Radcliff Kris, Zigler Jeff, Zigler Jack
*Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA †Musculoskeletal Clinical Regulatory Advisers, Washington, DC; and ‡Texas Back Institute, Plano, TX.
Spine (Phila Pa 1976). 2015 Apr 15;40(8):521-9. doi: 10.1097/BRS.0000000000000822.
Retrospective review of prospectively collective administrative data.
The purpose of this study was to determine the reoperation rates, adverse event rate, as well as the direct and follow-on costs of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF) in a "real-world" population of patients with single-level symptomatic cervical disc disease.
Until very recently, there was a paucity of human clinical data to demonstrate that CDA lowers the rate of adjacent segment disease over ACDF.
This was a retrospective, matched cohort analysis of a prospectively collected database of costs and outcomes for patients aged 18 to 60 years, who were continuously enrolled in a Blue Cross Plan contributing data to a claims database. Inclusion criteria were as follows: all patients who were treated surgically with either CDA or ACDF between January 2008 and December 2009, with single-level cervical pathology and claims reflecting at least 6 weeks of nonsurgical preoperative care without claims history of prior surgery.
There were 6635 ACDF patients and 327 CDA patients. There were no significant differences in the incidence of comorbidities or mean follow-up time (ACDF 25.7 mo vs. CDA 26.1 mo) between groups. By 36 months postoperatively, the reoperation rate was significantly increased in the ACDF group (10.5%) versus the CDA group (5.7%) (hazard ratio, P = 0.0214). The index surgery and 90-day global window costs were significantly lower in the CDA groups. At final follow-up, there was a statistically significant reduction in total costs paid by insurer in CDA patients (CDA $34,979 vs. ACDF $39,820).
Patients who underwent CDA for single-level degenerative disease had lower readmission rates, lower reoperation rates, and reduced index and total costs than those treated with ACDF. CDA was effective in reducing the monthly cost of care compared with ACDF.
对前瞻性收集的管理数据进行回顾性分析。
本研究旨在确定在患有单节段症状性颈椎间盘疾病的“真实世界”患者群体中，与颈椎前路椎间盘切除融合术（ACDF）相比，颈椎间盘置换术（CDA）的再次手术率、不良事件发生率以及直接和后续成本。
直到最近，仍缺乏足够的人体临床数据来证明CDA比ACDF降低相邻节段疾病发生率。
这是一项对前瞻性收集的18至60岁患者成本和结局数据库进行的回顾性匹配队列分析，这些患者持续参加蓝十字计划并向索赔数据库提供数据。纳入标准如下：2008年1月至2009年12月期间接受CDA或ACDF手术治疗的所有患者，患有单节段颈椎病变且索赔记录显示至少6周的非手术术前护理且无既往手术索赔史。
有6635例ACDF患者和327例CDA患者。两组之间的合并症发生率或平均随访时间（ACDF为25.7个月，CDA为26.1个月）无显著差异。术后36个月时，ACDF组（10.5%）的再次手术率显著高于CDA组（5.7%）（风险比，P = 0.0214）。CDA组的初次手术和90天全周期成本显著更低。在最终随访时，CDA患者的保险公司支付的总成本有统计学显著降低（CDA为34,979美元，ACDF为39,820美元）。
与接受ACDF治疗的患者相比，因单节段退行性疾病接受CDA治疗的患者再入院率更低、再次手术率更低，且初次手术和总成本更低。与ACDF相比，CDA在降低每月护理成本方面有效。
2级。
