TY - JOUR
T1 - Utilization trends of cervical artificial disc replacement after FDA approval compared with anterior cervical fusion
T2 - Adoption of new technology
AU - Lu, Young
AU - McAnany, Steven J.
AU - Hecht, Andrew C.
AU - Cho, Samuel K.
AU - Qureshi, Sheeraz A.
PY - 2014/2/1
Y1 - 2014/2/1
N2 - STUDY DESIGN.: Epidemiologic study. OBJECTIVE.: To compare the utilization of anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) in terms of patient and hospital characteristics during the 3 years after Food and Drug Administration (FDA) approval of CDA devices in 2007. SUMMARY OF BACKGROUND DATA.: There was a surge in CDA adoption in the 3 years prior to FDA approval of CDA devices in 2007. However, utilization trends of CDA versus ACDF since the FDA approval are unknown. METHODS.: The Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the United States in the 3 years after FDA approval of CDA devices (2008-2010). The frequencies of CDA and ACDF were estimated, stratified by patient and hospital characteristics. Average length of hospital stay and total charges and costs were estimated. Multivariable analysis was performed to identify patient and hospital characteristics associated with CDA utilization. RESULTS.: In the 3 years after FDA approval of cervical disc devices, population-adjusted growth rates for CDA and ACDF were 4.9% and 11.8%, respectively (P = 0.6977). Female, African American and Medicaid patients were less likely to receive CDA. CDA was less likely to be performed in patients with cervical spondylotic changes and more likely to be performed in younger and healthier patients. CDA was less likely to be performed in the Midwestern United States or in public hospitals. CONCLUSION.: The prevalence of CDA increased in the 3 years after FDA approval with a growth rate that is approximately twice than that for ACDF. Although there seems to be CDA adoption, CDA growth seemed to have reached a plateau and ACDF still remained the dominant surgical strategy for cervical disc disease. Possible regional, racial, and sex disparities in CDA utilization and a more strict approach in the selection of CDA over traditional ACDF may have impeded rapid adoption of CDA.Level of Evidence: 3
AB - STUDY DESIGN.: Epidemiologic study. OBJECTIVE.: To compare the utilization of anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) in terms of patient and hospital characteristics during the 3 years after Food and Drug Administration (FDA) approval of CDA devices in 2007. SUMMARY OF BACKGROUND DATA.: There was a surge in CDA adoption in the 3 years prior to FDA approval of CDA devices in 2007. However, utilization trends of CDA versus ACDF since the FDA approval are unknown. METHODS.: The Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the United States in the 3 years after FDA approval of CDA devices (2008-2010). The frequencies of CDA and ACDF were estimated, stratified by patient and hospital characteristics. Average length of hospital stay and total charges and costs were estimated. Multivariable analysis was performed to identify patient and hospital characteristics associated with CDA utilization. RESULTS.: In the 3 years after FDA approval of cervical disc devices, population-adjusted growth rates for CDA and ACDF were 4.9% and 11.8%, respectively (P = 0.6977). Female, African American and Medicaid patients were less likely to receive CDA. CDA was less likely to be performed in patients with cervical spondylotic changes and more likely to be performed in younger and healthier patients. CDA was less likely to be performed in the Midwestern United States or in public hospitals. CONCLUSION.: The prevalence of CDA increased in the 3 years after FDA approval with a growth rate that is approximately twice than that for ACDF. Although there seems to be CDA adoption, CDA growth seemed to have reached a plateau and ACDF still remained the dominant surgical strategy for cervical disc disease. Possible regional, racial, and sex disparities in CDA utilization and a more strict approach in the selection of CDA over traditional ACDF may have impeded rapid adoption of CDA.Level of Evidence: 3
KW - Nationwide Inpatient Sample
KW - anterior cervical discectomy and fusion
KW - cervical disc arthroplasty
KW - demographics
KW - disparities
UR - http://www.scopus.com/inward/record.url?scp=84894040288&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000000113
DO - 10.1097/BRS.0000000000000113
M3 - Article
C2 - 24253777
AN - SCOPUS:84894040288
SN - 0362-2436
VL - 39
SP - 249
EP - 255
JO - Spine
JF - Spine
IS - 3
ER -