Impact of Incidental Durotomy on Health Care Resource Utilization Following Posterior Cervical Decompression and Fusion

Study Design Retrospective cohort study. Objectives To evaluate the national incidence and hospitalization impact of incidental durotomy following elective posterior cervical decompression and fusion (PCDF), with respect to complications, length of stay (LOS), costs, and discharge disposition. Methods Adults undergoing elective PCDF were identified in the 2016–2022 National Inpatient Sample. Propensity score matching paired durotomy cases with controls at a 1:5 ratio using demographic, comorbidity, hospital, and procedural characteristics. Survey-weighted comparisons and multivariable regression evaluated complications, length of stay (LOS), hospitalization costs, and discharge disposition. Statistical significance was set at P < 0.05. Results The weighted cohort comprised 167,995 encounters, including 2,525 (1.5%) with incidental durotomy. After matching, weighted counts were 12,625 controls and 2,525 durotomy encounters. The durotomy cohort had more complications (41.2% vs 26.5%), longer LOS (7.82 vs 4.34 days), higher hospitalization costs ($65,292 vs $41,196), and more non-routine discharge (59.0% vs 47.7%). Adjusted analyses demonstrated higher odds of complications (OR, 2.03) and non-routine discharge (OR, 1.66), as well as longer LOS (adjusted mean ratio, 1.80) and higher costs (adjusted mean ratio, 1.59; all P <0.001). Conclusions Incidental durotomy was coded in 1.5% of elective PCDF admissions and was associated with greater inpatient morbidity and resource utilization after matching and adjustment. These findings may inform patient counseling, perioperative planning, and anticipation of discharge support needs. Potential coding inaccuracies and residual confounding inherent to administrative data limit causal interpretation.