Significance of Hospital Size in Outcomes of Single-Level Elective Anterior Cervical Discectomy and Fusion: A Nationwide Readmissions Database Analysis

Shah, Kush C.; Dominy, Calista; Tang, Justin E.; Geng, Eric; Arvind, Varun; Pasik, Sara; Yeshoua, Brandon; Kim, Jun; Cho, Samuel K.

doi:10.1016/j.wneu.2021.08.122

Cited by 3 publications

(4 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The anterior approach was proposed by Smith and Robinson in 1958 (19) and was acknowledged by spinal surgeons. The anterior approach can remove the compression by excising the herniated disc, the osteophyte behind the vertebrae, and the posterior longitudinal ligament, especially in single-level cervical spondylosis (20). To date, the consensus on the best approach to treat MCSM has not been achieved due to the complex pathogenesis and compression from the front and rear of the cervical vertebrae.…”

Section: Discussionmentioning

confidence: 99%

Treatment of three-level cervical spondylotic myelopathy using ACDF or a combination of ACDF and ACCF

Tian

Zhao²,

Han³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

ObjectivesThis study aims to compare the outcomes between two anterior decompression and fusion techniques to treat multilevel cervical spondylotic myelopathy (MCSM).MethodsAfter the screening for eligibility, a total of 66 patients were admitted to this study. These participants underwent anterior surgeries due to MCSM in our hospital between June 2016 and July 2018. All participants underwent either the anterior cervical discectomy and fusion (ACDF) surgery (ACDF group) or the combination of ACDF and anterior cervical corpectomy and fusion (ACCF), which was the anterior cervical hybrid decompression and fusion (ACHDF) surgery group. All the patients were followed up ≥18 months, the average latest followed up time was 23.64 (±2.69) months. The length of hospitalization, operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, improvement rate, Hounsfield units (HU) of C3–C7, cobb angle, and anterior column height of fusion levels pre and post operation were analyzed.ResultsThere were no statistical differences between the ACDF and ACHDF groups regarding the length of hospitalization, operation time, blood loss, HU of C3–C7, VAS, JOA score, improvement rate, cobb angle, and anterior column height in fusion levels in pre-operation and 3 months after operation (all P > 0.05). However, compared with the ACHDF group, the ACDF group achieved significantly better improvement in the anterior column height of fusion levels in the final 18–29 months post-operatively (P < 0.05).ConclusionsBoth approaches of ACDF alone and a combination of ACDF and ACCF can achieve satisfactory outcomes in the treatment of MCSM, but ACDF has better outcomes in maintaining anterior column height of fusion levels.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of three-level cervical spondylotic myelopathy using ACDF or a combination of ACDF and ACCF

Tian

Zhao²,

Han³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

show abstract

“…One explanation for our results is that larger tertiary care centers, which have been shown to care for more surgically complex patients and to charge more for spine surgeries, 34-36 may drive an association between poor “discharge to home” and higher mean gross charges. Alternatively, length of stay, which was also unaccounted for in our data set, has also been associated with both total inpatient charges for anterior cervical surgery 34,37 as well as discharge status 28,38 and may have been another potential confounder or effect modifier. In conclusion, the “discharge to home” category is liable to be influenced by several factors, so our interpretation of these results is limited.…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, we noted that large tertiary care centers, which typically treat medically complex patients, often earned low scores in the “discharge to home” metric. One explanation for our results is that larger tertiary care centers, which have been shown to care for more surgically complex patients and to charge more for spine surgeries, 34-36 may drive an association between poor “discharge to home” and higher mean gross charges. Alternatively, length of stay, which was also unaccounted for in our data set, has also been associated with both total inpatient charges for anterior cervical surgery 34,37 as well as discharge status 28,38 and may have been another potential confounder or effect modifier.…”

Section: Discussionmentioning

confidence: 91%

Price Transparency for Cervical Spinal Fusion Among High-Performing Spine Centers in the United States

Yoon,

Ng,

Hoffman

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: As of January 1, 2021, all US hospitals are required by the Hospital Price Transparency Final Rule (HPTFR) to publish standard charges for all items and services, yet the state of price transparency for cervical spinal fusion is unknown. Here, we assess the nationwide price transparency landscape for cervical spinal fusion among high-performing spine centers in the United States. METHODS: In this cross-sectional economic evaluation, we queried publicly available price transparency websites of 332 “high-performing” spine centers, as defined by the US News and World Report. We extracted variables including gross charges for cervical spinal fusion, payor options, price reporting methodology, and prices relevant to consumers including listed cash prices and minimum and maximum negotiated charges. RESULTS: While nearly all 332 high-performing spine surgery centers (99.4%) had an online cost estimation tool, the HPTFR compliance rate was only 8.4%. Gross charges for cervical spinal fusion were accessible for 68.1% of hospitals, discounted cash prices for 46.4% of hospitals, and minimum and maximum charges for 10.8% of hospitals. There were large IQRs for gross charges ($48 491.98-$99 293.37), discounted cash prices ($26 952.25-$66 806.63), minimum charges ($10 766.11-$21 248.36), and maximum charges ($39 280.49-$89 035.35). There was geographic variability in the gross charges of cervical spinal fusion among high-performing spine centers within and between states. There was a significant association between “excellent” discharge to home status and lower mean gross charges. CONCLUSION: Although online cost reporting has drastically increased since implementation of the HPTFR, data reported for cervical spinal fusion remain inadequate and difficult to interpret by both providers and patients.

show abstract

“… 26 Furthermore, patients who are readmitted after ACDF are more likely to have CAD. 20 28 Kamalapathy, et al 29 and Shah, et al 30 reported that patients with anxiety and depression have a higher risk of readmission after ACDF.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

Purpose With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs. Materials and Methods We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, “readmission” and “ACDF.” A total of 10 studies were included. Results Among the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30–5.56; p <0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10–1.36; p <0.001], and private insurance (OR, 0.34; 95% CI, 0.17–0.69; p <0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41–3.25; p <0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20–2.11; p =0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13–3.86; p <0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68–2.72; p <0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29–1.51; p <0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21–70.41; p <0.001) was significantly associated with unplanned readmission. Conclusion Male, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.

show abstract

Significance of Hospital Size in Outcomes of Single-Level Elective Anterior Cervical Discectomy and Fusion: A Nationwide Readmissions Database Analysis

Cited by 3 publications

References 40 publications

Treatment of three-level cervical spondylotic myelopathy using ACDF or a combination of ACDF and ACCF

Treatment of three-level cervical spondylotic myelopathy using ACDF or a combination of ACDF and ACCF

Price Transparency for Cervical Spinal Fusion Among High-Performing Spine Centers in the United States

Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About