Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Health Services Research

Background:

• Surgical process improvement requires performance benchmarks.
• Procedure length is a key metric for anterior cervical discectomy and fusion (ACDF).

Purpose of the Study:

• Establish reference procedure lengths for 1, 2, and 3-level ACDFs at teaching and non-teaching institutions.
• Provide data to guide surgical process improvement initiatives.

Main Methods:

• Retrospective analysis of 1122 ACDF cases from teaching (RT) and non-teaching (NT) institutions.
• Calculated mean procedure lengths and 30-day patient outcomes.
• Compared case lengths between RT and NT institutions for 1, 2, and 3-level ACDFs.

Main Results:

• RT institutions had significantly longer mean procedure lengths for all ACDF levels (1-level: 121.9 vs 73.6 min; 2-level: 172.7 vs 112.0 min; 3-level: 218.3 vs 167.6 min; p<0.001).
• Thirty-day outcomes were similar, except for a shorter hospital stay at the RT institution for 2-level ACDFs (1.6 vs 2.9 days; p=0.001).

Conclusions:

• This study provides the first reference procedure lengths for 1, 2, and 3-level ACDF.
• Established benchmarks can inform and advance surgical process improvement efforts for ACDF procedures.