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National Trends in Surgical Approach and Inpatient Costs for Degenerative Cervical Myelopathy
Vishwathsen Karthikeyan1,2,3, Christopher S Lozano1,2,3, Armaan K Malhotra1,2,3
1Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
Study Design:
Retrospective observational cohort study.
Objective:
To evaluate national trends in surgical approach for degenerative cervical myelopathy (DCM) in the United States, assess changes in associated inpatient costs, and quantify the independent contribution of surgical approach to cost.
Background:
DCM is the most common cause of spinal cord dysfunction in adults. While anterior cervical fusion has traditionally been the most used surgical approach, posterior and combined approaches are increasingly utilized, particularly in older and more complex patients. The implications of these trends on health care utilization and cost are not well established.
Methods:
We used the National Inpatient Sample to identify adult patients hospitalized with DCM who underwent cervical spinal fusion between 2016 and 2022. Patients were grouped by surgical approach: anterior-only, posterior-only, or combined. Survey-weighted multinomial logistic regression assessed changes in surgical approach over time. Generalized linear models with a gamma distribution and log-link quantified adjusted inpatient costs.
Results:
Among 100,390 hospitalizations, anterior-only fusion decreased from 76% in 2016 to 57% in 2022, while posterior-only and combined approaches increased from 20% to 36% and 4% to 7%, respectively (all P <0.001). Each advancing year was associated with higher odds of posterior (OR: 1.14, 95% CI: 1.12-1.15) and combined (OR: 1.13, 95% CI: 1.11-1.16) fusion use. Median costs rose significantly across all groups. Posterior-only and combined approaches were associated with 31% and 82% higher adjusted costs, respectively, compared with anterior-only fusion (both P <0.001).
Conclusions:
There has been a significant shift toward more complex and costlier fusion procedures for DCM. These findings highlight the importance of aligning surgical decision-making with value-based care principles to ensure sustainable health care delivery.
Level Of Evidence:
Level III-nonrandomized retrospective cohort study based on national inpatient data.
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