• Victor Gabriel El-Hajj, Abdul Karim Ghaith, Neil Nazar Al-Saidi, Ryan Nguyen, Karl J Habashy, and Adrian Elmi-Terander.
• Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
• World Neurosurg. 2024 Aug 31.

ObjectiveTo evaluate the short-term surgical outcomes and the reimbursement patterns, after treatment of type 2 odontoid fractures using the anterior or posterior approach.MethodsThe National Surgical Quality Improvement Program database was queried for surgically treated patients with type 2 odontoid fractures by the anterior or posterior approach between 2016 and 2020. Propensity score matching with the optimal approach was used to balance the cohorts.ResultsA total of 96 patients in the anterior and 352 patients in the posterior surgery group were included in the unmatched analysis. After propensity score matching 1:1, 96 anterior and 96 posterior cases were included in the matched analysis. Operative times were shorter in the anterior group (92.0 vs. 145.0 minutes, P < 0.001). The need for intraoperative or postoperative transfusions was higher in the posterior group (15% vs. 2.1%; P = 0.002). However, there were no significant differences in complications between groups (P > 0.05). Hospital stay was significantly longer in the posterior group (4.5 days vs. 3.0; P = 0.049). Nonroutine discharge was more frequent in the posterior group (55% vs. 40%, P = 0.030). However, the rate of 30-day readmission, reoperation, and mortality did not differ between groups (P > 0.05). Also, the work relative value units were significantly higher in the anterior group (22.7 vs. 20.6, P < 0.001), indicating higher reimbursement trends for this approach.ConclusionsIn this matched analysis, the anterior approach for type 2 odontoid fractures was superior to the posterior approach. The anterior approach was associated with significantly shorter operation times, hospital stays, fewer transfusions, nonroutine discharges, and higher reimbursements.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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