Perioperative Outcomes and Reimbursement Patterns Associated with the Anterior Versus Posterior Approach for Treatment of Type 2 Odontoid Fractures, a NSQIP Analysis.

Abstract

To evaluate the short-term surgical outcomes and the reimbursement patterns, after treatment of Type 2 odontoid fractures using the anterior or posterior approach. The NSQIP database was queried for surgically treated patients with Type 2 odontoid fractures by the anterior or posterior approach between 2016 and 2020. Propensity score matching with the optimal approach was used to balance the cohorts. A total of 96 patients in the anterior and 352 patients in the posterior surgery group were included in the unmatched analysis. After propensity score matching 1:1, 96 anterior and 96 posterior cases were included in the matched analysis. Operative times were shorter in the anterior group (92.0 vs. 145.0 minutes, p<0.001). The need for intra- or postoperative transfusions was higher in the posterior group (15% vs. 2.1% ; p=0.002). However, there were no significant differences in complications between groups (p>0.05). Hospital stay was significantly longer in the posterior group (4.5 days vs. 3.0; p=0.049). Non-routine discharge was more frequent in the posterior group (55% vs. 40%, p=0.030). However, the rate of 30-day readmission, reoperation, and mortality did not differ between groups (p>0.05). Also, the work relative value units (WRVUs) were significantly higher in the anterior group (22.7 vs. 20.6, p<0.001), indicating higher reimbursement trends for this approach. In this matched analysis, the anterior approach for type 2 odontoid fractures was superior to the posterior approach. The anterior approach was associated with significantly shorter operation times, hospital stays, fewer transfusions, non-routine discharges, and higher reimbursements.