OBJECTIVES: Cervical disc arthroplasty (CDA) was developed as an alternative to cervical spine fusion (CSF). It is hoped that CDA will significantly reduce the occurrence of adjacent segment disease common in CSF patients. Yet, little is known about the immediate complication rates between the two surgeries. The purpose of this study is compare the in-hospital complication rates between CDA and CSF patients.  METHODS: Data from the 2002-2013 Nationwide Inpatient Sample releases were analyzed. 3,938 CDA patients and 361,297 CSF patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 84.62 and 81.02/81.03 procedure codes, respectively. Using a previously reported classification system, ICD-9-CM diagnosis codes were utilized to classify major or minor in-hospital complications. CDA and CSF patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities, and pre-operative severity/loss of function. Unadjusted and adjusted minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression. RESULTS: Exact matches were identified for 3,846 (97.6%) CDA patients, with a mean age of 46.5 years. The major in-hospital complication rate for CDA patients was 2.4% (92 of 3,846) versus 2.7% (102 of 3,846) for CSF patients (p=.47). The minor complication rate for CDA was 2.2% (85 of 3,846) compared to 2.6% (99 of 3,846) for CSF (p=0.30). Fewer than 10 patients in either group died (p=1.00). When adjusted for case-mix, there were no significant differences in the risk of major in-hospital complications between groups [OR: 0.91 (95% CI: 0.68-1.22), p=0.51]. There were also no significant differences in minor complication risks between the groups [OR: 0.76 (95% CI 0.55-1.05); p=0.10]. CONCLUSIONS: After adjusting for patient factors, there was no difference in the rate of major or minor complications or mortality between patient groups.