What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty
Introduction: Compared to anterior cervical discectomy and fusion (ACDF), the motion preservation of cervical disc arthroplasty (CDA) provides an attractive alternative with similar short-term results. However, there is a paucity of the economics of performing CDA over ACDF. Study Design: This was r...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=331;epage=338;aulast=Katz |
| _version_ | 1797995565011697664 |
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| author | Austen David Katz Junho Song Daniel Bowles Terence Ng Eric Neufeld Sayyida Hasan Dean Perfetti Nipun Sodhi David Essig Jeff Silber Sohrab Virk |
| author_facet | Austen David Katz Junho Song Daniel Bowles Terence Ng Eric Neufeld Sayyida Hasan Dean Perfetti Nipun Sodhi David Essig Jeff Silber Sohrab Virk |
| author_sort | Austen David Katz |
| collection | DOAJ |
| description | Introduction: Compared to anterior cervical discectomy and fusion (ACDF), the motion preservation of cervical disc arthroplasty (CDA) provides an attractive alternative with similar short-term results. However, there is a paucity of the economics of performing CDA over ACDF.
Study Design: This was retrospective study.
Objective: The objective of this study is to evaluate relative-value-units (RVUs), operative time, and RVUs-per-minute between single-level ACDF and CDA. Secondary outcomes included 30-day readmission, reoperation, and morbidity.
Methods: Adults who underwent ACDF or CDA in 2011–2019 National Surgical Quality Improvement Program database datasets. Multivariate quantile regression was utilized.
Results: There were 26,595 patients (2024 CDA). ACDF patients were older, more likely to be female, discharged to inpatient rehabilitation, and have a history of obesity, smoking, diabetes, steroid use, and the American Society of Anesthesiologists-class ≥≥3. ACDF had greater median RVUs-per-case (41.2 vs. 24.1) and RVUs-per-minute (0.36 vs. 0.27), despite greater operative-time (109 min vs. 92 min) (P < 0.001). ACDF predicted a 16.9 unit increase in median RVUs per case (P < 0.001, confidence interval [CI]95: 16.3–17.5), an 8.81 min increase in median operative time per case (P < 0.001, CI95: 5.69–11.9), and 0.119 unit increase in median RVUs-per-minute (P < 0.001, CI95: 0.108–0.130). ACDF was associated with greater unadjusted rates of readmission (3.2% vs. 1.4%) morbidity (2.3% vs. 1.1%) (P < 0.001), but similar rates of reoperation (1.3% vs. 0.8%, P = 0.080). After adjusting for significant patient-related and procedural factors, readmission (odds ratio [OR] = 0.695, P = 0.130, CI95: 0.434–1.113) and morbidity (OR = 1.102, P = 0.688, CI95: 0.685–1.773) was similar between ACDF and CDA.
Conclusions: Median RVUs-per-minute increased by 0.119 points for ACDF over CDA, or $257.7/h for each additional-hour of surgery. Adjusted 30-day outcomes were similar between procedures. Reimbursement for CDA does not appear to be in line with ACDF and may be a barrier to widespread usage. |
| first_indexed | 2024-04-11T10:02:32Z |
| format | Article |
| id | doaj.art-1daa35d7323b4da3b8045047afc273bf |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-04-11T10:02:32Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-1daa35d7323b4da3b8045047afc273bf2022-12-22T04:30:19ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372022-01-0113333133810.4103/jcvjs.jcvjs_69_22What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplastyAusten David KatzJunho SongDaniel BowlesTerence NgEric NeufeldSayyida HasanDean PerfettiNipun SodhiDavid EssigJeff SilberSohrab VirkIntroduction: Compared to anterior cervical discectomy and fusion (ACDF), the motion preservation of cervical disc arthroplasty (CDA) provides an attractive alternative with similar short-term results. However, there is a paucity of the economics of performing CDA over ACDF. Study Design: This was retrospective study. Objective: The objective of this study is to evaluate relative-value-units (RVUs), operative time, and RVUs-per-minute between single-level ACDF and CDA. Secondary outcomes included 30-day readmission, reoperation, and morbidity. Methods: Adults who underwent ACDF or CDA in 2011–2019 National Surgical Quality Improvement Program database datasets. Multivariate quantile regression was utilized. Results: There were 26,595 patients (2024 CDA). ACDF patients were older, more likely to be female, discharged to inpatient rehabilitation, and have a history of obesity, smoking, diabetes, steroid use, and the American Society of Anesthesiologists-class ≥≥3. ACDF had greater median RVUs-per-case (41.2 vs. 24.1) and RVUs-per-minute (0.36 vs. 0.27), despite greater operative-time (109 min vs. 92 min) (P < 0.001). ACDF predicted a 16.9 unit increase in median RVUs per case (P < 0.001, confidence interval [CI]95: 16.3–17.5), an 8.81 min increase in median operative time per case (P < 0.001, CI95: 5.69–11.9), and 0.119 unit increase in median RVUs-per-minute (P < 0.001, CI95: 0.108–0.130). ACDF was associated with greater unadjusted rates of readmission (3.2% vs. 1.4%) morbidity (2.3% vs. 1.1%) (P < 0.001), but similar rates of reoperation (1.3% vs. 0.8%, P = 0.080). After adjusting for significant patient-related and procedural factors, readmission (odds ratio [OR] = 0.695, P = 0.130, CI95: 0.434–1.113) and morbidity (OR = 1.102, P = 0.688, CI95: 0.685–1.773) was similar between ACDF and CDA. Conclusions: Median RVUs-per-minute increased by 0.119 points for ACDF over CDA, or $257.7/h for each additional-hour of surgery. Adjusted 30-day outcomes were similar between procedures. Reimbursement for CDA does not appear to be in line with ACDF and may be a barrier to widespread usage.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=331;epage=338;aulast=Katzanteriorarthroplastycervicalcomparativefusionmorbiditynational surgical quality improvement program databaserelative-value-units |
| spellingShingle | Austen David Katz Junho Song Daniel Bowles Terence Ng Eric Neufeld Sayyida Hasan Dean Perfetti Nipun Sodhi David Essig Jeff Silber Sohrab Virk What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty Journal of Craniovertebral Junction and Spine anterior arthroplasty cervical comparative fusion morbidity national surgical quality improvement program database relative-value-units |
| title | What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty |
| title_full | What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty |
| title_fullStr | What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty |
| title_full_unstemmed | What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty |
| title_short | What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty |
| title_sort | what is a better value for your time anterior cervical discectomy and fusion versus cervical disc arthroplasty |
| topic | anterior arthroplasty cervical comparative fusion morbidity national surgical quality improvement program database relative-value-units |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=331;epage=338;aulast=Katz |
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