title: Hospital cost analysis of neuromuscular scoliosis surgery.
abstract: METHODS
  A retrospective review of 74 consecutive, surgical patients with neuromuscular scoliosis (NMS).
  
  
  OBJECTIVE
  This study evaluates the distribution of hospital and operating room costs incurred during surgical correction of NMS.
  
  
  BACKGROUND
  Recent studies have demonstrated that surgical treatment improves both medical outcomes and the quality of life in patients with progressive NMS. Characterization of the costs incurred at the time of surgery and hospitalization will facilitate the identification of opportunities for cost reduction.
  
  
  METHODS
  Demographic data collected included gender, age, preoperative height, weight, and BMI. Major coronal curvatures and T5-T12 kyphosis were assessed from radiographs. Construct type and number of screws, hooks, and wires implanted were recorded. Surgical costs were calculated based on cost of surgical correction, hospital stay, and postoperative care.
  
  
  RESULTS
  Mean age was 15.8 ± 7.3 years; 57% were male. Comorbidities included cerebral palsy (28%) and familial dysautonomia (14%). The mean preoperative major curve magnitude was 60°; minor curve magnitude was 33°. Posterior approach (76%) and pedicle screws (75%) were predominantly utilized. The average length of hospitalization was 8 days (range: 3 to 47). There were six major complications (8%). The total surgical cost was $50,096 ± $23,998. The highest individual cost was for implants ($13,916; 24% of total costs). The second highest was inpatient room and ICU costs ($12,483; 22%); bone grafts were the third ($6,398; 11%). Increased major and minor structural curve, increased total (A/P) levels fused, and increased length of hospital stay predicted an increase in total cost.
  
  
  CONCLUSIONS
  Major contributors to cost in NMS surgery are implants, inpatient room and ICU costs, and bone grafts. Independent predictors of higher cost are the degree of major and minor structural curve, total number of A/P levels fused, and length of hospital stay. These conclusions provide insight into costs associated with care for a medically fragile and challenging patient population.
authors.forename: Christopher
authors.initials: C
authors.lastname: Diefenbach
authors.forename: Marc N
authors.initials: MN
authors.lastname: Ialenti
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kamerlink
authors.forename: Kushagra
authors.initials: K
authors.lastname: Verma
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000191:economics; D002648:Child; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D009873:Operating Rooms / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics*; D011182:Postoperative Care / Q000191:economics; D019919:Prosthesis Implantation / Q000191:economics; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult