{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:22:55Z","timestamp":1793301775641,"version":"4.5.0"},"reference-count":17,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate national trends in utilization and inflation-adjusted charges for single-level posterior cervical decompression and fusion (PCDF) performed in hospital-owned ambulatory surgery centers (ASCs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The National Ambulatory Surgery Sample was queried from 2016 to 2022 for adult ASC encounters with CPT 22600, corresponding to single-level posterior cervical fusion. Survey-weighted methods estimated national volumes and modeled adjusted charges using generalized linear models. Statistical significance was set at\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A weighted total of 8,609 single-level PCDF procedures were performed in hospital-owned ASCs from 2016 to 2022 (unweighted n = 6,505). Annual volume increased from 577 cases in 2016 to 3,307 cases in 2021 before declining to 1,586 cases in 2022. Median inflation-adjusted charges rose from $41,697 in 2016 to $69,255 in 2022 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Adjusted mean charges varied significantly by payer and region, with higher charges for private insurance versus Medicaid ($62,621 vs $50,095,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and for the West versus the Northeast ($93,278 vs $19,847,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), based on adequate regional sample sizes (unweighted n = 653 and n = 1,557, respectively). Medicare demonstrated the fastest annual charge growth, higher than Medicaid (+10.35%\/year,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004), private (+12.31%\/year,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and Other (+11.87%\/year,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Outpatient PCDF adoption in ASCs rose sharply from 2016 to 2021 with persistent, pronounced regional and payer-associated charge variation. These findings suggest that geographic pricing ecosystems and payer dynamics are key drivers of outpatient PCDF economics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261466191","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:42:27Z","timestamp":1783406547000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["The First Wave: National Adoption and Economic Shifts of Posterior Cervical Decompression and Fusion in Hospital-Owned Ambulatory Surgery Centers"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5831-055X","authenticated-orcid":false,"given":"Mitchell K.","family":"Ng","sequence":"first","affiliation":[{"name":"Rothman Orthopaedic Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8926-3502","authenticated-orcid":false,"given":"Leonidas 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