Trends in cervical disc arthroplasty and revisions in the Medicare database

Niedzielak, Timothy; Ameri, Bijan; Emerson, Blaze; Vakharia, Rushabh M.; Malloy, John P.

doi:10.21037/jss.2018.09.04

Cited by 25 publications

(24 citation statements)

References 22 publications

(21 reference statements)

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“…42 In the United States, CDA has experienced a high rate of annual growth in its use both as a primary therapy (20.54%) and revision therapies (5.84%), attributed to better PROs compared with ACDF. 43 CDA as a good alternative to ACDF is further supported by the results of this current study. To our knowledge, this is the largest reported cohort to date of 3-and 4-level CDA patients reporting longterm clinical outcomes.…”

Section: Discussionsupporting

confidence: 83%

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

et al. 2020

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Background: Multilevel cervical degenerative disc disease in 2 or more segments poses treatment challenges. Anterior cervical discectomy and fusion is a viable treatment option, but one with high rates of adjacent segment disease and pseudoarthrosis. Cervical disc arthroplasty (CDA) is approved by the US Food and Drug Administration for the treatment of 1-and 2-level cervical pathology, with established long-term safety and effectiveness. Limited evidence exists for CDA at more than 2 levels. This study investigates the long-term outcomes of 3-and 4-level CDA out to 7 years. Methods: In a retrospective review of prospectively collected data, patient demographics and surgical characteristics were collected. Patient-reported outcomes (PROs) were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively, and annually thereafter, including: Neck Disability Index (NDI), numeric rating scales for neck pain and arm pain, the Veterans Rand 12-item Health Survey physical component summary (PCS) score and mental component summary (MCS) score, and patient satisfaction scores. Secondary surgery data were also collected. Predictive methods using mixed-effects regression models were used to analyze the data. Results: Data for 139 CDAs were available for evaluation (n ¼ 116 three-level and n ¼ 23 four-level). Statistical improvement was shown for all PRO scores at all postoperative intervals (P , .001). From preoperatively to 7 years postoperatively, mean NDI decreased from 57.9 to 31.3 (45.9% improvement), mean neck pain decreased from 15.6 to 7.9 (49.4% improvement), mean arm pain decreased from 12.2 to 5.6 (54.1% improvement), mean PCS increased from 29.2 to 41.4 (41.8% improvement), and mean MCS increased from 37.1 to 44.5 (19.9% improvement). Five (3.6%) 3level patients underwent secondary surgery. Patient satisfaction exceeded 88% 7 years after surgery. Conclusion: Statistical improvement in PROs, with a low rate of secondary surgeries out to 7 years, demonstrates that 3-and 4-level CDA may be performed safely and effectively in appropriately selected patients. Level of Evidence: 4.

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Section: Discussionsupporting

confidence: 83%

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

et al. 2020

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“…The commercially available database has been used extensively for orthopedic-related research. [12][13][14] The database contains over 100 million patients from the Humana insurance and Medicare insurance claims database and provides information such as diagnoses, procedures, complications, discharge dispositions, in addition to other metrics. Since the database contains deidentified information, our study was exempt from the institution's Institutional Review Board approvals.…”

Section: Materials and Methods Databasementioning

confidence: 99%

Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients

et al. 2020

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Introduction The purpose of this study was to investigate whether patients with depressive disorders undergoing primary total shoulder arthroplasty have higher rates of (1) in-hospital lengths of stay, (2) readmission rates, (3) medical complications, and (4) implant-related complications. Methods A retrospective query was performed using a national claims database. Study group patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 113,648 patients who were with (n = 18,953) and without (n = 94,695) depressive disorders. Pearson’s χ 2 analyses were used to compare patient demographics. Logistic regression analyses were used to calculate odds-ratios of complications and readmission rates. Welch’s t-tests were used to test for significance for in-hospital lengths of stay. A p-value less than 0.003 was considered statistically significant. Results Study group patients had significantly longer in-hospital lengths of stay (2.7 days versus 2.3 days; p < 0.0001). Patients who have depressive disorders had higher incidences and odds of readmissions (9.4 versus 6.15%; odds-ratio: 1.6, p < 0.0001), medical complications (2.7 versus 0.9%; odds-ratio: 3.0, p < 0.0001), and implant-related complications (6.1 versus 2.4%; odds-ratio: 2.59, p < 0.0001) compared to controls. Conclusion Depressive disorder patients have longer in-hospital lengths of stay and increased odds of readmissions and complications following primary total shoulder arthroplasty.

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“…[68][69][70] Nevertheless, recent studies have demonstrated an increased rate of CDA use for similar pathologies. [71][72][73][74][75][76] In a retrospective review of a nationwide inpatient sample, Nesterenko et al observed an estimated 700% increase in CDA cases performed from 2005 to 2008 (344 to 2434). 76 increase was after 2013, likely secondary to more devices being approved after this date.…”

Section: Overall Trends and Costs Of Acdf And Cdamentioning

confidence: 99%

Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature

et al. 2020

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Trends in cervical disc arthroplasty and revisions in the Medicare database

Cited by 25 publications

References 22 publications

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients

Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature

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