Regional differences in prolonged non-operative therapy utilization prior to primary ACDF surgery

Area of Science:

• Neurosurgery
• Health Economics
• Health Services Research

Background:

• Cervical stenosis management often involves conservative treatments before surgery.
• Understanding regional variations in pre-operative care is crucial for cost-effective healthcare.
• Outcomes-based reimbursement models necessitate analysis of regional healthcare utilization patterns.

Purpose of the Study:

• To investigate regional differences in the utilization and costs of maximal non-operative therapy (MNT) for cervical stenosis.
• To identify geographic variations in conservative management strategies prior to anterior cervical discectomy and fusion (ACDF) surgery.

Main Methods:

• Retrospective analysis of 15,825 patients undergoing ≤3-level ACDF for cervical stenosis (2007-2016).
• Data extracted from a large insurance database, categorized by U.S. Census Bureau regions.
• Analysis of MNT utilization (medications, injections, therapy, chiropractic) and associated costs within two years pre-ACDF.

Main Results:

• Significant regional variations were found in the use of NSAIDs, opioids, muscle relaxants, epidural steroid injections, physical/occupational therapy, and chiropractic care.
• The West and South regions had the highest proportion of patients using opioids.
• The Northeast and South regions billed the most opioid pills per patient; Midwest and South incurred the highest average MNT costs.

Conclusions:

• Substantial regional disparities exist in the utilization and cost of conservative treatments for cervical stenosis before ACDF.
• These findings highlight the need for standardized approaches to MNT to manage costs and improve value-based care.
• Further research should explore factors driving these regional variations in healthcare delivery.