PT - JOURNAL ARTICLE AU - Weir, Tristan B. AU - Usmani, M. Farooq AU - Camacho, Jael AU - Sokolow, Michael AU - Bruckner, Jacob AU - Jazini, Ehsan AU - Jauregui, Julio J. AU - Gopinath, Rohan AU - Sansur, Charles AU - Davis, Randy AU - Koh, Eugene Y. AU - Banagan, Kelley E. AU - Gelb, Daniel E. AU - Buraimoh, Kendall AU - Ludwig, Steven C. TI - Effect of Surgical Setting on Cost and Hospital Reported Outcomes for Single-Level Anterior Cervical Discectomy and Fusion AID - 10.14444/8092 DP - 2021 Aug 01 TA - International Journal of Spine Surgery PG - 701--709 VI - 15 IP - 4 4099 - https://www.ijssurgery.com/content/15/4/701.short 4100 - https://www.ijssurgery.com/content/15/4/701.full SO - Int J Spine Surg2021 Aug 01; 15 AB - Background: Hospitals seek to reduce costs and improve patient outcomes by decreasing length of stay (LOS), 30-day all-cause readmissions, and preventable complications. We evaluated hospital-reported outcome measures for elective single-level anterior cervical discectomy and fusions (ACDFs) between tertiary (TH) and community hospitals (CH) to determine location-based differences in complications, LOS, and overall costs.Methods: Patients undergoing elective single-level ACDF in a 1-year period were retrospectively reviewed from a physician-driven database from a single medical system consisting of 1 TH and 4 CHs. Adult patients who underwent elective single-level ACDF were included. Patients with trauma, tumor, prior cervical surgery, and infection were excluded. Outcomes measures included all-cause 30-day readmissions, preventable complications, LOS, and hospital costs.Results: A total of 301 patients (60 TH, 241 CH) were included. CHs had longer LOS (1.25 ± 0.50 versus 1.08 ± 0.28 days, P = .01). There were no differences in complication and readmission rates between hospital settings. CH, orthopaedic subspecialty, female sex, and myelopathy were predictors for longer LOS. Overall, costs at the TH were significantly higher than at CHs ($17 171 versus $11 737; Δ$ = 5434 ± 3996; P < .0001). For CHs, the total costs of drugs, rooms, supplies, and therapy were significantly higher than at the TH. TH status, orthopaedic subspecialty, and myelopathy were associated with higher costs.Conclusion: Patients undergoing single-level ACDFs at CHs had longer LOS, but similar complications and readmission rates as those at the TH. However, cost of ACDF was 1.5 times greater in the TH. To improve patient outcomes, optimize value, and reduce hospital costs, modifiable factors for elective ACDFs should be evaluated.Level of Evidence: 3.