Title : Comparative analysis of cervical disc arthroplasty and anterior cervical discectomy and fusion: Trends, demographics, and clinical outcomes in a nationwide inpatient sample
Abstract:
Introduction: Cervical Disc Diseases (CDD) are a significant cause of disability and diminished quality of life globally, with prevalence increasing with age. Two common surgical interventions for symptomatic CDD patients who do not respond to conservative treatments are Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Disc Arthroplasty (CDA). While ACDF is more established and has a more extended history of use, CDA has been gaining popularity due to its motion-preserving benefits and comparable, if not superior, long-term outcomes. This study aims to compare these two procedures using a comprehensive dataset of 97,999 patients, focusing on patient demographics, complications, costs, length of hospital stay, and mortality rates to contribute valuable insights that can inform clinical practice and healthcare policy.
Methods: In this study, data was sourced from the Nationwide Inpatient Sample (NIS) database, covering the period from January 1st, 2016, to December 31st, 2019. The dataset comprised 97,999 patients, with 85,584 undergoing ACDF and 11,415 CDA. Patients were identified using ICD-10 codes, with exclusions for non-elective admissions and surgeries performed prior to admission. Statistical analyses, including crosstabs and t-tests, were conducted, with a significance level of p < 0.05. Propensity score matching was utilized to control selection bias, resulting in a refined cohort of 11,415 matched pairs. Comorbidities and clinical outcomes were analyzed using the NIS dataset, including mortality, length of stay, complications, and hospitalization costs.
Results: The study observed a significant increase in the utilization of CDA surgeries compared to ACDF from 2016 to 2019. ACDF patients were older (55.6 vs. 47.2 years, P<0.001) and more likely to have Medicare coverage (33.9% vs. 10.7%, P<0.001). Comorbidities such as hypertension, dyslipidemia, and diabetes mellitus were more prevalent in ACDF patients (P<0.001). Propensity score matching balanced both groups, confirming comparable demographic and comorbidity profiles, with no significant differences in major conditions like hypertension (P=0.59) and dyslipidemia (P=0.93). Hospitalization outcomes revealed a slightly longer length of stay for ACDF (1.39 vs. 1.32 days, P<0.001), while CDA incurred higher mean charges ($82,431 vs. $58,472, P<0.001). Postoperatively, ACDF patients experienced more dysphagia (4.90% vs. 3.60%, P<0.001), venous thromboembolism (0.13% vs. 0.04%, P=0.03), and sepsis (0.04% vs. 0.00%, P=0.03). Cervical spinal cord injury and urinary tract infections were more frequent in the CDA group (P=0.04 and P=0.02, respectively).
Conclusions: This study highlights a growing trend in favor of CDA, particularly among younger patients and those with private insurance. The advantages of motion preservation, reduced adjacent-segment disease, shorter hospital stays, and lower complication rates make CDA an increasingly viable alternative to traditional ACDF, despite its higher initial costs. These findings align with recent literature, further supporting the adoption of CDA in appropriate patient populations.
