At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference on June 14, Richard Wohns, MD, JD, MBA, of NeoSpine in the Puget Sound Region of Washington, explored the safety, outcomes and cost effectiveness out of cervical disc arthroplasty.
1. Safety. Dr. Wohns has been performing cervical disc arthroplasties in the outpatient environment since 2009. The average operating room time is under 60 minutes and patients usually need only three hours of postoperative recovery before discharge. In comparison to anterior cervical discectomy and fusion, arthroplasty has less bone bleeding.
2. Outcomes. Total disc replacement patients in comparison with fusion had no reoperation due to implant breakage or failure. Anterior cervical discectomy and fusion patients are more likely to experience pseudoarthritis. In five years, 14.5 percent of ACDF patients were subject to reoperation and 2.9 percent of TDR patients were subject to reoperation. Arthroplasty has recovery time of about a month, while fusion patients can take six months to a year to recover. "The whole picture of doing arthroplasties in the outpatient setting makes sense when you can get patients back to their active lifestyle in a month," said Dr. Wohns.
Patients that are candidates for outpatient cervical disc arthroscopy tend to be younger, healthy and low risk for complication. The patients included in Dr. Wohns' study had one or two level cervical disc herniation, cervical radiculopathy and failed to respond to conservative treatment. The mean age of the patients was 46. The patient group was 56 percent female and 44 percent male.
Patients showed a 92 percent improvement rate. There were no worsened symptoms, no transfers to a hospital, no postoperative emergency room visits and no late hospitalizations. Of the 132 cases, there was one case of superficial infection, one case of dysphagia, zero cases on hoarseness, zero cases of vocal cord paralysis and no neurological worsening.
3. Cost effectiveness. Dr. Wohns compared the cost of ACDF performed in an inpatient setting compared to the cost of arthroplasty performed in the outpatient arena. He found that the total bill for ACDF is $68,000 and the average insurance payment is $48,000. The total cost of outpatient arthroplasty is $31,016 and the average insurance payment is $17,000. The implant cost for ACDF in an inpatient environment is $32,613 and the implant cost for an outpatient arthroscopy is $8,125. "The cost savings of cervical disc arthroplasty are great than 50 percent when compared to hospital inpatient costs," said Dr. Wohns.
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2. Outcomes. Total disc replacement patients in comparison with fusion had no reoperation due to implant breakage or failure. Anterior cervical discectomy and fusion patients are more likely to experience pseudoarthritis. In five years, 14.5 percent of ACDF patients were subject to reoperation and 2.9 percent of TDR patients were subject to reoperation. Arthroplasty has recovery time of about a month, while fusion patients can take six months to a year to recover. "The whole picture of doing arthroplasties in the outpatient setting makes sense when you can get patients back to their active lifestyle in a month," said Dr. Wohns.
Patients that are candidates for outpatient cervical disc arthroscopy tend to be younger, healthy and low risk for complication. The patients included in Dr. Wohns' study had one or two level cervical disc herniation, cervical radiculopathy and failed to respond to conservative treatment. The mean age of the patients was 46. The patient group was 56 percent female and 44 percent male.
Patients showed a 92 percent improvement rate. There were no worsened symptoms, no transfers to a hospital, no postoperative emergency room visits and no late hospitalizations. Of the 132 cases, there was one case of superficial infection, one case of dysphagia, zero cases on hoarseness, zero cases of vocal cord paralysis and no neurological worsening.
3. Cost effectiveness. Dr. Wohns compared the cost of ACDF performed in an inpatient setting compared to the cost of arthroplasty performed in the outpatient arena. He found that the total bill for ACDF is $68,000 and the average insurance payment is $48,000. The total cost of outpatient arthroplasty is $31,016 and the average insurance payment is $17,000. The implant cost for ACDF in an inpatient environment is $32,613 and the implant cost for an outpatient arthroscopy is $8,125. "The cost savings of cervical disc arthroplasty are great than 50 percent when compared to hospital inpatient costs," said Dr. Wohns.
More Articles on Spine:
Drs. Richard Kube & David Rothbart: 3 Key Considerations for the Transition of Spine to ASCs
5 Commonly Neglected Risks of Offering Innovative Spine Surgery
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