ABSTRACT
Background Hospitals seek to reduce costs and improve patient outcomes by decreasing length of stay (LOS), 30-day all-cause readmissions, and preventable complications. We evaluated hospital-reported outcome measures for elective single-level anterior cervical discectomy and fusions (ACDFs) between tertiary (TH) and community hospitals (CH) to determine location-based differences in complications, LOS, and overall costs.
Methods Patients undergoing elective single-level ACDF in a 1-year period were retrospectively reviewed from a physician-driven database from a single medical system consisting of 1 TH and 4 CHs. Adult patients who underwent elective single-level ACDF were included. Patients with trauma, tumor, prior cervical surgery, and infection were excluded. Outcomes measures included all-cause 30-day readmissions, preventable complications, LOS, and hospital costs.
Results A total of 301 patients (60 TH, 241 CH) were included. CHs had longer LOS (1.25 ± 0.50 versus 1.08 ± 0.28 days, P = .01). There were no differences in complication and readmission rates between hospital settings. CH, orthopaedic subspecialty, female sex, and myelopathy were predictors for longer LOS. Overall, costs at the TH were significantly higher than at CHs ($17,171 versus $11,737; Δ$ = 5434 ± 3996; P < .0001). For CHs, the total costs of drugs, rooms, supplies, and therapy were significantly higher than at the TH. TH status, orthopaedic subspecialty, and myelopathy were associated with higher costs.
Conclusion Patients undergoing single-level ACDFs at CHs had longer LOS, but similar complications and readmission rates as those at the TH. However, cost of ACDF was 1.5 times greater in the TH. To improve patient outcomes, optimize value, and reduce hospital costs, modifiable factors for elective ACDFs should be evaluated.
Level of Evidence 3.
- health care costs
- surgical outcomes
- value-based care
- tertiary hospitals
- community hospital
- anterior cervical discectomy and fusion
Footnotes
Disclosures and COI: Dr Davis receives royalties for Depuy/Synthes, Exactech, Altus, and Lanx-Biomet. Dr Sansur is a paid consultant for Stryker and Globus medical. Dr Gelb is a board member and fellowship committee chair for AOSpine NA. He receives payment for lectures and for development of educational presentations from AOSpine NA. He receives royalties from DePuy Synthes Spine and Globus Medical. He has stock in the American Society for Investigative Pathology. Dr Koh receives payment for consultancy from Biomet. His institution receives RO1 grant money from the National Institutes of Health. Dr Ludwig is a board member for Globus Medical, the American Board of Orthopaedic Surgery, the American Orthopaedic Association, the Cervical Spine Research Society, and the Society for Minimally Invasive Spine Surgery. He is a paid consultant for DePuy Synthes, K2M, and Globus Medical. He receives payment for lectures and travel accommodations from DePuy Synthes and K2M. He receives payment for patents and royalties from DePuy Synthes and Globus Medical. He has stock in Innovative Surgical Designs and the American Society for Investigative Pathology. He receives research support from AO Spine North America Spine Fellowship support, Pacira Pharmaceutical, and AOA Omega Grant. He is a board member of Maryland Development Corporation. He receives royalties from Thieme, Quality Medical Publishers. He is on the governing board of Journal of Spinal Disorders and Techniques, The Spine Journal, and Contemporary Spine Surgery. The authors have no further potential conflicts of interest to disclose. No outside funding was received for this work. The views expressed in the submitted article are our own.
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS
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