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Propensity-matched Comparison of Outcomes and Costs After Macroscopic and Microscopic Anterior Cervical Corpectomy Using a National Longitudinal Database

Ho, Allen Lin MD; Rezaii, Paymon Garakani MS; Pendharkar, Arjun Vivek MD; Sussman, Eric Scott MD; Veeravagu, Anand MD; Ratliff, John Kevin MD; Desai, Atman Mukesh MD

doi: 10.1097/BRS.0000000000003147
HEALTH SERVICES RESEARCH
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Study Design. A retrospective analysis of national longitudinal database.

Objective. The aim of this study was to examine the outcomes and cost-effectiveness of operating microscope utilization in anterior cervical corpectomy (ACC).

Summary of Background Data. The operating microscope allows for superior visualization and facilitates ACC with less manipulation of tissue and improved decompression of neural elements. However, many groups report no difference in outcomes with increased cost associated with microscope utilization.

Methods. A longitudinal database (MarketScan) was utilized to identify patients undergoing ACC with or without microscope between 2007 and 2016. Propensity matching was performed to normalize differences between the two cohorts. Outcomes and costs were subsequently compared.

Results. A total of 11,590 patients were identified for the “macroscopic” group, while 4299 patients were identified for the “microscopic” group. For the propensity-matched analysis, 4298 patients in either cohort were successfully matched according to preoperative characteristics. Hospital length of stay was found to be significantly longer in the macroscopic group than the microscopic group (1.86 nights vs. 1.56 nights, P < 0.0001). Macroscopic ACC patients had an overall higher rate of readmissions [30-day: 4.2% vs. 3.2%, odds ratio (OR) = 0.76 (0.61–0.96), P = 0.0223; 90-day: 7.0% vs. 5.9%, OR = 0.82 (0.69–0.98), P = 0.0223]. Microscopic ACC patients had a higher rate of discharge to home [86.6% vs. 92.5%, OR = 1.91 (1.65–2.21), P < 0.0001] and lower rates of new referrals to pain management [1.0% vs. 0.4%, OR = 0.42 (0.23–0.74), P = 0.0018] compared with macroscopic ACC. Postoperative complication rate was not found to be significantly different between the groups. Finally, total initial admission charges were not significantly different between the macroscopic and microscopic groups ($30,175 vs. $29,827, P = 0.9880).

Conclusion. The present study suggests that the use of the operating microscope for ACC is associated with decreased length of stay, readmissions, and new referrals to pain management, as well as higher rate of discharge to home.

Level of Evidence: 3

There has been debate about use of the operating microscope in anterior cervical corpectomy. Our propensity-matched analysis of a national database (MarketScan) revealed that patients undergoing anterior cervical corpectomy without an operating microscope had longer hospital length of stays, higher rates of readmissions, and no difference in cost.

Department of Neurosurgery, Stanford University, Stanford, CA.

Address correspondence and reprint requests to Atman Mukesh Desai, MD, Clinical Associate Professor of Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg./R-227, Stanford, CA 94305; E-mail: atman@stanford.edu

Received 11 February, 2019

Revised 17 April, 2019

Accepted 16 May, 2019

Both Allen Lin Ho and Paymon Garakani Rezaii contributed equally to this manuscript.

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.