STUDY DESIGN: Retrospective database analysis. OBJECTIVE: To compare the perioperative patient characteristics, early postoperative outcomes, and costs between anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (TDR) in the United States. SUMMARY OF BACKGROUND DATA: Cervical TDR and ACDF are indicated to treat symptomatic cervical degenerative pathology. The epidemiology, complication rates, and the cost differences between the 2 surgical approaches are not well characterized. METHODS: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002 to 2009. Patients undergoing cervical TDR or ACDF of 1 to 2 levels were identified. Patient demographics, comorbidities, length of stay, costs, and the in-hospital complications were assessed. SPSS (version 20) was used for statistical analysis with χ test for categorical data and independent-samples t test for continuous data. A value of P ≤ 0.001 denoted statistical significance. Multinomial regression analysis was used to identify the independent risk for complications in the TDR cohort compared with the ACDF cohort. RESULTS: There were 141,230 ACDF cases of 1 to 2 levels and 1830 cervical TDR cases identified in the Nationwide Inpatient Sample database. The ACDF cohort was older and demonstrated a greater comorbidity burden than the TDR group (P < 0.001). The ACDF-treated patients demonstrated a significantly greater length of stay than the TDR group (P < 0.001). In contrast, there were no significant differences in the incidence of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques. CONCLUSION: The ACDF cohort was significantly older and demonstrated a greater comorbidity burden that likely contributed to the greater length of stay when than the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications and costs. There were no significant differences in the risks for postoperative complications between the surgical cohorts. Further studies are warranted to characterize the long-term complications, costs, and patient outcomes between the 2 surgical techniques. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective database analysis. OBJECTIVE: To compare the perioperative patient characteristics, early postoperative outcomes, and costs between anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (TDR) in the United States. SUMMARY OF BACKGROUND DATA: Cervical TDR and ACDF are indicated to treat symptomatic cervical degenerative pathology. The epidemiology, complication rates, and the cost differences between the 2 surgical approaches are not well characterized. METHODS: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002 to 2009. Patients undergoing cervical TDR or ACDF of 1 to 2 levels were identified. Patient demographics, comorbidities, length of stay, costs, and the in-hospital complications were assessed. SPSS (version 20) was used for statistical analysis with χ test for categorical data and independent-samples t test for continuous data. A value of P ≤ 0.001 denoted statistical significance. Multinomial regression analysis was used to identify the independent risk for complications in the TDR cohort compared with the ACDF cohort. RESULTS: There were 141,230 ACDF cases of 1 to 2 levels and 1830 cervical TDR cases identified in the Nationwide Inpatient Sample database. The ACDF cohort was older and demonstrated a greater comorbidity burden than the TDR group (P < 0.001). The ACDF-treated patients demonstrated a significantly greater length of stay than the TDR group (P < 0.001). In contrast, there were no significant differences in the incidence of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques. CONCLUSION: The ACDF cohort was significantly older and demonstrated a greater comorbidity burden that likely contributed to the greater length of stay when than the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications and costs. There were no significant differences in the risks for postoperative complications between the surgical cohorts. Further studies are warranted to characterize the long-term complications, costs, and patient outcomes between the 2 surgical techniques. LEVEL OF EVIDENCE: 3.
Authors: Panagiotis Kerezoudis; Mohammed Ali Alvi; Anshit Goyal; Daniel S Ubl; Jenna Meyer; Elizabeth B Habermann; Bradford L Currier; Mohamad Bydon Journal: Oper Neurosurg (Hagerstown) Date: 2018-10-01 Impact factor: 2.703
Authors: Alexandria F Naftchi; John Vellek; Julia Stack; Eris Spirollari; Sima Vazquez; Ankita Das; Jacob D Greisman; Zehavya Stadlan; Omar H Tarawneh; Sabrina Zeller; Jose F Dominguez; Merritt D Kinon; Chirag D Gandhi; Syed Faraz Kazim; Meic H Schmidt; Christian A Bowers Journal: Dysphagia Date: 2022-08-09 Impact factor: 2.733