National trends in anterior cervical fusion procedures.
METHODS
Population-based database analysis.


OBJECTIVE
To analyze trends in patient- and healthcare-system-related characteristics, utilization and outcomes associated with anterior cervical spine fusions.


BACKGROUND
Anterior cervical decompression and spine fusion (ACDF) is one of the most commonly performed surgical procedures of the spine. However, few data analyzing trends in patient- and healthcare-system-related characteristics, utilization and outcomes exist.


METHODS
Data from 1990 to 2004 collected in the National Hospital Discharge Survey were accessed. ACDF procedures were identified. Five-year periods of interest (POI) were created for temporal analysis and changes in the prevalence and utilization of this procedure as well as in patient- and healthcare-system-related variables were examined. The changes in the occurrence of procedure-related complications were evaluated.


RESULTS
An estimated total of 771,932 discharges after ACDF were identified. Temporally, an almost 8-fold increase in total prevalence was accompanied by a similar increase in utilization (23/100.000 civilians/POI to 157/100.000/civilians/POI). The highest increase in utilization was observed in those > or =65 years (28-fold). Average age increased from 47.2 years to 50.5 years over time. Length of hospital stay decreased from 5.17 days to 2.38 days. Overall procedure-related complication rates decreased from 4.6% to 3.03%. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, pulmonary, and coronary artery increased over time among patients undergoing ACDF.


CONCLUSIONS
Despite limitations inherent to secondary analysis of large databases, we identified a number of significant changes in the utilization, demographics, and outcomes associated with ACDF, which can be used to assess the effect of changes in medical care, direct health care resources, and future research. The effect of the increased prevalence of comorbidities on medical practice remains to be evaluated. Further studies are necessary to evaluate causal relationships.
Marawar
Satyajit
S
Department of Orthopedic Surgery, Division of Spine Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Girardi
Federico P
FP
Sama
Andrew A
AA
Ma
Yan
Y
Gaber-Baylis
Licia K
LK
Besculides
Melanie C
MC
Memtsoudis
Stavros G
SG
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D013123:Spinal Fusion / Q000379:methods* / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult