Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993–2015)

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OBJECTIVE

The objective of this study was to investigate revision burden and associated demographic and economic data for atlantoaxial (AA) fusion procedures in the US.

METHODS

Patient data from the National Inpatient Sample (NIS) database for primary AA fusion were obtained from 1993 to 2015, and for revision AA fusion from 2006 to 2014 using ICD-9 procedure codes. Data from 2006 to 2014 were used in comparisons between primary and revision surgeries. National procedure rates, hospital costs/charges, length of stay (LOS), routine discharge, and mortality rates were investigated.

RESULTS

Between 1993 and 2014, 52,011 patients underwent primary AA fusion. Over this period, there was a 111% increase in annual number of primary surgeries performed. An estimated 1372 patients underwent revision AA fusion between 2006 and 2014, and over this time period there was a 6% decrease in the number of revisions performed annually. The 65–84 year-old age group increased as a proportion of primary AA fusions in the US from 35.9% of all AA fusions in 1997 to 44.2% in 2015, an increase of 23%. The mean hospital cost for primary AA surgery increased 32% between 2006 and 2015, while the mean cost for revision AA surgery increased by 35% between 2006 and 2014. Between 2006 and 2014, the mean hospital charge for primary AA surgery increased by 67%; the mean charge for revision surgery over that same period increased by 57%. Between 2006 and 2014, the mean age for primary AA fusions was 60 years, while the mean age for revision AA fusions was 52 years. The mean LOS for both procedures decreased over the study period, with primary AA fusion decreasing by 31% and revision AA fusion decreasing by 24%. Revision burden decreased by 21% between 2006 and 2014 (mean 4.9%, range 3.2%–6.4%). The inpatient mortality rate for primary AA surgery decreased from 5.3% in 1993 to 2.2% in 2014.

CONCLUSIONS

The number of primary AA fusions between 2006 and 2014 increased 22%, while the number of revision procedures has decreased 6% over the same period. The revision burden decreased by 21%. The inpatient mortality rate decreased 62% (1993–2014) to 2.2%. The increased primary fusion rate, decreased revision burden, and decreased inpatient mortality determined in this study may suggest an improvement in the safety and success of primary AA fusion.

ABBREVIATIONS AA = atlantoaxial; ACDF = anterior cervical decompression and fusion; LOS = length of stay; NIS = National Inpatient Sample; PLIF = posterior lumbar interbody fusion; TLIF = transforaminal lumbar interbody fusion.
Article Information

Contributor Notes

Correspondence Comron Saifi: University of Pennsylvania Hospital System, Philadelphia, PA. comron.saifi@pennmedicine.upenn.edu.INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.11.SPINE19551.Disclosures Dr. Pugely reports being a consultant for Globus Medical and Medtronic. Dr. Ludwig reports support of non–study-related clinical or research effort from AOSpine, PACIRA Pharmaceuticals, an AOA Omega grant, and Thieme; ownership in the Maryland Development Corporation; being a consultant for DePuy Synthes, K2M, and Globus Medical; direct stock ownership in Innovative Surgical Design and Advance Spinal Intellectual Property; being a board member for Globus Medical, the American Board of Orthopaedic Surgery, the American Orthopaedic Association, the Cervical Spine Research Society, and the Society for Minimally Invasive Spine Surgery; and serving on the governing board of the Journal of Spinal Disorders and Techniques, The Spine Journal, and Contemporary Spine Surgery. Dr. Saifi reports direct stock ownership in Vertera/NuVasive.
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