The First Wave: National Adoption and Economic Shifts of Posterior Cervical Decompression and Fusion in Hospital-Owned Ambulatory Surgery Centers

Study Design Retrospective cross-sectional study. Objective 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). Methods 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 P < 0.05. Results 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 ( P < 0.001). Adjusted mean charges varied significantly by payer and region, with higher charges for private insurance versus Medicaid ($62,621 vs $50,095, P < 0.001) and for the West versus the Northeast ($93,278 vs $19,847, P < 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, P = 0.004), private (+12.31%/year, P < 0.001), and Other (+11.87%/year, P < 0.001). Conclusions 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.