Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2022 Apr;160:e96-e110. doi: 10.1016/j.wneu.2021.12.099. Epub 2021 Dec 29.
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) has been considered the standard treatment for degenerative cervical disc disease; however, recent trials have shown comparable outcomes with cervical disc arthroplasty (CDA). This study aimed to observe disparities in treatment paradigms of single-level cervical disc diseases and compare inpatient outcomes between procedures. METHODS: A retrospective cohort of patients treated for single-level cervical disc herniation or degeneration without myelopathy was queried from the Nationwide Inpatient Sample spanning 2012-2015. Multivariate logistic regression was performed to assess the effects of demographics, temporality of admission, and hospital characteristics on odds of receiving CDA versus ACDF. Propensity-score matching was performed to compare cost, length of stay (LOS), non-home discharge, and inpatient complications. RESULTS: In total, 1028 CDAs and 44,374 ACDFs were performed for single-level cervical disc disease during 2012-2015. Matched comparison showed that while non-home discharges were not different between CDA and ACDF (P = 0.248), patients who received CDA had a 0.19-day shorter LOS (P < 0.001) and $4694 greater total cost (P < 0.001). There were no statistically significant differences in inpatient complication rates. Multivariate analysis showed that patients in the 26th-50th percentile, 51st-75th percentile, and 76th-100th percentile of median household income had greater odds of CDA compared with patients in the 0-25th percentile (odds ratio [OR] 1.35, P = 0.003; OR 1.31, P = 0.013; OR 1.34, P = 0.011, respectively). Patients with private insurance had greater odds of receiving CDA compared with patients on Medicare (OR 1.91, P < 0.001). CONCLUSIONS: CDA was associated with shorter LOS but greater costs compared with ACDF. Patients with greater median income and private insurance were more likely to receive CDA.
目的:颈椎前路椎间盘切除术和融合术(ACDF)被认为是治疗退行性颈椎间盘疾病的标准治疗方法;然而,最近的试验表明颈椎间盘置换术(CDA)的结果相当。本研究旨在观察单节段颈椎间盘疾病治疗方案的差异,并比较两种手术的住院治疗结果。
方法:从 2012 年至 2015 年,从全国住院患者样本中查询了接受单节段颈椎间盘突出症或无脊髓病退行性变治疗的患者的回顾性队列。使用多变量逻辑回归评估人口统计学、入院时间和医院特征对接受 CDA 与 ACDF 的几率的影响。采用倾向评分匹配比较成本、住院时间(LOS)、非家庭出院和住院并发症。
结果:在 2012 年至 2015 年期间,共进行了 1028 例 CDA 和 44374 例 ACDF 治疗单节段颈椎间盘疾病。匹配比较显示,CDA 和 ACDF 之间非家庭出院率没有差异(P=0.248),但接受 CDA 的患者 LOS 缩短 0.19 天(P<0.001),总费用增加 4694 美元(P<0.001)。住院并发症发生率无统计学差异。多变量分析显示,收入中位数处于 0-25%分位、26-50%分位、51-75%分位和 76-100%分位的患者接受 CDA 的可能性高于收入中位数处于 0-25%分位的患者(比值比[OR]1.35,P=0.003;OR 1.31,P=0.013;OR 1.34,P=0.011)。与医疗保险患者相比,私人保险患者接受 CDA 的可能性更高(OR 1.91,P<0.001)。
结论:与 ACDF 相比,CDA 具有更短的 LOS 但更高的成本。收入中位数较高和私人保险的患者更有可能接受 CDA。
J Neurosurg Spine. 2017-5
J Orthop Surg Res. 2024-4-3
Spine (Phila Pa 1976). 2023-10-15