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National Trends in Anterior Cervical Fusion Procedures

Marawar, Satyajit MD*; Girardi, Federico P. MD*; Sama, Andrew A. MD*; Ma, Yan PhD; Gaber-Baylis, Licia K. BA; Besculides, Melanie C. DrPH, MPH§; Memtsoudis, Stavros G. MD, PhD, FCCP

doi: 10.1097/BRS.0b013e3181bef3cb
Cervical Spine

Study Design. Population-based database analysis.

Objective. To analyze trends in patient- and healthcare-system-related characteristics, utilization and outcomes associated with anterior cervical spine fusions.

Summary of Background Data. Anterior cervical decompression and spine fusion (ACDF) is one of the most commonly performed surgical procedures of the spine. However, few data analyzing trends in patient- and healthcare-system-related characteristics, utilization and outcomes exist.

Methods. Data from 1990 to 2004 collected in the National Hospital Discharge Survey were accessed. ACDF procedures were identified. Five-year periods of interest (POI) were created for temporal analysis and changes in the prevalence and utilization of this procedure as well as in patient- and healthcare-system-related variables were examined. The changes in the occurrence of procedure-related complications were evaluated.

Results. An estimated total of 771,932 discharges after ACDF were identified. Temporally, an almost 8-fold increase in total prevalence was accompanied by a similar increase in utilization (23/100.000 civilians/POI to 157/100.000/civilians/POI). The highest increase in utilization was observed in those ≥65 years (28-fold). Average age increased from 47.2 years to 50.5 years over time. Length of hospital stay decreased from 5.17 days to 2.38 days. Overall procedure-related complication rates decreased from 4.6% to 3.03%. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, pulmonary, and coronary artery increased over time among patients undergoing ACDF.

Conclusion. Despite limitations inherent to secondary analysis of large databases, we identified a number of significant changes in the utilization, demographics, and outcomes associated with ACDF, which can be used to assess the effect of changes in medical care, direct health care resources, and future research. The effect of the increased prevalence of comorbidities on medical practice remains to be evaluated. Further studies are necessary to evaluate causal relationships.

We analyzed the trends in utilization and outcomes of anterior cervical discectomy and fusion in the population. An 8-fold increase in the prevalence of anterior cervical discectomy and fusion over 15 years was seen. The utilization rate increased from 23/100.000 civilians/periods of interest to 157/100.000/civilians/periods of interest. The prevalence of comorbidities increased, but the postoperative complication rate reduced from 4.06% to 3.03%.

From the *Department of Orthopedic Surgery, Division of Spine Surgery, and †Department of Public Health, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY; ‡LKG Consulting, Plainsboro, NJ; §Mathematical Policy Research Inc., Princeton, NJ; and ¶Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY.

Acknowledgment date: April 24, 2009. Revision date: August 29, 2009. Acceptance date: August 31, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Department of Anesthesiology at Hospital for Special Surgery, NYC (Institution) funded research on which the article is based. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by the Hospital for Special Surgery Anesthesiology Young Investigator Award provided by the Department of Anesthesiology at the Hospital for Special Surgery (to S.G.M.) and Center for Education and Research in Therapeutics (CERTs) (AHRQ RFA-HS-05–14) and Clinical Translational Science Center (CTSC) (NIH UL1-RR024996) (to Y.M.).

Address correspondence and reprint requests to Stavros G. Memtsoudis, MD, PhD, Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021l; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.