Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study.
BACKGROUND
Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature.


OBJECTIVE
This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up.


METHODS
Single-center retrospective analysis of consecutive surgical patients.


METHODS
Four hundred eighty-four consecutive patients undergoing surgical treatment for ASD from January 2005 through January 2011 with minimum three levels fused.


METHODS
Costs were collected from hospital administrative data on the total hospital costs incurred for the operation and any related readmissions, expressed in 2010 dollars and discounted at 3.5% per year. Detailed data on OR costs, including implants and biologics, were also collected.


METHODS
We performed a series of paired t tests and Wilcoxon signed-rank tests for differences in total hospital costs over different follow-up periods. The goal of these tests was to identify a time period over which average costs plateau and remain relatively constant over time. Generalized linear model regression was used to estimate the effect of patient and surgical factors on hospital inpatient costs, with different models estimated for different follow-up periods. A similar regression analysis was performed separately for OR costs and all other hospital costs.


RESULTS
Patients were predominantly women (n=415 or 86%) with an average age of 48 (18-82) years and an average follow-up of 4.8 (2-8) years. Total hospital costs averaged $120,394, with primary surgery averaging $103,143 and total readmission costs averaging $67,262 per patient with a readmission (n=130 or 27% of all patients). Operating room costs averaged $70,514 per patient, constituting the majority (59%) of total hospital costs. Average total hospital costs across all patients significantly increased (p<.01) after primary surgery, from $111,807 at 1-year follow-up to $126,323 at 4-year follow-up. Regression results also revealed physician preference as the largest determinant of OR costs, accounting for $14,780 of otherwise unexplained OR cost differences across patients, with no significant physician effects on all other non-OR costs (p<.05).


CONCLUSIONS
The incidence of readmissions increased the average cost of ASD surgery by more than 70%, illustrating the financial burden of revisions/reoperations; however, the cost burden resulting from readmissions appeared to taper off within 5 years after surgery. The estimated impact of physician preference on OR costs also highlights the variation in current practice and the opportunity for large cost reductions via a more standardized approach in the use of implants and biologics.
Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75206, USA; Southern Methodist University, Department of Economics, 3110 University Blvd, Dallas, TX 75205, USA. Electronic address: ian.mccarthy@baylorhealth.edu.
Ian M
IM
McCarthy
Baylor Scoliosis Center, 4708 Alliance Blvd, Suite 800, Plano, TX 75093, USA.
Richard A
RA
Hostin
University of California-San Francisco, Department of Neurosurgery, 400 Parnassus Ave, San Francisco, CA 94143, USA.
Christopher P
CP
Ames
Hospital for Special Surgery, Department of Orthopaedic Surgery, 535 East 70th St, New York, NY 10021, USA.
Han J
HJ
Kim
University of Virginia, Department of Neurosurgery, PO Box 800212, Charlottesville, VA 22908, USA.
Justin S
JS
Smith
Hospital for Special Surgery, Department of Orthopaedic Surgery, 535 East 70th St, New York, NY 10021, USA.
Ohenaba
O
Boachie-Adjei
New York Spine Institute, Department of Orthopaedic Surgery, 761 Merrick Ave, Westbury, NY 11590, USA.
Frank J
FJ
Schwab
University of California Davis, Department of Orthopaedic Surgery, 3301 C St, Suite 1500, Sacramento, CA 95816, USA.
Eric O
EO
Klineberg
University of Virginia, Department of Neurosurgery, PO Box 800212, Charlottesville, VA 22908, USA.
Christopher I
CI
Shaffrey
University of California Davis, Department of Orthopaedic Surgery, 3301 C St, Suite 1500, Sacramento, CA 95816, USA.
Munish C
MC
Gupta
University of Minnesota, Department of Orthopaedic Surgery, 2512 South 7th St, Suite R200, Minneapolis, MN 55454, USA.
David W
DW
Polly
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics*; D019637:Orthopedic Procedures / Q000191:economics*; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics* / Q000601:surgery; D013997:Time Factors; D055815:Young Adult
Adult spinal deformity; Cost-effectiveness; Hospital costs; Implant costs; Physician preference; Spine fusion