Synthetic cages associated with increased rates of revision surgery and higher costs compared to allograft in acdf in the nonelderly patient

Objective: The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology. Methods: We queried a private claims database to identify adult patients (≤ 65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p < 0.05. Results: A total of 26, 754 patients were included in the study. 11, 514 patients (43%) underwent ACDF with structural allograft and 15, 240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of all-cause reoperation compared to the allograft group (9. 1% vs. 8. 0%, p = 0. 002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23, 475 vs. $20, 836, p < 0. 001). Conclusion: Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.