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. 2018 May;8(3):244-253.
doi: 10.1177/2192568217722562. Epub 2017 Sep 22.

National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy

Caroline E Vonck  1   2 , Joseph E Tanenbaum  1   2 , Gabriel A Smith  1 , Edward C Benzel  1 , Thomas E Mroz  1 , Michael P Steinmetz  1
Affiliations

National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy

Caroline E Vonck et al. Global Spine J. 2018 May.

Abstract

Study design: Retrospective trends analysis.

Objectives: Cervical fusion is a common adjunctive surgical modality used in the treatment of cervical spondylotic myelopathy (CSM). The purpose of this study was to quantify national trends in patient demographics, hospital characteristics, and outcomes in the surgical management of CSM.

Methods: This was a retrospective study that used the National Inpatient Sample. The sample included all patients over 18 years of age with a diagnosis of CSM who underwent cervical fusion from 2003 to 2013. The outcome measures were in-hospital mortality, length of stay, and hospital charges. Chi-square tests were performed to compare categorical variables. Independent t tests were performed to compare continuous variables.

Results: We identified 62 970 patients with CSM who underwent cervical fusion from 2003 to 2013. The number of fusions performed per year in the treatment of CSM increased from 3879 to 8181. The average age of all fusion patients increased from 58.2 to 60.6 years (P < .001). Length of stay did not change significantly from a mean of 3.7 days. In-hospital mortality decreased from 0.6% to 0.3% (P < .01). Hospital charges increased from $49 445 to $92 040 (P < .001).

Conclusions: This study showed a dramatic increase in cervical fusions to treat CSM from 2003 to 2013 concomitant with increasing age of the patient population. Despite increases in average age and number of comorbidities, length of stay remained constant and a decrease in mortality was seen across the study period. However, hospital charges increased dramatically.

Keywords: NIS; National Inpatient Sample; anterior cervical fusion; cervical spondylotic myelopathy; hospital charges; mortality; posterior cervical fusion; trends.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Number of comorbidities by percentage for all cervical spondylotic myelopathy (CSM) patients undergoing cervical fusion. The trends in the average number of comorbidities by percentage are shown for all CSM patients undergoing cervical fusion. Data from 2003 was compared to data from 2013 by number of comorbidities to determine statistically significant changes over time. A “*” denotes statistical significance with P < .01. A “**” represents statistical significance with P < .001.
Figure 2.
Figure 2.
Breakdown of insurance status by percentage for all cervical spondylotic myelopathy (CSM) patients undergoing cervical fusion. The percentage of CSM patients undergoing cervical fusions are represented by insurance status. Data from 2003 was compared to data from 2013 by beneficiary to determine statistically significant changes over time. A “*” denotes statistical significance with P < .01. A “**” represents statistical significance with P < .001.
Figure 3.
Figure 3.
Number of cervical fusions performed per year in the treatment of cervical spondylotic myelopathy (CSM). The number of fusions performed in the treatment of CSM are stratified by procedure (anterior cervical fusion [ACF] and posterior cervical fusion [PCF]) from 2003 to 2013.
Figure 4.
Figure 4.
Average age of cervical spondylotic myelopathy (CSM) patients undergoing anterior cervical fusion (ACF) and posterior cervical fusion (PCF). The trends in the average age of CSM patients undergoing ACF and PCF are shown. PCF patients were significantly older than ACF patients (P < .01). Data from 2003 was compared to data from 2013 by procedure to determine statistically significant changes over time. A “*” denotes statistical significance with P < .01. A “**” represents statistical significance with P < .001.
Figure 5.
Figure 5.
Trends in in-hospital mortality following anterior cervical fusion (ACF) and posterior cervical fusion (PCF) in the treatment of cervical spondylotic myelopathy (CSM). Declining trends in in-hospital mortality percentage are shown for ACF and PCF. Data from 2003 wascompared to data from 2013 by procedure to determine statistically significant changes over time. A “*” denotes statistical significance with P < .01.
Figure 6.
Figure 6.
Trends in hospital charges for cervical fusions in the treatment of cervical spondylotic myelopathy (CSM). Trends in the average hospital charges for anterior cervical fusion (ACF) and posterior cervical fusion (PCF) performed in the treatment of CSM are shown. Charge data from 2003 was compared to data from 2013 by procedure to determine statistically significant changes over time. A “**” represents statistical significance with P < .001.
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