title: Spinal Surgeon Variation in Single-Level Cervical Fusion Procedures: A Cost and Hospital Resource Utilization Analysis.
abstract: METHODS
  Retrospective analysis.
  
  
  OBJECTIVE
  To compare perioperative costs and outcomes of patients undergoing single-level anterior cervical discectomy and fusions (ACDF) at both a service (orthopedic vs. neurosurgical) and individual surgeon level.
  
  
  BACKGROUND
  Hospital systems are experiencing significant pressure to increase value of care by reducing costs while maintaining or improving patient-centered outcomes. Few studies have examined the cost-effectiveness cervical arthrodesis at a service level.
  
  
  METHODS
  A retrospective review of patients who underwent a primary 1-level ACDF by eight surgeons (four orthopedic and four neurosurgical) at a single academic institution between 2013 and 2015 was performed. Patients were identified by Diagnosis-Related Group and procedural codes. Patients with the ninth revision of the International Classification of Diseases coding for degenerative cervical pathology were included. Patients were excluded if they exhibited preoperative diagnoses or postoperative social work issues affecting their length of stay. Comparisons of preoperative demographics were performed using Student t tests and chi-squared analysis. Perioperative outcomes and costs for hospital services were compared using multivariate regression adjusted for preoperative characteristics.
  
  
  RESULTS
  A total of 137 patients diagnosed with cervical degeneration underwent single-level ACDF; 44 and 93 were performed by orthopedic surgeons and neurosurgeons, respectively. There was no difference in patient demographics. ACDF procedures performed by orthopedic surgeons demonstrated shorter operative times (89.1 ± 25.5 vs. 96.0 ± 25.5 min; P = 0.002) and higher laboratory costs (Δ+$6.53 ± $5.52 USD; P = 0.041). There were significant differences in operative time (P = 0.014) and labor costs (P = 0.034) between individual surgeons. There was no difference in total costs between specialties or individual surgeons.
  
  
  CONCLUSIONS
  Surgical subspecialty training does not significantly affect total costs of ACDF procedures. Costs can, however, vary between individual surgeons based on operative times. Variation between individual surgeons highlights potential areas for improvement of the cost effectiveness of spinal procedures.
  
  
  METHODS
  4.
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Fady Y
authors: FY
authors: Hijji
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Dustin H
authors: DH
authors: Massel
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Benjamin C
authors: BC
authors: Mayo
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Ankur S
authors: AS
authors: Narain
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: William W
authors: WW
authors: Long
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Krishna D
authors: KD
authors: Modi
authors: Department of Health Systems Management, Rush University Medical Center, Chicago, IL.
authors: Rory M
authors: RM
authors: Burke
authors: Department of Health Systems Management, Rush University Medical Center, Chicago, IL.
authors: Jeff
authors: J
authors: Canar
authors: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Kern
authors: K
authors: Singh
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics* / Q000592:standards; D066231:Surgeons / Q000191:economics* / Q000592:standards