Variation in Outcomes Following ACDF Performed by Orthopedic and Neurosurgery-Trained Surgeons: A Propensity Score-Matched Single-Institution Analysis.

BACKGROUND CONTEXT: ACDF is performed by both orthopedic and neurosurgery-trained surgeons, but prior studies comparing outcomes across specialties are limited to 30-day endpoints and multi-institution databases. PURPOSE: To compare outcomes between orthopedic and neurosurgery-performed ACDF at a single institution. DESIGN: Retrospective propensity score-matched cohort study. PATIENT SAMPLE: 662 pairs (N=1,324) undergoing ACDF at a single academic medical center from 2016-2023. OUTCOME MEASURES: Operative and hospital course duration, 30- and 90-day readmission, 90-day complications, opioid fills at 31-180 days, and one-year complications. METHODS: Adults undergoing ACDF (CPT 22551) were identified from an institutional database. Surgeons below the 50th percentile of annual volume (<5.2 cases/year) were excluded. Matching (1:1) incorporated age, sex, BMI, ASA class, Van Walraven Elixhauser comorbidity score, procedure setting, insurance type, fusion levels, myelopathy, and surgeon volume. RESULTS: Neurosurgery cases had longer surgery duration (3.38 vs. 2.71 h) and anesthesia time (4.22 vs. 3.40 h; both p<0.001). Length of stay was longer in neurosurgery (2.84 vs. 2.05 days; p<0.001), as were 30-day (9.8% vs. 5.9%; p=0.008) and 90-day (13.7% vs. 8.6%; p=0.003) postoperative readmission rates. The 90-day complication rate was higher in neurosurgery (22.1% vs. 16.9%; p=0.018). Neurosurgery cases had higher opioid fill rates at 31-90 days (25.8% vs. 19.6%; p=0.007) and 91-180 days (19.6% vs. 14.2%; p=0.008) post-operatively. CONCLUSIONS: The pattern of short-term differences and long-term convergence suggests differences in perioperative management instead of surgical proficiency. Hospitals performing ACDF across both specialties should standardize perioperative protocols.