Health care burden of anterior cervical spine surgery: National trends in hospital charges and length of stay, 2000-2009

Study Design: A retrospective review. Objective: Our goals were: (1) to document national trends in total hospital charges and length of stay (LOS) associated with anterior cervical spine procedures from 2000 through 2009 and (2) to evaluate how those trends relate to demographic factors. Summary of Background Data: Since 2000, the number of anterior cervical spine procedures has increased dramatically in the United States. MATERIALS AND Methods: We reviewed 86,622,872 hospital discharge records (2000-2009) from the Nationwide Inpatient Sample and used ICD-9-CM codes to identify anterior cervical spine procedures (927,103). We assessed those records for outcomes (total hospital charges, LOS) and covariates (age, sex, race/ethnicity, insurance status, geographic location, comorbidities, presence of traumatic cervical spine injury on admission) of interest and determined (with multivariable linear regression models) the independent effects of covariates on outcomes (significance, P<0.05). Results: From 2000 through 2009, yearly charges significantly increased ($1.62 billion to $5.63 billion, respectively) and LOS significantly decreased (2.23±0.043 d to 2.20±0.045 d, respectively). The average hospital charges increased yearly after adjustment for covariates. All covariates but age were significant, independent predictors of hospital charges and LOS. Conclusions: To our knowledge, this investigation is the first to identify the significant demographic predictors of hospital charges and LOS associated with anterior cervical spine surgery.