Variation in Outcomes Following ACDF Performed by Orthopedic and Neurosurgery-Trained Surgeons: A Propensity Score-Matched Single-Institution Analysis.

Abstract

ACDF is performed by both orthopedic and neurosurgery-trained surgeons, but prior studies comparing outcomes across specialties are limited to 30-day endpoints and multi-institution databases. To compare outcomes between orthopedic and neurosurgery-performed ACDF at a single institution. Retrospective propensity score-matched cohort study. 662 pairs (N=1,324) undergoing ACDF at a single academic medical center from 2016-2023. Operative and hospital course duration, 30- and 90-day readmission, 90-day complications, opioid fills at 31-180 days, and one-year complications. Adults undergoing ACDF (CPT 22551) were identified from an institutional database. Surgeons below the 50th percentile of annual volume (<5.2 cases/year) were excluded. Matching (1:1) incorporated age, sex, BMI, ASA class, Van Walraven Elixhauser comorbidity score, procedure setting, insurance type, fusion levels, myelopathy, and surgeon volume. Neurosurgery cases had longer surgery duration (3.38 vs. 2.71 h) and anesthesia time (4.22 vs. 3.40 h; both p<0.001). Length of stay was longer in neurosurgery (2.84 vs. 2.05 days; p<0.001), as were 30-day (9.8% vs. 5.9%; p=0.008) and 90-day (13.7% vs. 8.6%; p=0.003) postoperative readmission rates. The 90-day complication rate was higher in neurosurgery (22.1% vs. 16.9%; p=0.018). Neurosurgery cases had higher opioid fill rates at 31-90 days (25.8% vs. 19.6%; p=0.007) and 91-180 days (19.6% vs. 14.2%; p=0.008) post-operatively. The pattern of short-term differences and long-term convergence suggests differences in perioperative management instead of surgical proficiency. Hospitals performing ACDF across both specialties should standardize perioperative protocols.