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Iowa Orthop J. 2018;38:167-176.

Trends and Costs of Anterior Cervical Discectomy and Fusion: a Comparison of Inpatient And Outpatient Procedures.

Author information

Christopher T. Martin, MD, Department of Orthopaedic Surgery, University of Minnesota Minneapolis, MN 55454 (Email:
The Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Durango Orthopedic Associates, P.C./Spine Colorado, Durango, Colorado, USA.
Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijongbu, Korea.
Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany.
Department of Orthopedics, University of Utah School of Medicine, USA.
The Department of Orthopaedic Surgery, Emory University School of Medicine, Emory Spine Center, Altanta, GA 30329.


Study Design:

Epidemiologic Study.


To identify the trends in utilization of outpatient discharge for single level anterior cervical discectomy and fusion (ACDF), between 2007 and 2014, and to compare the costs and incidence of complications against a cohort of inpatients.


We retrospectively reviewed 18,386 patients from the PearlDiver database from between 2007 and 2014. Discharge status was determined from billing codes. The total cost of all procedures and diagnostic tests, was determined for the global period from the time of diagnosis up until 90-days post-operatively, and the incidence of complications was recorded for 30-days.


The proportion of outpatient discharges was stable around 20% from 2007 to 2014 (range17-23%). The mean 90-day cost was lower for outpatients ($39,528 v. $47,330) but reimbursement fell nearly 1/3 from 2007-2014 for both groups, and the difference between the two narrowed over time ($13,745 difference in 2008, to $3,834 in 2014). Outpatients had a lower incidence of overall 30-day complications (9.5% v. 18.6%, p<0.0001), but were also significantly less comorbid (mean Charlson comorbidity index 2.32 v. 3.85, p<0.001). Older patient age, obesity, cardiac, renal, and pulmonary comorbidity were each more common in the inpatients (p<0.05 for each).


Outpatient discharge after ACDF is a viable treatment option with a reasonable safety profile and decreased costs relative to inpatient admission. Appropriate patient selection is key, and the standard of care nationally for the comorbid patient remains inpatient admission. The economic trends and epidemiologic data presented here should be useful for health policy decisions.

[Indexed for MEDLINE]
Free PMC Article

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