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Trends in Inpatient versus Outpatient Anterior Cervical Discectomy and Fusion in the United States of America: An Epidemiologic and Economic Analysis



Objective: Neck pain is a leading cause of disability with an increased prevalence of up to 20% annually in some reports. Various studies have shown improvements in symptoms and quality of life in patients who underwent anterior cervical discectomy and fusion (ACDF) for symptomatic nerve root compression and spondylosis. With the increased prevalence of these aforementioned conditions, it is imperative to understand the national trends in the use of ACDF. The authors aim to report on the incidence of ACDF in the United States of America (USA) over a four-year period and the associated procedural reimbursement costs.

Methods: A query was performed for patients who underwent ACDF using the PearlDiver supercomputer (Warsaw, IN) from 2011 to 2014. Patients were identified by current procedural terminology (CPT) Codes 22551 and 22552 and their demographics, location of surgery and reimbursement costs were later analysed.

Results: Our query returned a total of 13 143 ACDFs over the four-year study period of 2011 to 2014. The total number of procedures done in the outpatient setting increased significantly from 454 in 2011 to 815 in 2014 (p = 0.005); whereas those in the hospital setting did not from 1986 in 2011 to 2925 in 2014 (p = 0.118). Of the total amount of surgeries, 10.556 (80.4%) were performed in the hospital setting compared to 2587 performed in the ambulatory surgical centre [ACS: outpatient setting] (p < 0.001). The four-year mean reimbursement cost for ACDF done in the inpatient setting was $2407.75 compared to $5014 in the outpatient setting, which was not statistically significant (p= 0.36).

Conclusion: Over the four-year study period, the total number of ACDF performed in the outpatient setting increased significantly. There was no difference in the mean reimbursement according to the location where the surgery was performed (p = 0.36).

12 May, 2017
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e-Published: 24 May, 2017
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