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ACDF found to have higher costs, reoperation rates than cervical total disc replacement

Reoperation-free survivorship rates at 4 years were 91% for ACDF, 95% for cervical disc replacement.

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NEW ORLEANS — Using the Blue Health Intelligence Database, investigators from the Rothman Institute and Texas Back Institute found higher reoperation rates and acute and increased acute and long-term costs associated with anterior cervical discectomy and fusion compared to cervical disc replacement performed in patients with single-level disc disease.

“Looking at real-world empirical data outside of Investigational Device Exemption-study conditions, there was a lower rate of reoperation in cervical arthroplasty vs. anterior cervical discectomy and fusion [ACDF] group,” Kris E. Radcliff, MD, of the Rothman Institute at Thomas Jefferson, in Philadelphia, said. “There was a higher cost at 90 days and at the 48-month follow-up period in the ACDF group, and even excluding the cost of the index procedure, the maintenance costs were also higher in the ACDF group.”

Radcliff presented the study findings at the North American Spine Society Annual Meeting, here.

Kris E. Radcliff

Complication rates

In their retrospective matched cohort analysis, Radcliff and colleagues used ICD-9 codes to identify 327 patients who underwent cervical disc arthroplasty and 6,635 patients who had an ACDF as an index surgical procedure for single-level cervical disc disease following 6 weeks of conservative care. The investigators compared the groups for direct costs including adverse events, reoperation rates up to 90 days after surgery and total costs at the longest available follow-up.

Comparing baseline factors, although patients in the ACDF group were about 3 years older than the arthroplasty group, the investigators identified no significant differences between the groups for gender distribution, incidence of comorbidities, readmission rates up to 90 days and average follow-up of about 26 months. At follow-up, there were no significant differences between the groups for pain-related complications and the rate of dysphasia was 0% at 24 months in both groups.

The investigators, however, discovered an increased rate of mechanical complications and a statistically significant increased incidence of adverse events in the ACDF group compared to the arthroplasty cohort. They also determined the cumulative incidence of reoperation at 4 years was 10% in the ACDF group and 5.7% in the arthroplasty group.

“The reoperation-free survival on the Kaplan-Meier curve showed a difference of 95% for cervical arthroplasty vs. 91% ACDF,” Radcliff said.

Costs compared

Regarding the costs of the procedures, the researchers found index procedure costs and costs at each subsequent follow-up visit were lower in the arthroplasty cohort compared to the ACDF cohort.

“As a result, the total costs were lower in the cervical arthroplasty group — $34,000 on average at 48 months vs. $39,000 in the ACDF group,” Radcliff said at the meeting. “We also identified a cost savings in the total cost per patient per month excluding the cost of the index procedure, and that was also lower in the cervical arthroplasty group at $1,600 vs. $2,000,” he said. – by Gina Brockenbrough, MA