Volume and outcomes in posterior cervical fusion: Insights from a national inpatient analysis

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Context: Hospital procedural volume is often linked to outcomes and costs, but whether this relationship holds for posterior cervical fusion (PCF) remains unclear. Aims: The objective of this study was to evaluate whether hospital PCF volume is associated with complications, discharge disposition, and hospital costs. Settings and Design: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS) from 2016 to 2022. Subjects and Methods: Elective PCF encounters were analyzed, with hospitals stratified by annual PCF volume (low, intermediate, high). Survey-weighted multivariable logistic regression estimated odds of cardiovascular complications, overall adverse events, and nonroutine discharge; linear regression assessed total costs and lengths of stay (LOS). Models adjusted for demographic, clinical, and hospital covariates. Statistical Analysis Used: Survey-weighted regression with odds ratios (ORs), coefficients, and 95% confidence intervals (CIs). Significance was set at P < 0.05. Results: We included 163,230 weighted elective PCF cases. Baseline characteristics differed across volume groups ( P < 0.001) except for sex ( P = 0.163). Compared with low-volume hospitals, high-volume hospitals had higher odds of cardiovascular complications (OR 1.87, 95% CI 1.70–2.06, P < 0.001), overall adverse events (OR 1.30, 95% CI 1.21–1.40, P < 0.001), and non-routine discharge (OR 1.09, 95% CI 1.02–1.16, P = 0.008). High-volume hospitals were also associated with higher total costs (coefficient: $4298; 95% CI $3468–$5128; P < 0.001), with no significant difference in LOS ( P = 0.387). Conclusions: Hospital PCF volume is tied to complications, nonroutine discharges, and higher costs, challenging the volume–outcome paradigm and underscoring adjustment for patient complexity and case mix in benchmarking and allocation.

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