Resource Utilization Following Anterior Versus Posterior Cervical Decompression and Fusion for Acute Central Cord Syndrome.

Study Design: Retrospective cohort study.
Objective: The purpose of this study is to compare the impact of anterior cervical decompression and fusion (ACDF) versus posterior cervical decompression and fusion (PCDF) for the treatment of acute traumatic central cord syndrome (CCS) on hospital episodes of care in terms of (1) cost, (2) length of hospital stay, and (3) discharge destination.
Summary of Background Data: Acute traumatic CCS is the most common form of spinal cord injury in the United States. CCS is commonly treated with surgical decompression and fusion. Hospital resource utilization based on surgical approach remains unclear.
Methods: Patients undergoing ACDF and PCDF for acute traumatic CCS were identified using the 2019 Medicare Provider Analysis and Review Limited Data Set and Centers for Medicare and Medicaid Services 2019 Impact File. Multivariate models for hospital cost of care, length of stay, and discharge destination were performed, controlling for confounders. Subanalysis of accommodation and revenue center cost drivers was performed.
Results: There were 1474 cases that met inclusion criteria: 673 ACDF (45.7%) and 801 PCDF (54.3%). ACDF was independently associated with a decreased cost of $9802 ( P <0.001) and a 59.2% decreased risk of discharge to nonhome destinations (adjusted odds ratio: 0.408, P <0.001). The difference in length of stay was not statistically significant. On subanalysis of cost drivers, ACDF was associated with decreased charges ($55,736, P <0.001) compared with PCDF, the largest drivers being the intensive care unit ($15,873, 28% of total charges, P <0.001) and medical/surgical supply charges ($19,651, 35% of total charges, P <0.001).
Conclusions: For treatment of acute traumatic CCS, ACDF was associated with almost $10,000 less expensive cost of care and a 60% decreased risk of discharge to nonhome destination compared with PCDF. The largest cost drivers appear to be ICU and medical/surgical-related. These findings may inform value-based decisions regarding the treatment of acute traumatic CCS. However, injury and patient clinical factors should always be prioritized in surgical decision-making, and increased granularity in reimbursement policies is needed to prevent financial disincentives in the treatment of patients with CCS better addressed with posterior approach-surgery.
Competing Interests: N.U.A.: North American Spine Society: Board or committee member; Osseus: Other financial or material support; Research support; SeaSpine: Research support; and Spine, The Spine Journal: Editorial or governing board. T.J.A.: Augmedics: Stock or stock Options; Back Story, LLC: Board or committee member; Biomet: IP royalties; Care Equity: Stock or stock Options; CytoDyn Inc.: Stock or stock Options; DePuy, A Johnson & Johnson Company: IP royalties; Hospital for Special Surgery: Board or committee member; HS2, LLC: Stock or stock Options; In ViVo Therapeutics: Stock or stock Options; Innovative Surgical Designs, Inc.: Stock or stock Options; Journal of Bone and Joint Surgery—American: Editorial or governing board; JP Medical Publishers: Publishing royalties, financial or material support; Morphogenesis: Stock or stock Options; Nuvasive: Paid consultant; Orthopedics Today: Board or committee member; Editorial or governing board; Paradigm Spine: Stock or stock Options; Parvizi Surgical Innovations: Stock or stock Options; Physician Recommended Nutriceuticals: Stock or stock Options; Precision Orthopedics: Stock or stock Options; Pulse Equity: Stock or stock Options; Saunders/Mosby-Elsevier: Publishing royalties, financial or material support; Spine: Editorial or governing board; Spine Deformity Journal: Editorial or governing board; Spine Universe: Board or committee member; Spinicity: Stock or stock Options; Springer: Publishing royalties, financial or material support; Strathspey Crown: Stock or stock Options; Surg.IO LLC: Stock or stock Options; and Thieme: Publishing royalties, financial or material support. R.E.M.: Blue Cross Blue Shield Association Pharmacy & Medical Policy Committee: Other financial or material support; Blue Cross Blue Shield Medical Advisory Panel: Other financial or material support; and Clinical Orthopaedics and Related Research: Editorial or governing board. J.R.C.: Cervical Spine Research Society: Board or committee member; DePuy, A Johnson & Johnson Company: Research support; Evidence-based Spine Journal: Editorial or governing board; Evidence-based Spine Journal: Publishing royalties, financial or material support; Global Spine Journal: Publishing royalties, financial or material support; Globus Medical: Paid consultant; Journal of Spine: Editorial or governing board; Medtronic Sofamor Danek: Research support; Spine: Editorial or governing board; and Stryker: Research support. The authors do not have direct conflicts of interest in the manuscript. J.D., K.S., and C.B. have no conflicts to declare.
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