What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty

Katz, Alvin; Song, Junho; Bowles, Daniel W.; Ng, TP; Neufeld, Eric V.; Hasan, Sayyida; Perfetti, Dean C.; Sodhi, Nipun; Essig, David A.; Silber, Jeff S.; Virk, Sohrab

doi:10.4103/jcvjs.jcvjs_69_22

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Possible barriers to the greater adoption of CDA include very strict inclusion/exclusion criteria limiting caseload, 35 minimal training opportunities, 35 low public awareness, 36 and less competitive reimbursement. 37 Furthermore, surgeons may be waiting for longer-term follow-up opportunities among their own patients (i.e., > 5 years) before the widespread adoption of CDA into their practice. The current study does have limitations.…”

Section: Discussionmentioning

confidence: 99%

“…The equivalent long-term outcomes of patients after ACDF and CDA suggest that the recent plateau in the use of CDA may not be related to postoperative recovery, but rather other factors influencing surgeons’ choice of treatment. Possible barriers to the greater adoption of CDA include very strict inclusion/exclusion criteria limiting caseload, 35 minimal training opportunities, 35 low public awareness, 36 and less competitive reimbursement 37 . Furthermore, surgeons may be waiting for longer-term follow-up opportunities among their own patients ( i.e., >5 years) before the widespread adoption of CDA into their practice.…”

Section: Discussionmentioning

confidence: 99%

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Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021

Ratnasamy¹,

Rudisill²,

Maloy³

et al. 2022

Spine

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021

Ratnasamy¹,

Rudisill²,

Maloy³

et al. 2022

Spine

View full text Add to dashboard Cite

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“…An important limitation of this study is the lack of granularity in data inherent to the utilization of a national surgical database, with an inability of the dataset to capture individual surgeon experience. [ 24 25 26 ] It is possible that newer, less experienced surgeons, are more frequently utilizing navigated technologies, which could skew outcomes more favorably toward conventional surgery. Other surgeon- and patient-related factors may influence operative time, blood loss, and infection with and without the use of navigation.…”

Section: Discussionmentioning

confidence: 99%

Navigated versus conventional pediatric spinal deformity surgery: Navigation independently predicts reoperation and infectious complications

Katz

Song

Hasan

et al. 2023

J Craniovert Jun Spine

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Context: Literature on treating pediatric spinal deformity with navigation is limited, particularly using large nationally represented cohorts. Further, the comparison of single-institution data to national-level database outcomes is also lacking. Aim: (1) To compare navigated versus conventional posterior pediatric deformity surgery based on 30-day outcomes and perioperative factors using the National Surgical Quality Improvement Program (NSQIP) database and (2) to compare the outcomes of the NSQIP navigated group to those of fluoroscopy-only and navigated cases from a single-institution. Settings and Design: Retrospective cohort study. Subjects and Methods: Pediatric patients who underwent posterior deformity surgery with and without navigation were included. Primary outcomes were 30-day readmission, reoperation, morbidity, and complications. The second part of this study included AIS patients < 18 years old at a single institution between 2015 and 2019. Operative time, length of stay, transfusion rate, and complication rate were compared between single-institution and NSQIP groups. Statistical Analysis Used: Univariate analyses with independent t -test and Chi-square or Fisher's exact test was used. Multivariate analyses through the application of binary logistic regression models. Results: Part I of the study included 16,950 patients, with navigation utilized in 356 patients (2.1%). In multivariate analysis, navigation predicted reoperation, deep wound infection, and sepsis. After controlling for operative year, navigation no longer predicted reoperation. In Part II of the study, 288 single institution AIS patients were matched to 326 navigation patients from the NSQIP database. Operative time and transfusion rate were significantly higher for the NSQIP group. Conclusions: On a national scale, navigation predicted increased odds of reoperation and infectious-related events and yielded greater median relative value units (RVUs) per case but had longer operating room (OR) time and fewer RVUs-per-minute. After controlling for operative year, RVUs-per-minute and reoperation rates were similar between groups. The NSQIP navigated surgery group was associated with significantly higher operative time and transfusion rates compared to the single-institution groups.

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“…RVU is the basis for the Medicare reimbursement formula and is used to determine physician payments nationally. RVUs consider the physician’s work, the expenses of the physician’s practice, and professional liability insurance ( 12 , 13 ).…”

Section: Methodsmentioning

confidence: 99%

Lumbar fusion during the COVID-19 pandemic: greater rates of morbidity and longer procedures

Song¹,

Katz²,

Qureshi³

et al. 2023

J Spine Surg

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Background The coronavirus disease 2019 (COVID-19) pandemic has altered the standard of care for spine surgery in many ways. However, there is a lack of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic. In particular, no large database study evaluating the impact of the COVID-19 pandemic on spine surgery outcomes has yet been published. Therefore, the aim of this study was to evaluate the impact of the COVID-19 pandemic on perioperative factors and postoperative outcomes of lumbar fusion procedures. Methods This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which was queried for all adult patients who underwent primary lumbar fusion in 2019 and 2020. Patients were grouped into cohorts based on 2019 (pre-pandemic) or 2020 (intra-pandemic) operation year. Differences in 30-day readmission, reoperation, and morbidity rates were evaluated using multivariate logistic regression. Differences in total relative value units (RVUs), RVUs per minute, and total operation time were evaluated using quantile (median) regression. Odds ratios (OR) for length of stay were estimated via negative binomial regression. Results A total of 27,446 patients were included in the analysis (12,473 cases in 2020). Unadjusted comparisons of outcomes revealed that lumbar fusions performed in 2020 were associated with higher rates of morbidity, pneumonia, bleeding transfusions, deep venous thrombosis (DVT), and sepsis. 2020 operation year was also associated with longer length of hospital stay, less frequent non-home discharge, higher total RVUs, and higher RVUs per minute. After adjusting for baseline differences in regression analyses, the differences in bleeding transfusions, length of stay, and RVUs per minute were no longer statistically significant. However, operation year 2020 independently predicted morbidity, pneumonia, DVT, and sepsis. In terms of perioperative variables, operation year 2020 predicted greater operative time, non-home discharge, and total RVUs. Conclusions Lumbar fusion procedures performed amidst the COVID-19 pandemic were associated with poorer outcomes, including higher rates of morbidity, pneumonia, DVT, and sepsis. In addition, surgeries performed in 2020 were associated with longer operative times and less frequent non-home discharge disposition.

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What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty

Cited by 5 publications

References 32 publications

Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021

Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021

Navigated versus conventional pediatric spinal deformity surgery: Navigation independently predicts reoperation and infectious complications

Lumbar fusion during the COVID-19 pandemic: greater rates of morbidity and longer procedures

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