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Trends in use, outcomes, and revision procedures of anterior cervical disc replacement in the United States: a premiere database analysis from 2006–2019

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Abstract

Purpose

We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures.

Methods

In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor.

Results

A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034).

Conclusion

PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Lisa Oezel, Stavros G. Memtsoudis, Manuel Moser, Dominik Adl Amini, Jashvant Poeran, Jennifer Shue & Andrew A. Sama

  2. Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany

    Lisa Oezel

  3. Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Stavros G. Memtsoudis, Haoyan Zhong & Jiabin Liu

  4. Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland

    Manuel Moser

  5. Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Dominik Adl Amini

  6. Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/ Department of Orthopedics/ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L.Levy Pl, New York, NY, 10029, USA

    Jashvant Poeran

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  1. Lisa Oezel
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Corresponding author

Correspondence to Andrew A. Sama.

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Competing interests

SGM is a one-time consultant for Teikoku. He is owner of a US Patent for a Multicatheter Infusion System. US-2017-0361063. He is the owner of SGM Consulting, LLC and co-owner of FC Monmouth, LLC. None of the above relations influenced the conduct of the present study. AAS has following healthcare industry relationships: Clariance, Inc.—Consultant; Scientific Advisory Board, Centinel Spine (Vbros Venture Partners V)—Ownership Interest, Depuy Synthes Products, Inc. (a Johnson & Johnson Company)—Advisory Board; Consultant; ISPH II, LLC -Ownership Interest, Kuros Biosciences- Consultant; Strategic Advisory Board, Medical Device Business Services, Inc (f/d/b/a DePuy Synthese, Inc.)- Advisory Board; Consultant; Designer, Ortho Development Corp.—Consultant; Designer; Royalties, Vestia Ventures MiRus Investment, LLC- Ownership Interest. All other authors declare no competing interest.

Ethics approval

This study was approved by the hospital’s Institutional Review Board (IRB #2012-050), and written informed consent was waived given the de-identified nature of the data.

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Appendices

Appendix 1

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Table 3 Procedure codes
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Appendix 2

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Table 4 Diagnosis Codes
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Oezel, L., Memtsoudis, S.G., Moser, M. et al. Trends in use, outcomes, and revision procedures of anterior cervical disc replacement in the United States: a premiere database analysis from 2006–2019. Eur Spine J 32, 667–681 (2023). https://doi.org/10.1007/s00586-022-07465-8

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  • DOI: https://doi.org/10.1007/s00586-022-07465-8

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