Thursday, September 27, 2018 3:35 PM–5:05 PM Section on Motion Technology Abstract Presentations: 138. Inpatient cost and length of stay for cervical disc arthroplasty and anterior cervical discectomy and fusion: a cohort-matched comparison

Abstract

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is the most common surgical treatment for cervical disc pathology. However, recent evidence has demonstrated superior outcomes with cervical disc arthroplasty (CDA). PURPOSE This study aims to compare inpatient cost and length of stay (LOS) between cervical disc arthroplasty and anterior cervical discectomy and fusion. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 676 patients were analyzed (338 ACDF and 338 CDA). The average patient ages for ACDF and CDA were 49.15 years and 49.11 years, respectively (p=.957). Only elective hospital admissions were included in this sample. Patients in the ACDF group were limited to those with one to two level fusions. OUTCOME MEASURES This study compared the ACDF and CDA cohorts on high-end hospital charges and prolonged inpatient length of stay. METHODS This study screened over 35 million hospital discharges in the United States from 2010 to 2014 using the National Inpatient Sample and the Nationwide Inpatient Sample. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 75,377 patients who underwent ACDF of two or three vertebrae (ICD 81.02 and 81.62), and 387 patients who underwent CDA (ICD 84.62). The ACDF and CDA groups were statistically matched based on age, year of procedure, sex, indication for surgery, race, hospital type, and comorbidities. Mean hospital charges and LOS for each cohort were calculated and compared using the Kruskal Wallis H test. Univariate and multivariate logistic regression were used to compare high-end cost and prolonged LOS between the cohorts, defined as patients with LOS and total hospital charges greater than the 75th percentile of the respective means. RESULTS We matched 338 (87.34%) CDA patients with patients who underwent ACDF. The average LOS was greater for CDA (x=1.56, SD=0.946) compared to ACDF (x=1.43, SD=1.12; p=.001). Additionally, the average inpatient hospital charges for CDA were $21,320 (SD=10,854) compared to $16,123 (SD=8,499) for ACDF (p CONCLUSIONS Patients who underwent ACDF had significantly lower LOS and hospital charges than a statistically matched CDA cohort. This conclusion directly contradicts recent findings in the literature, although this study is the first to use a large cohort-matched analysis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.