Katz Austen David, Song Junho, Bowles Daniel, Ng Terence, Neufeld Eric, Hasan Sayyida, Perfetti Dean, Sodhi Nipun, Essig David, Silber Jeff, Virk Sohrab
Department of Orthopedic Surgery, North Shore University Hospital and Long Island Jewish Medical Center, Zucker School of Medicine, Hofstra University, New York, USA.
J Craniovertebr Junction Spine. 2022 Jul-Sep;13(3):331-338. doi: 10.4103/jcvjs.jcvjs_69_22. Epub 2022 Sep 14.
Compared to anterior cervical discectomy and fusion (ACDF), the motion preservation of cervical disc arthroplasty (CDA) provides an attractive alternative with similar short-term results. However, there is a paucity of the economics of performing CDA over ACDF.
This was retrospective study.
The objective of this study is to evaluate relative-value-units (RVUs), operative time, and RVUs-per-minute between single-level ACDF and CDA. Secondary outcomes included 30-day readmission, reoperation, and morbidity.
Adults who underwent ACDF or CDA in 2011-2019 National Surgical Quality Improvement Program database datasets. Multivariate quantile regression was utilized.
There were 26,595 patients (2024 CDA). ACDF patients were older, more likely to be female, discharged to inpatient rehabilitation, and have a history of obesity, smoking, diabetes, steroid use, and the American Society of Anesthesiologists-class ≥3. ACDF had greater median RVUs-per-case (41.2 vs. 24.1) and RVUs-per-minute (0.36 vs. 0.27), despite greater operative-time (109 min vs. 92 min) ( < 0.001). ACDF predicted a 16.9 unit increase in median RVUs per case ( < 0.001, confidence interval [CI]: 16.3-17.5), an 8.81 min increase in median operative time per case ( < 0.001, CI: 5.69-11.9), and 0.119 unit increase in median RVUs-per-minute ( < 0.001, CI: 0.108-0.130). ACDF was associated with greater unadjusted rates of readmission (3.2% vs. 1.4%) morbidity (2.3% vs. 1.1%) ( < 0.001), but similar rates of reoperation (1.3% vs. 0.8%, = 0.080). After adjusting for significant patient-related and procedural factors, readmission (odds ratio [OR] = 0.695, = 0.130, CI: 0.434-1.113) and morbidity (OR = 1.102, = 0.688, CI: 0.685-1.773) was similar between ACDF and CDA.
Median RVUs-per-minute increased by 0.119 points for ACDF over CDA, or $257.7/h for each additional-hour of surgery. Adjusted 30-day outcomes were similar between procedures. Reimbursement for CDA does not appear to be in line with ACDF and may be a barrier to widespread usage.
与颈椎前路椎间盘切除融合术（ACDF）相比，颈椎间盘置换术（CDA）的运动保留功能提供了一种具有吸引力的替代方案，且短期效果相似。然而，关于进行CDA相对于ACDF的经济学研究较少。
这是一项回顾性研究。
本研究的目的是评估单节段ACDF和CDA之间的相对价值单位（RVU）、手术时间和每分钟RVU。次要结局包括30天再入院、再次手术和发病率。
对2011 - 2019年国家外科质量改进计划数据库数据集中接受ACDF或CDA的成年人进行研究。采用多变量分位数回归分析。
共有26595例患者（2024例行CDA）。ACDF组患者年龄更大，女性比例更高，出院后进入住院康复机构，且有肥胖、吸烟、糖尿病、使用类固醇病史以及美国麻醉医师协会分级≥3级。尽管ACDF手术时间更长（109分钟对92分钟），但每例患者的中位数RVU更高（41.2对24.1），每分钟RVU也更高（0.36对0.27）（P<0.001）。ACDF预测每例患者的中位数RVU增加16.9个单位（P<0.001，置信区间[CI]：16.3 - 17.5），每例患者的中位数手术时间增加8.81分钟（P<0.001，CI：5.69 - 11.9），每分钟RVU中位数增加0.119个单位（P<0.001，CI：0.108 - 0.130）。ACDF与未调整的再入院率（3.2%对1.4%）和发病率（2.3%对1.1%）更高相关（P<0.001），但再次手术率相似（1.3%对0.8%，P = 0.080）。在对显著的患者相关和手术因素进行调整后，ACDF和CDA之间的再入院率（优势比[OR]=0.695，P = 0.130，CI：0.434 - 1.113）和发病率（OR = 1.102，P = 0.688，CI：0.685 - 1.773）相似。
ACDF的每分钟RVU中位数比CDA增加0.119分，即每增加一小时手术，每小时费用增加257.7美元。调整后的30天结局在两种手术之间相似。CDA的报销似乎与ACDF不一致，这可能是其广泛应用的一个障碍。
