0.82, 95% CI: .50-1.29; P = .417) within 90-days following the index procedure among Medicare beneficiaries vs alternative payers. Non-Medicare beneficiaries had higher 90-day reimbursements compared to Medicare beneficiaries ($6,700 vs $7,086,P < .001). CONCLUSIONS Medicare beneficiaries despite having slightly longer lengths of stay did not have higher rates of medical complications or readmissions. Surgeons and policy makers may use this data to consider alternative treatments in Medicare patients.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Nilssen PK, Narendran N, Chen I, Kanim LE, Walker CT, Bae HW, Skaggs DL, Tuchman A. Risk Factors for Reoperation Following Single-Level Cervical Disc Arthroplasty as Utilized in a Representative Sample of United States Clinical Practice: A Retrospective PearlDiver Study. Global Spine J 2024:21925682241230965. [PMID: 38279691 DOI: 10.1177/21925682241230965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES Most data regarding cervical disc arthroplasty (CDA) outcomes are from highly controlled clinical trials with strict inclusion/exclusion criteria. This study aimed to identify risk factors for CDA reoperation, in "real world" clinical practice using a national insurance claims database. METHODS The PearlDiver database was queried for patients (2010-2020) who underwent a subsequent cervical procedure following a single-level CDA. Patients with less than 2 years follow-up were excluded. Primary outcome was to evaluate risk factors for reoperation. Secondary outcome was to evaluate the types of reoperations. Risk factors were compared using descriptive statistics. Multivariate regression analyses were used to ascertain the association among risk factors and reoperation. RESULTS Of 14,202 patients who met inclusion criteria, 916 (6.5%) underwent reoperation. Patients undergoing reoperation were slightly older with higher Elixhauser Comorbidity Index (ECI) scores, however both were not risk factors for reoperation. Patients with diagnoses such as smoking, myelopathy, inflammatory disorders, spinal deformity, trauma, or a history of prior cervical surgery were at greater risk for reoperation. No association was found between the year of index surgery and reoperation risk. The most common reoperation procedure was cervical fusion. CONCLUSIONS As billed for in the United States since 2010, CDA was associated with a 6.5% reoperation rate over a mean follow-up time of 5.3 years. Smoking, myelopathy, inflammatory disorders, spinal deformity, and a history of prior cervical surgery or trauma are risk factors for reoperation following CDA. Though patients who underwent a reoperation were older, age was not found to be an independent risk factor for a subsequent procedure.
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Affiliation(s)
- Paal K Nilssen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ida Chen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda E Kanim
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Corey T Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hyun W Bae
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David L Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander Tuchman
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Nunna RS, Ryoo JS, Ostrov PB, Patel S, Godolias P, Daher Z, Price R, Chapman JR, Oskouian RJ. Single-level cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF): A Nationwide matched analysis of complications, 30- and 90-day readmission rates, and cost. World Neurosurg X 2024; 21:100242. [PMID: 38221950 PMCID: PMC10787284 DOI: 10.1016/j.wnsx.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Ravi S. Nunna
- Department of Neurosurgery, University of Missouri Columbia Health Care, Columbia, MO, USA
| | - James S. Ryoo
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Philip B. Ostrov
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Zeyad Daher
- Swedish Neuroscience Institute, Seattle, WA, USA
- Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
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Ratnasamy PP, Rudisill KE, Maloy GC, Grauer JN. Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021. Spine (Phila Pa 1976) 2023; 48:E342-E348. [PMID: 36728785 PMCID: PMC10300227 DOI: 10.1097/brs.0000000000004560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/18/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Descriptive epidemiologic study. OBJECTIVE To compare trends in utilization and predictive factors for single-level cervical disc arthroplasty (CDA) relative to anterior cervical discectomy and fusion (ACDF) over the years. BACKGROUND CDA is an alternative to ACDF for the treatment of cervical spine pathologies. With both procedures performed for similar indications, controversy on best practices exists. MATERIALS AND METHODS Patients who underwent single-level CDA or ACDF were identified in the 2010 through 2021 PearlDiver M151Ortho data set. The yearly number of CDAs performed and proportionality was assessed. Predictive patient factors for undergoing CDA as opposed to ACDF were determined. Kaplan Meyer survival analysis with an endpoint of cervical spine reoperation compared 5-year outcomes between CDA and ACDF. RESULTS From 2010 to 2021, 19,301 single-level CDAs and 181,476 single-level ACDFs were identified. The proportional utilization of CDA relative to ACDF increased from 4.00% in 2010 to 14.15% in 2018 ( P < 0.0001), after which there was a plateau between 2018 and 2021 where proportional utilization was 14.47% ( P = 0.4654). Multivariate analysis identified several predictors of undergoing CDA rather than ACDF, including: younger age [odds ratio (OR) per decade decrease: 1.72], having surgery performed in the Midwest, Northeast, or West (relative to South, OR: 1.16, 1.13, 2.26, respectively), having Commercial insurance (relative to Medicare, OR: 1.75), and having surgery performed by an orthopedic surgeon (relative to a neurological surgeon, OR: 1.54) ( P < 0.0001 for each). There was no statistically significant difference in 5-year survival to further cervical spine surgery between CDA and ACDF at 5 years (97.6% vs. 97.7%, P = 0.4249). CONCLUSIONS Although the use of CDA relative to ACDF rose from 2010 to 2018, its use has subsequently plateaued between 2018 and 2021 and remained a relatively low percentage of the single-level anterior cervical surgeries performed (14.47% in 2021). The causes for such changes in the trend are unclear.
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Affiliation(s)
- Philip P Ratnasamy
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Gordon AM, Golub IJ, Ng MK, Lam AW, Houten JK, Saleh A. Primary and Revision Cervical Disc Arthroplasty from 2010–2020: Patient Demographics, Utilization Trends, and Health Care Reimbursements. World Neurosurg 2022; 168:e344-e349. [DOI: 10.1016/j.wneu.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
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Lee NJ, Joaquim AF, Boddapati V, Mathew J, Park P, Kim JS, Sardar ZM, Lehman RA, Riew KD. Revision Anterior Cervical Disc Arthroplasty: A National Analysis of the Associated Indications, Procedures, and Postoperative Outcomes. Global Spine J 2022; 12:1338-1344. [PMID: 33464126 PMCID: PMC9393989 DOI: 10.1177/2192568220979140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To examine the associated indications, procedures, and postoperative outcomes after revision ACDA. METHODS We utilized a national database to identify adult(≥18 years) patients who underwent either a primary ACDA or removal of ACDA over a 10-year period(2008-2017). An in-depth assessment of the reasons for revision surgery and the subsequent procedures performed after the removal of ACDA was done by using both Current Procedural Terminology(CPT) and International Statistical Classification of Diseases (ICD-9,10) coding. RESULTS From 2008 to 2017, a total of 3,350 elective, primary ACDA cases were performed. During this time, 69 patients had a revision surgery requiring the removal of ACDA. The most common reasons for revision surgery included cervical spondylosis(59.4%) and mechanical complications(27.5%). After removal of ACDA, common procedures performed included anterior cervical fusion with or without decompression(69.6%), combined anterior/posterior fusion/decompression (11.6%), and replacement of ACDA (7.2%). The indications for surgery did not vary significantly among the different procedures performed (p = 0.318). Patients requiring revision surgery for mechanical complications or those who underwent a combined surgical approach were at significantly higher risk for subsequent short-term complications (p<0.05). CONCLUSION Over a 10-year period, the rate of revision surgery for ACDA was low (2.1%). Nearly 90% of revision cases were due to either cervical spondylosis or mechanical complications. These indications for surgery did not vary significantly among the different procedures performed. These findings will be important during the shared-decision making process for patients undergoing primary or revision ACDA.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA,Nathan J. Lee, MD, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
| | - Andrei F. Joaquim
- Department of Neurosurgery, University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M. Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K. Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Ostrov PB, Reddy AK, Ryoo JS, Behbahani M, Mehta AI. Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Comparison of National Trends and Outcomes. World Neurosurg 2022; 160:e96-e110. [PMID: 34973439 DOI: 10.1016/j.wneu.2021.12.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) has been considered the standard treatment for degenerative cervical disc disease; however, recent trials have shown comparable outcomes with cervical disc arthroplasty (CDA). This study aimed to observe disparities in treatment paradigms of single-level cervical disc diseases and compare inpatient outcomes between procedures. METHODS A retrospective cohort of patients treated for single-level cervical disc herniation or degeneration without myelopathy was queried from the Nationwide Inpatient Sample spanning 2012-2015. Multivariate logistic regression was performed to assess the effects of demographics, temporality of admission, and hospital characteristics on odds of receiving CDA versus ACDF. Propensity-score matching was performed to compare cost, length of stay (LOS), non-home discharge, and inpatient complications. RESULTS In total, 1028 CDAs and 44,374 ACDFs were performed for single-level cervical disc disease during 2012-2015. Matched comparison showed that while non-home discharges were not different between CDA and ACDF (P = 0.248), patients who received CDA had a 0.19-day shorter LOS (P < 0.001) and $4694 greater total cost (P < 0.001). There were no statistically significant differences in inpatient complication rates. Multivariate analysis showed that patients in the 26th-50th percentile, 51st-75th percentile, and 76th-100th percentile of median household income had greater odds of CDA compared with patients in the 0-25th percentile (odds ratio [OR] 1.35, P = 0.003; OR 1.31, P = 0.013; OR 1.34, P = 0.011, respectively). Patients with private insurance had greater odds of receiving CDA compared with patients on Medicare (OR 1.91, P < 0.001). CONCLUSIONS CDA was associated with shorter LOS but greater costs compared with ACDF. Patients with greater median income and private insurance were more likely to receive CDA.
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Affiliation(s)
- Philip B Ostrov
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abhinav K Reddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James S Ryoo
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Mortenson M, Montgomery A, Buttermann G. Chiropractic Care of a Female Veteran After Cervical Total Disk Replacement: A Case Report. J Chiropr Med 2022; 21:60-65. [PMID: 35747610 DOI: 10.1016/j.jcm.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The purpose of this case study is to describe chiropractic care of the cervical spine for a patient who previously underwent cervical total disk replacement (CTDR) of the C5-6 and C6-7 disks. Clinical Features A 42-year-old female veteran of the U.S. Army presented to a Veterans Affairs chiropractic clinic with chronic cervical pain and radiculopathy. She had previously undergone CTDR surgery of the C5-6 disk 9 years earlier, but the pain had become severe and radicular symptoms had returned in the upper left extremity. Imaging taken before the chiropractic referral demonstrated significant joint space narrowing and disk herniation of the C6-7 disk with protrusion to the left side. Intervention and Outcome The patient received spinal manipulative therapy, trigger-point therapy, and manual traction to the cervical spine. However, these treatments were not effective in reducing her cervical pain and radiculopathy. She then opted for CTDR of the C6-7 disk. After surgery, the patient reported that radicular symptoms were mostly relieved and cervical pain had decreased by 50%. After 6 additional spinal manipulative therapy treatments, she reported having no neurologic symptoms and that her pain had decreased more than 70% from presurgery levels. Conclusion This case report is the first reported example of chiropractic care after CTDR within an integrated health care environment. The patient's cervical pain and radiculopathy improved with CTDR along with postsurgical chiropractic care.
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Affiliation(s)
- Michael Mortenson
- Whole Health Department, Fargo VA Healthcare System, Fargo, North Dakota
| | - Anna Montgomery
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Glenn Buttermann
- Surgery, Midwest Spine & Brain Institute, Minneapolis, Minnesota
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Katz A, Song J, Bowles D, Ng T, Neufeld E, Hasan S, Perfetti D, Sodhi N, Essig D, Silber J, Virk S. What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty. J Craniovertebr Junction Spine 2022; 13:331-338. [PMID: 36263340 PMCID: PMC9574118 DOI: 10.4103/jcvjs.jcvjs_69_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Compared to anterior cervical discectomy and fusion (ACDF), the motion preservation of cervical disc arthroplasty (CDA) provides an attractive alternative with similar short-term results. However, there is a paucity of the economics of performing CDA over ACDF. Study Design: This was retrospective study. Objective: The objective of this study is to evaluate relative-value-units (RVUs), operative time, and RVUs-per-minute between single-level ACDF and CDA. Secondary outcomes included 30-day readmission, reoperation, and morbidity. Methods: Adults who underwent ACDF or CDA in 2011–2019 National Surgical Quality Improvement Program database datasets. Multivariate quantile regression was utilized. Results: There were 26,595 patients (2024 CDA). ACDF patients were older, more likely to be female, discharged to inpatient rehabilitation, and have a history of obesity, smoking, diabetes, steroid use, and the American Society of Anesthesiologists-class ≥3. ACDF had greater median RVUs-per-case (41.2 vs. 24.1) and RVUs-per-minute (0.36 vs. 0.27), despite greater operative-time (109 min vs. 92 min) (P < 0.001). ACDF predicted a 16.9 unit increase in median RVUs per case (P < 0.001, confidence interval [CI]95: 16.3–17.5), an 8.81 min increase in median operative time per case (P < 0.001, CI95: 5.69–11.9), and 0.119 unit increase in median RVUs-per-minute (P < 0.001, CI95: 0.108–0.130). ACDF was associated with greater unadjusted rates of readmission (3.2% vs. 1.4%) morbidity (2.3% vs. 1.1%) (P < 0.001), but similar rates of reoperation (1.3% vs. 0.8%, P = 0.080). After adjusting for significant patient-related and procedural factors, readmission (odds ratio [OR] = 0.695, P = 0.130, CI95: 0.434–1.113) and morbidity (OR = 1.102, P = 0.688, CI95: 0.685–1.773) was similar between ACDF and CDA. Conclusions: Median RVUs-per-minute increased by 0.119 points for ACDF over CDA, or $257.7/h for each additional-hour of surgery. Adjusted 30-day outcomes were similar between procedures. Reimbursement for CDA does not appear to be in line with ACDF and may be a barrier to widespread usage.
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Boddapati V, Lee NJ, Mathew J, Vulapalli MM, Lombardi JM, Dyrszka MD, Sardar ZM, Lehman RA, Riew KD. Hybrid Anterior Cervical Discectomy and Fusion and Cervical Disc Arthroplasty: An Analysis of Short-Term Complications, Reoperations, and Readmissions. Global Spine J 2021; 11:1183-1189. [PMID: 32705903 PMCID: PMC8453682 DOI: 10.1177/2192568220941453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Although cervical disc arthroplasty (CDA) has become a well-established and effective treatment for symptomatic cervical degeneration, many patients with multilevel disease are not good candidates for CDA at all levels. For such patients, hybrid surgery (HS)-a combination of adjacent anterior cervical discectomy and fusion (ACDF) and CDA-may be more appropriate. Given the novelty of HS and the relative dearth of studies adequately assessing short-term perioperative complications, this current study sought to assess the short-term morbidity profile of HS, differences in operative duration, length of stay (LOS), and readmission and reoperation rates and reasons relative to a 2-level ACDF cohort. METHODS All patients who underwent HS and 2-level ACDF were identified between 2011 and 2018 using a large, prospectively collected registry. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis. RESULTS A total of 390 patients undergoing HS were identified. Two-level procedures were the most common (74.9%). Patients undergoing HS were more likely to be younger, male, and have fewer comorbidities. There were no differences between HS and 2-level ACDF in rates of any postoperative complication, transfusion, readmissions, and operative duration. However, HS had a decreased LOS (0.5 days), relative to a 2-level ACDF. HS patients had low rates of reoperation (1.28%) with 1 case for hematoma evacuation and another for revision CDA. CONCLUSIONS This study represents one of the largest cohorts of patients undergoing HS reported to date. Patients undergoing HS are not at increased risk of perioperative complications relative to a 2-level ACDF and may benefit from shorter LOS.
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Affiliation(s)
- Venkat Boddapati
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA,Venkat Boddapati, Columbia University Irving Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA.
| | - Nathan J. Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Mathew
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Meghana M. Vulapalli
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M. Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Marc D. Dyrszka
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Zeeshan M. Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald A. Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - K. Daniel Riew
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Wang X, Meng Y, Liu H, Hong Y, Wang B, Ding C, Yang Y. Comparison of the Safety of Outpatient Cervical Disc Replacement With Inpatient Cervical Disc Replacement: A Systematic Review and Meta-Analysis. Global Spine J 2021; 11:1121-1133. [PMID: 32959686 PMCID: PMC8351065 DOI: 10.1177/2192568220959265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES Outpatient cervical disc replacement (CDR) has been performed with an increasing trend in recent years. However, the safety profile surrounding outpatient CDR remains insufficient. The present study systematically reviewed the current studies about outpatient CDR and performed a meta-analysis to evaluate the current evidence on the safety of outpatient CDR as a comparison with the inpatient CDR. METHODS We searched the PubMed, Embase, Web of Science, and Cochrane Library databases comprehensively up to April 2020. Patient demographic data, overall complication, readmission, returning to the operation room, operating time were analyzed with the Stata 14 software and R 3.4.4 software. RESULTS Nine retrospective studies were included. Patients underwent outpatient CDR were significantly younger (mean difference [MD] = -1.97; 95% CI -3.80 to -0.15; P = .034) and had lower prevalence of hypertension (OR = 0.68; 95% CI 0.53-0.87; P = .002) compared with inpatient CDR. The pooled prevalence of overall complication was 0.51% (95% CI 0.10% to 1.13%) for outpatient CDR. Outpatient CDR had a 59% reduction in risk of developing complications (OR = 0.41; 95% CI 0.18-0.95; P = .037). Outpatient CDR showed significantly shorter operating time (MD = -18.37; 95% CI -25.96 to -10.77; P < .001). The readmission and reoperation rate were similar between the 2 groups. CONCLUSIONS There is a lack of prospective studies on the safety of outpatient CDR. However, current evidence shows outpatient CDR can be safely performed under careful patient selection. High-quality, large prospective studies are needed to demonstrate the generalizability of this study.
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Affiliation(s)
- Xiaofei Wang
- West China Hospital, Sichuan University, Chengdu, China,Xiaofei Wang and Yang Meng contributed equally to this work and should be considered co–first authors
| | - Yang Meng
- West China Hospital, Sichuan University, Chengdu, China,Xiaofei Wang and Yang Meng contributed equally to this work and should be considered co–first authors
| | - Hao Liu
- West China Hospital, Sichuan University, Chengdu, China,Hao Liu, Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China.
| | - Ying Hong
- West China Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Ying Hong, West China School of Nursing, Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, China.
| | - Beiyu Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- West China Hospital, Sichuan University, Chengdu, China
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Pingel A, Hoffmann CH, Scholz M, Kandziora F. Late Implant Failure in Cervical Disc Arthroplasty (M6-C, Spinal Kinetics) Causing Radiculopathy and Myelopathy. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:207-212. [PMID: 33296944 DOI: 10.1055/a-1286-5172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cervical disc arthroplasty (CDA) is an approved surgical treatment option in selected patients with cervical spinal disc degeneration. Even though CDA is a standard procedure since 20 years, there is a lack of information about long term performance. The published reoperation rates after CDA are low and comparable to anterior cervical fusion. The authors describe a severe failure and dysfunction with a partial core dislocation of a cervical prosthesis into the spinal canal (M6-C, Spinal Kinetics, Sunnyvale, CA, USA). Six years after implantation of a cTDR (cervical Total Disk Replacement) of the M6 type at C4/5 level, a 52 year-old women presented herself with new clinical signs of cervical myelopathy and radicular pain. Complete posterior dislocation of the central core of the implant into the spinal canal was identified as a cause. The failed device was removed completely and an ACCF (anterior cervical corpectomy and fusion) was performed. Intraoperatively, rupture of the posterior portion of the mesh tissue with posterior dislocation of the whole prosthesis core was detected. This is the second described case of a severe implant failure with core dislocation in this type of cTDR device. Even though there are thousands of successful implantations and middle term outcomes, it seems to be necessary to continue with long term radiological follow up to exclude similar failure in this type of prosthesis.
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Affiliation(s)
- Andreas Pingel
- Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany
| | | | - Matti Scholz
- Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany
| | - Frank Kandziora
- Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany
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Patient Risk Factors Associated With 30- and 90-Day Readmission After Cervical Discectomy: A Nationwide Readmission Database Study. Clin Spine Surg 2020; 33:E434-E441. [PMID: 32568863 DOI: 10.1097/bsd.0000000000001030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE The aim of this study was to assess the patient-level risk factors associated with 30- and 90-day unplanned readmissions following elective anterior cervical decompression and fusion (ACDF) or cervical disk arthroplasty (CDA). SUMMARY OF BACKGROUND DATA For cervical disk pathology, both ACDF and CDA are increasingly performed nationwide. However, relatively little is known about the adverse complications and rates of readmission for ACDF and CDA. METHODS A retrospective cohort study was performed using the Nationwide Readmission Database from the years 2013 to 2015. All patients undergoing either CDA or ACDF were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Unique patient linkage numbers were used to follow patients and to identify 30- and 31-90-day readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 days (30-R), and readmission within 31-90 days (90-R). RESULTS There were a total of 13,093 index admissions with 856 (6.5%) readmissions [30-R: n=532 (4.0%); 90-R: n=324 (2.5%)]. Both overall length of stay and total cost were greater in the 30-R cohort compared with 90-R and Non-R cohorts. The most prevalent 30- and 90-day complications seen among the readmitted cohorts were infection, genitourinary complication, and device complication. On multivariate regression analysis, age, Medicaid status, medium and large hospital bed size, deficiency anemia, and any complication during index admission were independently associated with increased 30-day readmission. Whereas age, large hospital bed size, coagulopathy, and any complication during the initial hospitalization were independently associated with increased 90-day readmission. CONCLUSION Our nationwide study identifies the 30- and 90-day readmission rates and several patient-related risk factors associated with unplanned readmission after common anterior cervical spine procedures. LEVEL OF EVIDENCE Level III.
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Wang X, Meng Y, Liu H, Hong Y, Wang B. Comparison of the safety of outpatient cervical disc replacement with inpatient cervical disc replacement: A protocol for a meta-analysis. Medicine (Baltimore) 2020; 99:e21609. [PMID: 32871877 PMCID: PMC7458200 DOI: 10.1097/md.0000000000021609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical disc replacement (CDR) has been widely used as an effective treatment for cervical degenerative disc diseases in recent years. However, the cost of this procedure is very high and may bring a great economic burden to patients and the health care system. It is reported that outpatient procedures can reduce nearly 30% of the costs associated with hospitalization compared with inpatient procedures. However, the safety profile surrounding outpatient CDR remains poorly resolved. This study aims to evaluate the current evidence on the safety of outpatient CDR METHODS:: Four English databases were searched. The inclusion and exclusion criteria were developed according to the PICOS principle. The titles and abstracts of the records will be screened by 2 authors independently. Records that meet the eligibility criteria will be screened for a second time by reading the full text. An extraction form will be established for data extraction. Risk of bias assessment will be performed by 2 authors independently using Cochrane risk of bias tool or Newcastle-Ottawa scale. Data synthesis will be conducted using Stata software. Heterogeneity among studies will be assessed using I test. The funnel plot, Egger regression test, and Begg rank correlation test will be used to examine the publication bias. RESULTS The results of this meta-analysis will be published in a peer-review journal. CONCLUSION This will be the first meta-analysis that compares the safety of outpatient CDR with inpatient CDR. Our study will help surgeons fully understand the complications and safety profile surrounding outpatient CDR. OSF REGISTRATION NUMBER:: doi.org/10.17605/OSF.IO/3597Z.
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Affiliation(s)
- Xiaofei Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Sichuan, China
- West China School of Nursing, Sichuan University, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Sichuan, China
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Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature. World Neurosurg 2020; 140:534-540. [PMID: 32353543 DOI: 10.1016/j.wneu.2020.04.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Recently, there has been significant interest in understanding the cost-effectiveness of treatments in spine surgery as health care systems in the United States move toward value-based care and alternative payment models. Previous studies have shown comparable outcomes of cervical disc arthroplasty (CDA) and anterior cervical discectomy fusion; however, there is a lack of consensus on the cost-effectiveness of CDA to support full adoption. Evidence of the limitations of these cost-analysis studies also exists in the literature, including industry funding, potential selection bias, and varying methods of calculating value. The goal of this narrative review is to provide an overview of the cost-effectiveness of CDA compared with anterior cervical discectomy and fusion, and potential limitations with cost-analysis studies in spine surgery.
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