High Volume Hospitals are Associated With Decreased Rates of Non-Routine Discharge Following Single-Level Cervical Disc Arthroplasty

Study Design: Retrospective cohort study. Objectives: This study aims to evaluate the impact of hospital volume on postoperative outcomes following single-level cervical disc arthroplasty (CDA), focusing on non-routine discharge rates, length of stay (LOS), and hospital costs. Methods: After applying the appropriate exclusion criteria, the National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients undergoing single-level CDA between 2016 and 2020. Patients were stratified by hospital volume into low, intermediate, and high categories based on annual case numbers. Multivariate logistic regression evaluated odds of non-routine discharge and complications, while linear regression analyzed LOS and hospital costs. Models were adjusted for age, sex, and comorbidities. Statistical significance was set at P < .05. Results: Patients in high-volume hospitals had significantly lower odds of non-routine discharge compared to both intermediate-volume (OR: 0.63, 95% CI: 0.44-0.91, P = .014) and low-volume hospitals (OR: 0.66, 95% CI: 0.45-0.98, P = .040). Patients in high-volume hospitals also incurred significantly higher costs compared to low-volume hospitals (coefficient: $1,232.22, 95% CI: $189.05-$2,275.38, P = .021), while length of stay did not differ significantly across volume categories. Conclusions: High-volume hospitals are associated with improved discharge outcomes, but also increased costs following single-level CDA. These findings underscore the need to disseminate high-volume center practices to lower-volume hospitals while addressing cost management. Further research should explore the impact of outpatient settings and long-term outcomes to enhance care delivery for CDA patients.