Short-Term Differences in Hospital Resource Utilization and Quality of Care Between Anterior Cervical Discectomy and Fusion and Posterior Cervical Foraminotomy: A National Propensity-Scored Observational Study Utilizing the ACS-NSQIP Database.

Background/

Objective

Anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) are common treatments for cervical radiculopathy. This study compared post-operative outcomes between ACDF and PCF utilizing the American College of Surgeons-National Surgical Quality Improvement Program database.

Methods

An observational study following STROBE and TRIPOD + AI guidelines compared hospital resource utilization and quality of care between single-level ACDF and PCF (2005-2022). Primary outcomes compared operative time, length of stay (LOS), and post-operative complications. Propensity-scored stabilized inverse probability of treatment weighting adjusted for confounders, specifically demographics, lifestyle-related factors, pre-operative labs, pre-existing comorbidities, and surgery-related factors. Subgroup analysis compared baseline characteristics and outcomes, stratified by 30-day re-admission and re-operation.

Results

PCF group demonstrated shorter LOS (MD -0.7 days, 95% CI -0.9 to -0.5 days, p < 0.001), operative time (MD -32.9 min, 95% CI -35.7 to -30.1 min, p < 0.001), higher rate of re-admission associated with overall SSI (PD 1.2%, 95% CI 0.7-1.7%, p < 0.001), deep incisional SSI (PD 0.8%, 95% CI 0.4-1.2%, p < 0.001), and organ/space SSI (PD 0.3%, 95% CI 0.0-0.5%, p = 0.011). Furthermore, the PCF group had greater systemic sepsis (PD 0.8%, 95% CI 0.4-1.3%, p < 0.001), overall post-operative SSI (PD 2.8%, 95% CI 2.0-3.6%, p < 0.001), superficial SSI (PD 1.9%, 95% CI 1.2-2.5%, p < 0.001), and deep incisional SSI (PD 0.8%, 95% CI 0.4-1.2%, p < 0.001) rates. Subgroup analysis showed increased early post-operative re-operation rates in the PCF cohort (PD 23.4%, 95% CI 9.5-37.4%, p = 0.001) and increased early post-operative re-admission associated with post-operative overall SSI (PD 35.3%, 95% CI 22.7-48.0%, p < 0.001).

Conclusions

Although the PCF cohort demonstrated lower hospital utilization, it had reduced quality of care and increased post-operative complications.