{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:25:50Z","timestamp":1791044750684,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Catherine Sharpe Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: Anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) are common treatments for cervical radiculopathy. This study compared post-operative outcomes between ACDF and PCF utilizing the American College of Surgeons-National Surgical Quality Improvement Program database. Methods: An observational study following STROBE and TRIPOD + AI guidelines compared hospital resource utilization and quality of care between single-level ACDF and PCF (2005\u20132022). Primary outcomes compared operative time, length of stay (LOS), and post-operative complications. Propensity-scored stabilized inverse probability of treatment weighting adjusted for confounders, specifically demographics, lifestyle-related factors, pre-operative labs, pre-existing comorbidities, and surgery-related factors. Subgroup analysis compared baseline characteristics and outcomes, stratified by 30-day re-admission and re-operation. Results: PCF group demonstrated shorter LOS (MD \u22120.7 days, 95% CI \u22120.9 to \u22120.5 days, p &lt; 0.001), operative time (MD \u221232.9 min, 95% CI \u221235.7 to \u221230.1 min, p &lt; 0.001), higher rate of re-admission associated with overall SSI (PD 1.2%, 95% CI 0.7\u20131.7%, p &lt; 0.001), deep incisional SSI (PD 0.8%, 95% CI 0.4\u20131.2%, p &lt; 0.001), and organ\/space SSI (PD 0.3%, 95% CI 0.0\u20130.5%, p = 0.011). Furthermore, the PCF group had greater systemic sepsis (PD 0.8%, 95% CI 0.4\u20131.3%, p &lt; 0.001), overall post-operative SSI (PD 2.8%, 95% CI 2.0\u20133.6%, p &lt; 0.001), superficial SSI (PD 1.9%, 95% CI 1.2\u20132.5%, p &lt; 0.001), and deep incisional SSI (PD 0.8%, 95% CI 0.4\u20131.2%, p &lt; 0.001) rates. Subgroup analysis showed increased early post-operative re-operation rates in the PCF cohort (PD 23.4%, 95% CI 9.5\u201337.4%, p = 0.001) and increased early post-operative re-admission associated with post-operative overall SSI (PD 35.3%, 95% CI 22.7\u201348.0%, p &lt; 0.001). Conclusions: Although the PCF cohort demonstrated lower hospital utilization, it had reduced quality of care and increased post-operative complications.<\/jats:p>","DOI":"10.3390\/jcm14186438","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T12:08:16Z","timestamp":1757678896000},"page":"6438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Short-Term Differences in Hospital Resource Utilization and Quality of Care Between Anterior Cervical Discectomy and Fusion and Posterior Cervical Foraminotomy: A National Propensity-Scored Observational Study Utilizing the ACS-NSQIP Database"],"prefix":"10.3390","volume":"14","author":[{"given":"Jaskeerat","family":"Gujral","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3057-3550","authenticated-orcid":false,"given":"Jonathan H.","family":"Sussman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohannes","family":"Ghenbot","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Arena","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-8877","authenticated-orcid":false,"given":"Susanna","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6152-2510","authenticated-orcid":false,"given":"Hasan S.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang W.","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5201-6720","authenticated-orcid":false,"given":"Mert Marcel","family":"Dagli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/os.12285","article-title":"Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review","volume":"8","author":"Liu","year":"2016","journal-title":"Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s11420-011-9218-z","article-title":"Cervical radiculopathy: A review","volume":"7","author":"Caridi","year":"2011","journal-title":"HSS J."},{"key":"ref_3","unstructured":"Magnus, W., Viswanath, O., Viswanathan, V.K., and Mesfin, F.B. (2024). Cervical Radiculopathy, StatPearls."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1016\/j.spinee.2015.02.026","article-title":"Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: A propensity-matched analysis","volume":"15","author":"Lubelski","year":"2015","journal-title":"Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1097\/BRS.0b013e31819e2fd5","article-title":"Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005","volume":"34","author":"Wang","year":"2009","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1097\/BRS.0b013e318154c57e","article-title":"Anterior cervical discectomy and fusion associated complications","volume":"32","author":"Fountas","year":"2007","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S536","DOI":"10.4103\/2152-7806.148029","article-title":"Cervical laminoforaminotomy for radiculopathy: Symptomatic and functional outcomes in a large cohort with long-term follow-up","volume":"5","author":"Church","year":"2014","journal-title":"Surg. Neurol. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.1016\/j.spinee.2014.01.048","article-title":"Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy","volume":"14","author":"Skovrlj","year":"2014","journal-title":"Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.21037\/jss-21-39","article-title":"Single-level posterior cervical foraminotomy associated with increased incidence of early postoperative wound infection rates relative to anterior cervical discectomy with fusion and cervical disc arthroplasty","volume":"9","author":"Ng","year":"2023","journal-title":"J. Spine Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"418","DOI":"10.14444\/8447","article-title":"Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy","volume":"17","author":"Santangelo","year":"2023","journal-title":"Int. J. Spine Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1186\/s13018-020-01723-5","article-title":"Anterior cervical discectomy and fusion versus posterior cervical foraminotomy for the treatment of single-level unilateral cervical radiculopathy: A meta-analysis","volume":"15","author":"Fang","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e485","DOI":"10.1016\/j.wneu.2019.05.188","article-title":"Does the Neck Pain, Function, or Range of Motion Differ After Anterior Cervical Fusion, Cervical Disc Replacement, and Posterior Cervical Foraminotomy?","volume":"129","author":"Lin","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1097\/01.brs.0000217604.02663.59","article-title":"Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: Results in 292 patients with monoradiculopathy","volume":"31","author":"Korinth","year":"2006","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1055\/s-0034-1366914","article-title":"Participation in quality measurement nationwide","volume":"27","author":"Irani","year":"2014","journal-title":"Clin. Colon. Rectal Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1007\/s00464-011-1612-6","article-title":"Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: A multicenter analysis of 14,251 patients","volume":"25","author":"Gupta","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"7549","DOI":"10.1007\/s00464-022-09189-8","article-title":"Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery","volume":"36","author":"Ricciardi","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Stone, K., Zwiggelaar, R., Jones, P., and Mac Parthalain, N. (2022). A systematic review of the prediction of hospital length of stay: Towards a unified framework. PLoS Digit. Health, 1.","DOI":"10.1371\/journal.pdig.0000017"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/BF00996639","article-title":"Surgical unit time utilization review: Resource utilization and management implications","volume":"12","author":"Gordon","year":"1988","journal-title":"J. Med. Syst."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"415","DOI":"10.7326\/0003-4819-122-6-199503150-00003","article-title":"The association between the quality of inpatient care and early readmission","volume":"122","author":"Ashton","year":"1995","journal-title":"Ann. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1136\/bmj.301.6761.1139","article-title":"Can readmission rates be used as an outcome indicator?","volume":"301","author":"Milne","year":"1990","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/00005650-199905000-00008","article-title":"Hospital readmissions and quality of care","volume":"37","author":"Weissman","year":"1999","journal-title":"Med. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1089\/sur.2006.7.263","article-title":"Unplanned reoperations for infection complications: A survey for quality control","volume":"7","author":"Froschl","year":"2006","journal-title":"Surg. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/1062860607300652","article-title":"Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery?","volume":"22","author":"Kroon","year":"2007","journal-title":"Am. J. Med. Qual."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1001\/archsurg.136.4.405","article-title":"Is unplanned return to the operating room a useful quality indicator in general surgery?","volume":"136","author":"Birkmeyer","year":"2001","journal-title":"Arch. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1245\/s10434-019-07748-3","article-title":"Patient-Reported Outcomes: Understanding Surgical Efficacy and Quality from the Patient\u2019s Perspective","volume":"27","author":"Billig","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1177\/21925682211055094","article-title":"Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis","volume":"12","author":"Platt","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_29","first-page":"3982","article-title":"Minimally invasive posterior cervical foraminotomy vs. anterior cervical discectomy and fusion in the treatment of patients with single-level unilateral cervical radiculopathy","volume":"28","author":"Yang","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chahoud, J., Kanafani, Z., and Kanj, S.S. (2014). Surgical site infections following spine surgery: Eliminating the controversies in the diagnosis. Front. Med., 1.","DOI":"10.3389\/fmed.2014.00007"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107153","DOI":"10.1016\/j.ijscr.2022.107153","article-title":"Sweat contamination induced surgical site infections after spine surgery: Three case reports and literature review","volume":"94","author":"Ma","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1097\/BRS.0b013e3181a03013","article-title":"Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery","volume":"34","author":"Cohen","year":"2009","journal-title":"Spine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6438\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:44:36Z","timestamp":1760035476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186438"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186438","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]}}}