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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