Impact of Surgeon Procedural Volume on Outcomes Following Cervical Disc Arthroplasty: A Retrospective Cohort Study

Purpose The purpose of this retrospective matched cohort study was to investigate the impact of surgeon procedural volume on postoperative outcomes and healthcare utilization following CDA. Cervical disc arthroplasty (CDA) is considered a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for addressing cervical radiculopathy and myelopathy. Increased surgeon procedural volume has been linked to improved patient outcomes and reduced costs in other orthopedic surgeries. However, limited large-scale data exist regarding the effects of surgeon experience on CDA outcomes. Methods Adult patients who underwent CDA between 2010 and 2022 and had database activity for at least 90 days postoperatively were identified from the PearlDiver database. Three cohorts were defined by providers' procedural volume: high-volume, >75 procedures; mid-volume, 26 to 75 procedures; and low-volume, 11 to 25 procedures performed during the study period. Differences in baseline demographic and clinical characteristics were assessed, and logistic regression was conducted to compare postoperative complications, 30-day and 90-day emergency department (ED) visits, and readmission rates. Survival probabilities for revision and cervical reoperation were determined using Kaplan-Meier analysis. Results Of the 18,538 patients identified, 7,819 (42.2%) were treated by low-volume surgeons, 7,017 (37.9%) were treated by mid-volume surgeons, and 3,702 (20.0%) were treated by high-volume surgeons. There were no significant differences in 90-day complication rates or postoperative healthcare utilization in the multivariate analysis, with the exception of an increased rate of atelectasis in the high-volume cohort. Survival probabilities for revision CDA or cervical reoperation did not differ across groups (log-rank P > 0.05). Conclusions Surgeon procedural volume did not have a significant impact on postoperative complications, healthcare utilization, or revision rates after CDA. Nevertheless, careful attention to appropriate patient selection and surgical technique remains critical to achieving favorable outcomes. Level of evidence This retrospective cohort study provides Level III evidence.