Spine. 35(15):1454-1459, JUL 2010
DOI: 10.1097/BRS.0b013e3181bef3cb
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PMID: 20216341
Issn Print: 0362-2436
Publication Date: 2010/07/01
National Trends in Anterior Cervical Fusion Procedures
Satyajit Marawar;Federico P. Girardi;Andrew A. Sama;Yan Ma;Licia K. Gaber-Baylis;Melanie C. Besculides;Stavros G. Memtsoudis;
+ Author Information
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.
Abstract
Population-based database analysis.To analyze trends in patient- and healthcare-system-related characteristics, utilization and outcomes associated with anterior cervical spine fusions.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.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.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.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.
