Characteristics and outcomes of patients treated with cervical spine fusion at high volume hospitals

Background High volume (HV) has been associated with improved outcomes in various neurosurgical procedures. The objective of this study was to explore the regional distribution of HV spine centers for cervical spine fusion, and compare characteristics and outcomes or patients treated at HV centers versus lower volume centers. Methods The National Inpatient Sample (NIS) database 2016-2020 was queried for patients undergoing cervical spine fusion for degenerative pathology. High volume (HV) was defined as case-loads greater than two standard deviations above the mean. Patient characteristics, procedures, and outcomes were compared. Results Of 3,895 hospitals performing cervical spine fusion, 28 (0.76%) were HV. The Mid-Atlantic and West South Central region had the highest number of HV hospitals. HV hospitals were more likely to perform open anterior fusion surgeries (p < 0.01). Patients treated at HV hospitals were less likely to have severe symptomatology or comorbidities (p < 0.01 for all). When controlling for severity and demographics on multivariate analysis, HV centers had higher odds of length of stay ≤ 1 day, favorable discharge, and decreased total charges. Conclusion Patients who underwent cervical spine fusion surgery at high-volume hospitals were less complex and had increased odds of LOS ≤ 1, favorable discharge, and total charges in the lower 25th percentile than patients treated at non high-volume hospitals. Physician comfort, patient selection, institutional infrastructure, and geographic characteristics likely play a role.