A Regional Cost and Outcomes Analysis of Outpatient Single-Level Anterior Cervical Discectomy and Fusion in the United States: 2016-2022.

STUDY

DESIGN

Retrospective health care claims database study.

OBJECTIVE

To assess variations in costs and outcomes for single ACDFs in the outpatient setting across census bureau divisions.

BACKGROUND

The proportion of ACDFs performed in the outpatient setting is growing rapidly in the United States. However, there is a paucity of literature that describes the costs and outcomes of these procedures on a national scale.

MATERIALS AND

METHODS

Patients who underwent single-level ACDF in an outpatient setting between January 2016 and June 2022 were queried from the Premier Healthcare database. Demographic, outcomes, and cost information was collected for each patient and census division averages of these measures were regionally and across time. Multivariate analysis with adjustments for demographics, patient comorbidities, and time-fixed effects was conducted to isolate regional differences in costs and outcomes.

RESULTS

A total of 56,736 patients were included (54.2 ± 11.9 yr, 51.2% females). Patient costs over time increased significantly in the Pacific division while decreasing in the Mountain division. Univariate analysis showed large differences in price, readmission rate, and reoperation rate outcomes between regions. In multivariate analysis, differences between regions persisted for costs but not for outcomes. When considering both costs and outcomes, there is no apparent relationship between the two factors by region.

CONCLUSION

Even after adjustments for patient comorbidities, demographics, and payor type, differences in regional costs persisted for single-level ACDF procedures over the study period. These results align with the previous literature while adding further dimensions of regional changes across time.

LEVEL OF EVIDENCE: Level III.