Regional differences in prolonged non-operative therapy utilization prior to primary ACDF surgery

• Published in: Journal of clinical neuroscience Vol. 80; pp. 143 - 151
• Main Authors: Davison, Mark A., Lilly, Daniel T., Eldridge, Cody M., Singh, Ravinderjit, Bagley, Carlos, Adogwa, Owoicho
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.10.2020
• Subjects: ACDF; Adult; Cervical stenosis; Cervical Vertebrae - surgery; Conservative Treatment - economics; Conservative Treatment - methods; Conservative Treatment - statistics & numerical data; Constriction, Pathologic - therapy; Diskectomy - economics; Diskectomy - methods; Diskectomy - statistics & numerical data; Female; Healthcare utilization; Humans; Middle Aged; Non-operative therapy; Opioid analgesics; Regional differences; Retrospective Studies; Spinal Diseases - epidemiology; Spinal Diseases - therapy; Spinal fusion; Spinal Fusion - economics; Spinal Fusion - methods; Spinal Fusion - statistics & numerical data; Treatment Outcome; United States - epidemiology; United States; Cervical stenosis; ACDF; Healthcare utilization; Non-operative therapy; Opioid analgesics; Spinal fusion; Regional differences
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2020.07.056

•A total of 15,825 index 1, 2, or 3-level ACDF surgeries met inclusion criteria.•Significant regional variation existed in conservative therapy use prior to ACDF.•The greatest proportion of opioid users were from the South and the West regions.•The South and the Midwest had the greatest average dollars billed per patient. There is a paucity of data characterizing regional variations in the utilization and costs of conservative management in patients suffering from cervical stenosis prior to anterior cervical discectomy and fusion (ACDF) surgery. An understating of these regional trends becomes critical as outcomes-based reimbursement strategies become standard. The objective of this investigation was to evaluate for regional differences in the utilization and overall costs of maximal non-operative therapy (MNT) prior to ACDF surgery. Medical records from patients with symptomatic cervical stenosis undergoing a ≤3-level index ACDF procedure between 2007 and 2016 were accessed from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected U.S. Census Bureau definitions. MNT utilization within 2-years prior to ACDF surgery was analyzed. An index ACDF surgery was performed in 15,825 patients. Patient regional breakdown was as follows: South (67.6% of patients), Midwest (21.8% of patients), West (8.9% of patients), Northeast (1.6% of patients). Regional variations were identified in the number of patients utilizing NSAIDs (p < 0.001), opioids (p < 0.001), muscle relaxants (p < 0.001), cervical epidural steroid injections (p = 0.001), physical therapy/occupational therapy treatments (p < 0.001), and chiropractor visits (p < 0.001). The West (64.5%) and South (63.5%) had the greatest proportion of patients utilizing narcotics. When normalized by the number of opioid using-patients however, the Northeast (691.4 pills/patient) and South (674.4 pills/patient) billed for the most opioid pills. The total direct cost associated with all MNT prior to index ACDF was $17,255,828. The Midwest ($1,277.72 per patient) and South ($1,047.86 per patient) had the greatest average dollars billed.