title: Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis.
abstract: METHODS
  Retrospective database review.
  
  
  OBJECTIVE
  To determine the variability in cost and surgical technique by geographic region and patient demographic.
  
  
  BACKGROUND
  Some patients with idiopathic scoliosis (IS) ultimately require surgical treatment. The costs associated with hospitalization can be substantial, yet it is unknown how these vary depending on geographic region.
  
  
  METHODS
  Patients aged 10 to 24 who underwent surgical fusion for idiopathic scoliosis from 2004 to 2006 were identified in a publicly available, searchable national database of insurance billing records for patients with orthopaedic diagnoses (PearlDiver Patient Record Database) by searching ICD-9 diagnosis and procedure codes. Inpatient hospital charges for the procedure, length of stay (LOS), and surgical procedure (anterior, posterior, anterior-posterior, posterior interbody) were recorded. Patients were stratified by geographic region (Northeast, South, Midwest, West) and age group (10-14, 15-19, and 20-24).
  
  
  RESULTS
  Seventy-six thousand seven hundred forty-one patients had IS and 955 patients had spinal fusion procedure codes. Per patient average charge (PPAC) was $113,303 with average LOS 5.6 days. There was no significant difference in procedure type based on geographic region or age. The Northeast had the lowest rate of posterior surgery and highest rate of anterior only procedures. The Midwest had the highest rate of anterior-posterior surgery and Northeast had the lowest. Patients age 10 to 14 had the highest rate of posterior only procedures, those age 20 to 24 had the lowest. Patients age 15 to 19 were more likely to have anterior only procedures. Taken together, anterior-posterior and posterior interbody techniques were most common in patients age 20 to 24. Inpatient hospital charges varied significantly from region to region. Charges were highest in the West ($152,637) and lowest in the South ($103,256). There was no significant difference in PPAC based on age. LOS was significantly highest in the Midwest (6.5 days) and lowest in the South (5.2 days). LOS was significantly higher in the oldest age group compared with the younger groups.
  
  
  CONCLUSIONS
  PPAC and LOS varied by region. Although there was no significant difference in treatment type based on age or region, older patients tended to have more complex procedures and a higher LOS. This did not translate into a significant change in PPAC based on age. These data point to the need for further studies examining reasons for geographic variability in idiopathic scoliosis surgeries.
authors.affiliation: Department of Orthopaedics, WV University, Morgantown, WV 26506, USA. sdaffner@hsc.wvu.edu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Daffner
authors.forename: Claire F
authors.initials: CF
authors.lastname: Beimesch
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D003365:Costs and Cost Analysis / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008499:Medical Records / Q000191:economics; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics* / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics* / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery; D014481:United States; D055815:Young Adult