Length of Stay After 1 and 2-Level Anterior Cervical Discectomy and Fusion: The Impact of an Orthopedic Specialty Hospital.

Abstract

A retrospective cohort study. This study explores the impact of an orthopedic specialty hospital (OSH) on length of stay (LOS) in patients undergoing 1 and 2-level anterior cervical discectomy/decompression and fusion (ACDF). ACDF is a spine procedure whose associated financial burden is cause for evaluation. LOS is the strongest predictor of total ACDF cost. Patients who underwent 1 or 2-level elective, primary ACDF at an OSH and a tertiary referral center (TRC) were reviewed and propensity score-matched. A total of 77 TRC patients were matched to the OSH cohort, with 39 and 38 patients matched for a 1 and 2-level ACDF, respectively. Mean 1-level ACDF LOS at the TRC was 1.05 days compared with 1.00 day at the OSH (P=1.000). Mean LOS for 2-level ACDF patients at the TRC was 1.26 days compared with 1.03 days at the OSH (P=0.039). No patient who underwent a 1-level ACDF was readmitted within 90 days. Two patients who received a 2-level ACDF at the OSH were readmitted within 30 days (P=0.493). Performing 2-level ACDF at an OSH relative to a TRC is associated with reduced LOS without a difference in hospital readmissions. Selective utilization of an OSH may serve as an avenue for cost containment.