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Variation in outcomes following ACDF performed by orthopedic and neurosurgery-trained surgeons: a propensity
Anoop Sunkara1, Jacob W McDevitt1, Connor P McCloskey1
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Background Context:
ACDF is performed by both orthopedic and neurosurgery-trained surgeons, but prior studies comparing outcomes across specialties are limited to 30-day endpoints and multi-institution databases.
Purpose:
To compare outcomes between orthopedic and neurosurgery-performed ACDF at a single institution.
Design:
Retrospective propensity score-matched cohort study.
Patient Sample:
Total of 662 pairs (n=1,324) undergoing ACDF at a single academic medical center from 2016 to 2023.
Outcome Measures:
Operative and hospital course duration, 30- and 90-day readmission, 90-day complications, opioid fills at 31-180 days, and one-year complications.
Methods:
Adults undergoing ACDF (CPT 22551) were identified from an institutional database. Surgeons below the 50th percentile of annual volume (<5.2 cases/year) were excluded. Matching (1:1) incorporated age, sex, BMI, ASA class, Van Walraven Elixhauser comorbidity score, procedure setting, insurance type, fusion levels, myelopathy, and surgeon volume.
Results:
Neurosurgery cases had longer surgery duration (3.38 vs 2.71 h) and anesthesia time (4.22 vs 3.40 h; both p<.001). Length of stay was longer in neurosurgery (2.84 vs 2.05 days; p<.001), as 30-day (9.8% vs 5.9%; p=.008) and 90-day (13.7% vs 8.6%; p=.003) postoperative readmission rates were greater. The 90-day complication rate was higher in neurosurgery (22.1% vs 16.9%; p=.018). Neurosurgery cases had higher opioid fill rates at 31-90 days (25.8% vs 19.6%; p=.007) and 91-180 days (19.6% vs 14.2%; p=.008) postoperatively.
Conclusions:
The pattern of short-term differences and long-term convergence suggests differences in perioperative management instead of surgical proficiency. Hospitals performing ACDF across both specialties should standardize perioperative protocols.
