• Azeem Tariq Malik, Jack J Xie, Joseph P Drain, Elizabeth Yu, Safdar N Khan, and Jeffery Kim.
• Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH.
• Spine. 2021 Mar 15; 46 (6): 401407401-407.

Study DesignRetrospective observational study.ObjectiveThe aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals.Summary Of Background DataAlthough the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited.MethodsThe 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in "Neurosurgery" and "Orthopedics." The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals.ResultsA total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001).ConclusionDespite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.Level of Evidence: 3.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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