Cost of Admission Predictors for 3-level Anterior Cervical Discectomy and Fusion

Introduction: Anterior cervical discectomy and fusion (ACDF) is a versatile operation that treats degenerative disc disease, cervical myelopathy, and spinal canal stenosis. Performed over 130,000 times each year in the United States, ACDF is a very common surgery that can constitute a significant area of healthcare spending. Compared to single- and 2-level ACDF, however, the costs of admission (COA) for ACDF spanning three intervertebral levels for multilevel spinal disease are not well understood. To improve healthcare resource efficiency and promote value-based care within spine surgery, this study examined specific predictors of COA for patients undergoing 3-level ACDF.

Methods: All patients undergoing 3-level ACDF from 2013 to 2023 were retrospectively identified. Patient demographics, medical history, presenting symptoms, surgery characteristics, and postoperative outcomes were collected. COA included operative, supply, and hospital stay costs, and was calculated by the Johns Hopkins Core for Clinical Research Data Acquisition. Univariable analysis was conducted for each variable with COA as the primary outcome of interest. Variables significant at p< 0.10 were subsequently incorporated in a multivariable regression model for COA.

Results: A total of 118 patients were included in the cohort. The mean age was 58.0±11.0 years, and 64 (54.2%) of the patients were male. The median (interquartile range) COA was $34,900 ($10,238). In the multivariable model, significantly increased COA was observed for the C5-T1 operative levels (β=$36,270, 95% CI $21,620–$50,920, p< 0.001), patients with total functional dependence (β=$14,346, 95% CI $765–$27,926, p=0.039), longer postoperative hospital stays (≥7 days: β=$63,179, 95% CI $42,462–$83,897, p< 0.001), and non-home discharge to acute inpatient rehabilitation or a skilled nursing facility (β=$30,749, 95% CI $12,162–$49,335, p=0.001).

Conclusion : Specific operative levels, patient functional status, postoperative hospital lengths of stay, and non-home discharge are significantly correlated with the COA of 3-level ACDF. Knowledge of these cost factors can help clinicians and healthcare systems work towards greater resource efficiency and high value-based care within the field of spine surgery.