Spine Journal - 2026-06-01 - Journal Article
Outpatient anterior cervical discectomy and fusion on the rise: changing economics and utilization patterns in U.S. hospital-owned ambulatory surgical centers.
Ng MK, Mastrokostas LE, Mastrokostas PG, Podolski I, Baek G, Hitchner M, Razi AE, Woods B, Wilt Z, Alvarez AP, Dalton J, Cha TD, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK
Topics
Key Takeaway
Single-level ACDF volume in hospital-owned ASCs more than doubled from 33,687 cases in 2016 to 73,024 in 2021, with Medicare's share of payer mix expanding from 8.6% to 29% over the same period.
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Summary
This retrospective cross-sectional analysis of the NASS database characterized national trends in volume, payer mix, and inflation-adjusted charges for single-level ACDF (CPT 22551) performed in hospital-owned ASCs from 2016 to 2022. Case volume more than doubled over the study period, median patient age rose from 52 to 57 years, and Medicare's payer share increased from 8.6% to 29% while private insurance fell from 74% to 53%. Overall geometric mean charge was $57,600, with Western region procedures 41% more expensive than the Northeast and significant variation by payer and season.
Key Limitation
The NASS database is restricted to hospital-owned ASCs, excluding the large and growing independent ASC sector, which means the reported volume and cost trends likely underestimate true national ASC-based ACDF utilization.
Original Abstract
BACKGROUND CONTEXT
The migration of spine surgery to ambulatory surgical centers (ASCs) continues to expand, but national trends in the utilization and cost of anterior cervical discectomy and fusion (ACDF) in these settings remain understudied. This study evaluates trends in volume, payer mix, and inflation-adjusted charges for single-level ACDF procedures performed in hospital-owned ASCs across the United States.
PURPOSE
To characterize national trends in the utilization and inflation-adjusted cost of single-level ACDF procedures performed in hospital-owned ASCs from 2016 to 2022.
DESIGN
Retrospective cross-sectional study.
PATIENT SAMPLE
Adult patients undergoing single-level ACDF procedures at ASCs from the National Ambulatory Surgery Sample (NASS) database.
OUTCOME MEASURES
Our outcomes included outpatient procedure volumes, patient and facility demographics, and payer composition stratified by region and season.
METHODS
We conducted a retrospective cross-sectional analysis of the NASS database from 2016 to 2022, identifying single-level ACDF procedures using CPT code 22551. Adult patients undergoing outpatient surgery were included. Survey-weighted methods were used to generate national estimates. Generalized linear models assessed differences in inflation-adjusted per-procedure charges by payer, geographic region, and season. Volume and market share trends were evaluated using linear regression.
RESULTS
A total of 399,939 weighted single-level ACDF procedures were identified. Case volume increased from 33,687 in 2016 to 73,024 in 2021, with a slight decline in 2022. Median patient age increased from 52 to 57 years. The share of Medicare patients grew from 8.6% to 29%, while private insurance declined from 74% to 53%. The overall geometric mean cost was $57,600. Charges varied significantly by payer (p<.001), region (p<.001), and season (p<.001). Procedures in the West were 41% more expensive than in the Northeast. Medicare exhibited the fastest growth in both volume and cost.
CONCLUSION
ASC-based ACDF procedures have increased substantially, with increasing median patient age, Medicare relative to private patients, and regional cost variation. These findings have important implications for surgical planning, reimbursement, and policy development.
LEVEL OF EVIDENCE
III.