Single-level anterior cervical discectomy and fusion is associated with higher nonroutine discharge rates compared to cervical disc arthroplasty in obese patients.

Context: Obesity is a recognized risk factor for adverse outcomes in cervical spine surgery. While cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF), comparative outcomes among obese patients remain underexplored.

Aims: The aim of this study is to compare nonroutine discharge rates and other postoperative outcomes between obese patients undergoing single-level ACDF and CDA.

Settings And Design: Retrospective cohort study using a national database.

Subjects And Methods: The National Inpatient Sample was queried to identify obese patients who underwent single-level ACDF or CDA between 2016 and 2020. Inclusion and exclusion criteria were applied. Propensity score matching (1:3) was performed based on age, sex, race, Elixhauser Comorbidity Index, and primary diagnosis to create comparable cohorts. Outcomes included nonroutine discharge, length of stay (LOS), total cost, and postoperative complications.

Statistical Analysis Used: Chi-square tests and Student's t-tests were used for categorical and continuous outcomes, respectively, with significance set at < 0.05.

Results: After matching, 1455 ACDF and 485 CDA cases were analyzed. Obese patients undergoing ACDF had significantly higher nonroutine discharge rates (11.3% vs. 4.1%, = 0.037). ACDF patients had lower total costs ($16,400 vs. $19,400, = 0.003), with similar LOS (1.4 ± 0.1 days, = 0.931) and adverse event rates (7.6% vs. 8.2%, P = 0.827).

Conclusions: Obese patients undergoing ACDF experience higher nonroutine discharge rates compared to those receiving CDA. While CDA is associated with higher costs, it may offer superior discharge outcomes in this high-risk population.