Journal Article

Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity

Ames, Christopher P, Moriates, Christopher, Ratliff, John, Gonzales, Ralph, Dudley, R Adams, Zygourakis, Corinna C, Liu, Caterina Y, Keefe, Malla, Mummaneni, Praveen V

2018

Overview

Abstract BACKGROUND Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity. OBJECTIVE To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery. METHODS The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses. RESULTS The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05). CONCLUSION The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.

• Publisher: Oxford University Press,Copyright by the Congress of Neurological Surgeons,Wolters Kluwer Health, Inc
• Subject: Adult / Adults / Aged / Cohort Studies / Databases, Factual - trends / Female / Hospital costs / Hospital Costs - trends / Hospitalization - economics / Hospitalization - trends / Humans / Length of Stay - trends / Male / Middle Aged / Multivariate Analysis / Neurosurgery / Neurosurgical Procedures - economics / Neurosurgical Procedures - trends / Spinal Diseases - economics / Spinal Diseases - epidemiology / Spinal Diseases - surgery / Spinal Fusion - economics / Spinal Fusion - trends / Spine / Surgery / Surgical techniques / United States - epidemiology