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. 2025 Apr 28;16(1):21925682251339621.
doi: 10.1177/21925682251339621. Online ahead of print.

High Volume Hospitals are Associated With Decreased Rates of Non-Routine Discharge Following Single-Level Cervical Disc Arthroplasty

Paul G Mastrokostas  1   2 , Bruce B Zhang  1 , Aaron B Lavi  1 , Leonidas E Mastrokostas  1   2 , Jad Bou Monsef  1   2 , Afshin E Razi  2 , Mitchell K Ng  2
Affiliations

High Volume Hospitals are Associated With Decreased Rates of Non-Routine Discharge Following Single-Level Cervical Disc Arthroplasty

Paul G Mastrokostas et al. Global Spine J. .

Abstract

Study DesignRetrospective cohort study.ObjectivesThis study aims to evaluate the impact of hospital volume on postoperative outcomes following single-level cervical disc arthroplasty (CDA), focusing on non-routine discharge rates, length of stay (LOS), and hospital costs.MethodsAfter applying the appropriate exclusion criteria, the National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients undergoing single-level CDA between 2016 and 2020. Patients were stratified by hospital volume into low, intermediate, and high categories based on annual case numbers. Multivariate logistic regression evaluated odds of non-routine discharge and complications, while linear regression analyzed LOS and hospital costs. Models were adjusted for age, sex, and comorbidities. Statistical significance was set at P < .05.ResultsPatients in high-volume hospitals had significantly lower odds of non-routine discharge compared to both intermediate-volume (OR: 0.63, 95% CI: 0.44-0.91, P = .014) and low-volume hospitals (OR: 0.66, 95% CI: 0.45-0.98, P = .040). Patients in high-volume hospitals also incurred significantly higher costs compared to low-volume hospitals (coefficient: $1,232.22, 95% CI: $189.05-$2,275.38, P = .021), while length of stay did not differ significantly across volume categories.ConclusionsHigh-volume hospitals are associated with improved discharge outcomes, but also increased costs following single-level CDA. These findings underscore the need to disseminate high-volume center practices to lower-volume hospitals while addressing cost management. Further research should explore the impact of outpatient settings and long-term outcomes to enhance care delivery for CDA patients.

Keywords: cervical disc arthroplasty; complications; discharge; hospital volume; national inpatient sample; resource utilization.

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Conflict of interest statement

Mitchell K. Ng is a paid consultant at Johnson & Johnson Ethicon Inc., Pacira BioSciences Inc., Sage Products Inc., Alafair Biosciences Inc., Next Science LLC, Bonutti Technologies Inc., Hippocrates Opportunities Fund LLC, and Ferghana Partners Inc.

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